April 15, 2011

The plane was at cruising altitude: far from its departure point of Albuquerque, N.M., but still about 1,000 miles from its destination of Washington, D.C.

Paul Williamson didn’t care.

After several minutes of worsening pain, he turned to his wife and rasped, “Chest pain. I think I’m going to need help.” One of the flight attendants called out to a physician who was onboard the flight, who then grabbed a defibrillator and hurried to Williamson’s aid.

But when Williamson continued to fail after chewing aspirin and taking three nitroglycerine tablets, the doctor advised the crew that they needed to make an emergency landing. The nearest airport was Kansas City International. The plane’s wheels touched down on the runway at KCI at 11:20 a.m. By 11:47, Williamson was in the Emergency Department of Saint Luke’s North Hospital–Barry Road. The heart cath lab team was already there, ready and waiting.

Hitting the wall

In retrospect, Williamson had been warned. He’d felt a tingling sensation in his arms when he woke up that morning but thought little of it. Besides, he and his wife, Val, needed to get back home to Virginia after being in New Mexico with family for the Christmas holiday.

Then came the chest pain on the plane.

“There was this heavy pressure and constriction,” said Williamson. “It felt like a wall was across my chest and that my breathing wouldn’t
go below the wall.” Williamson was conscious when the paramedics rushed him from the plane to the ambulance that was waiting on the airport tarmac.

“I decided to shut down and get small within myself,” Williamson, 55, said. “I learned later that adrenaline works against you.” But he could hear the paramedics comment on how he’d turned gray. Then one of them said to him, “You’re a STEMI.”

Widow maker

STEMI is an acronym for ST segment Elevation Myocardial Infarction, a string of technical words that signal time is short because the patient is having a major heart attack.

“STEMI is the big one—the complete blockage that happens abruptly in the left anterior descending artery,” said Jason Lindsey, M.D., interventional cardiologist at Saint Luke’s North Hospital–Barry Road.

Doctors have their own shorthand for this kind of attack, which debilitates the heart’s major muscle: the widow maker.

“It’s definitely life-threatening,” said Dr. Lindsey. “One in five people who have this attack at home never even make it to the hospital.”

Fortunately, Williamson did.

The paramedic wasn’t just guessing that Williamson had suffered a major heart attack. He performed an EKG in the ambulance and called in the results to the hospital’s Emergency Department, about six miles away. Dr. Lindsey was in another part of the hospital that morning but rushed to the Emergency Department when he got the page. The longer Williamson’s artery stayed closed, the more his major heart muscle was dying.

Since the STEMI team already knew the results of Williamson’s EKG, the doctors and nurses had gained valuable time. Williamson was in the heart cath lab, prepped for his procedure, within five minutes of his arrival at Saint Luke’s.

Door-to-balloon

Dr. Lindsey immediately inserted a balloon to open Williamson’s artery. Then he expanded the artery with a stent to ensure it stayed open. One moment Williamson was in severe pain; the next moment it was gone.

“It was like a light switch went on,” he said. “My head pain left, my chest pain disappeared. I said, ‘Guys, I’m back.’”

The policy at Saint Luke’s for door-to-balloon time—the time from when a patient arrives at the Emergency Department door to when doctors insert the balloon to open the clogged heart artery— is that it be no more than 90 minutes. Almost all of the hospitals’ door-to-balloons are less than this. Williamson’s set a record: 29 minutes

“We’re constantly tweaking our protocol,” said Dr. Lindsey. “In Paul’s case we had an astute paramedic who made the EKG diagnosis, which saved us time. Plus, Paul came in during normal hospital hours, so the STEMI team was already here.”

Saint Luke’s STEMI response is a 24-7 operation. If an emergency occurs after hours, team members must make it back to the
hospital in 30 minutes or less. Saint Luke’s fast work also gave Williamson a hedge against future heart problems.

“The faster you open the artery and keep the muscle alive, the less likely the chance for heart failure and other potential life threatening heart rhythm problems later on,” said Dr. Lindsey.

73 hours

Williamson’s recovery in the cath lab was one of the most dramatic the STEMI team had ever seen. Even so, the patient spent the next three days in the hospital so Dr. Lindsey could make sure there would be no complications from the heart attack. Then Williamson and his wife managed to get on a plane headed for Dulles Airport, and home. He’d been rushed to Saint Luke’s Dec. 28. It was now New Year’s Eve. Williamson got home in time to watch the ball drop at midnight.

A happy New Year, indeed.

“Essentially, we had a 73-hour layover in Kansas City,” quipped Williamson. “Other than that, the trip was pretty smooth.”