Heart Of The Matter: Treating The Disease Instead Of The Person

Heart Of The Matter: Treating The Disease Instead Of The Person

June 25, 201411:05 AM ET
Maria Fabrizio for NPR

Maria Fabrizio for NPR

A 56-year-old man is having lunch with his wife at a seafood restaurant just outside Boston when he develops crushing chest pain. He refuses an ambulance, so the man’s wife drives him to the ER.

What happens next says a lot about the difference that being a doctor or a patient can make in how one feels about the health care system.

First, how did the patient and his wife see the trip to the hospital?

When the man arrives in the ER, he is told to take off his shirt. He lies in the hallway, in pain, naked from the waist up. Strangers surround him. They don’t introduce themselves, and they talk over him, at each other.

Pagers ring and there’s a lot of beeping. Someone else must be really sick, he thinks; that must be why no one is paying attention.

After a few minutes, he signs some forms and finds himself being wheeled into an elevator. Masked figures enter. He feels a cool liquid flowing into his veins. The lights go out.

He wakes up hooked up to machines, uncertain what has happened. It takes several hours for the staff to find his wife, who is still waiting in the ER lobby and has no idea why her husband is in intensive care.

They are both surprised when they find out, two days later, that he’s had a heart attack. As soon as they get home, they file a complaint with the hospital about their terrible experience.

Now, how did the staff at the hospital see it?

A triage nurse greets the patient immediately upon his arrival and finds out that he has chest pain. Within three minutes, he gets an electrocardiogram that shows he is having a heart attack. The ER doctor activates the special heart attack pager, which immediately summons the emergency cardiology team.

The doctors and nurses arrive and bring the patient up to the catheterization suite. There, the attending cardiologist threads a catheter through an artery in his groin and pushes it all the way to his heart, where the doctor sees on an X-ray machine that a vessel is blocked. She inflates a small balloon in the catheter, opening the artery and restoring the flow of blood to the man’s heart.

All told, it took only 22 minutes from the time the man entered the hospital for the cardiology team to clear the blockage. The cardiology team is proud that they beat the national averagefor what they call door-to-balloon time by 42 minutes. The faster a blockage can be cleared, the better the odds are for a full recovery.

The patient gets well without complications. Two weeks later, he’s back at work and exercising again. The ER and cardiology teams consider the man’s case a resounding success.

Why then are there such different views of the same ER visit? Who’s right? The doctors who believe they delivered exemplary care, or the patient and his wife who feel he was treated badly?

As an emergency physician and advocate for my patients, I frequently hear clashing stories like these. When I review the cases, I find that the doctors and nurses are often surprised by the patient’s complaint because they did everything by the book and made no medical mistakes.

Indeed, in this case, every measure of sound medical care was met: prompt diagnosis, speedy and effective treatment and an uneventful, full recovery.

The objective measures that health care workers focus on are necessary, but they’re not enough by themselves. Every provider in this man’s case had good intentions and was working hard to respond to the medical emergency. But in their rush to open the blocked heart artery, they treated him as a disease to be cured, not a person to be cared for.

Would it have alleviated the patient’s anxiety for the doctors and nurses to introduce themselves, and to ask if he wanted his wife by his side? Would it have helped to assure him that all the activity was happening around him because everyone was trying to take care of him?

I think those simple courtesies would have made a difference.

These instructions aren’t on typical checklists for treatment of heart attack, yet they are part of caring for people as human beings. In modern medicine, we are fortunate to have incredible high-tech options available, but we must not forget the low-tech approaches that can improve communication and quality of care.

Patients and family members can also speak up when they are confused and scared. It’s possible that doctors explained what was happening, but not clearly enough.

What if the patient said he didn’t understand what was going on? What problems could have been avoided if the patient and his wife didn’t wait until after he was discharged to raise their concerns?

The two viewpoints of this ER visit end with one thing in common. Just as the providers were surprised by the patient’s complaint, the patient and his wife were taken aback when the team that I was part of presented them with their doctors’ point of view.

“We had no idea they were trying so hard,” the man said. “It’s too bad we didn’t know that at the time.”

Wen is an attending physician and director of patient-centered care research in the Department of Emergency Medicine at George Washington University. She is the author of“When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Care,” and founder of Who’s My Doctor, a project to encourage transparency in medicine.

Source:  http://www.npr.org/blogs/health/2014/06/25/324005981/heart-of-the-matter-treating-the-disease-instead-of-the-person?utm_source=facebook.com&utm_medium=social&utm_campaign=npr&utm_term=nprnews&utm_content=20140625

Delay in seeking medical attention for heart attack changes life

Don’t delay in seeking medical attention if you are concerned about a heart attack

Time is muscle if the heart is not getting the proper blood flow to the muscle, the muscle dies. The muscle is unable to repair itself and eventually that portion that dies is converted to scar tissue. Scar tissue is not flexible and doesn’t push the blood out of the chamber of the heart. If the blood is not pushed through the heart the amount circulating through the body is reduced. This can lead to serious heart related complications, including congestive heart failure, angina, shortness of breath and limited ability for physical activity.  This creates complications for many things including returning to work, or causing early retirement as the article above discusses.

Discomfort, squeezing, pressure, heaviness, aching…in the chest, between the shoulder blades, the neck, jaw or down the arms are the classic symptoms. If accompanied  by shortness of breath, nausea, profuse sweating the condition is all the more urgent. Chew up 325mg aspirin and call 911.

Resource for Heart Failure



Below is some of the content from the above listed web site. It is a great resource for helping heart patients to understand the warning signs of heart failure and the actions to take. If you are a heart patient, or the significant other/caregiver take the time to review this site. It is important sometimes the symptoms sneak up on you.



Heart failure can be managed well with the right treatment and lifestyle adjustments, as recommended by your doctor or nurse. However, it is important to monitor all your symptoms on a regular basis as heart failure can progress slowly.


You can use the list on the left or any of the links below to learn more about the symptoms you should be monitoring and what to do if they get worse.


You should call for help immediately if you experience:


Persistent Chest pain that is not relieved by glyceryl trinitrate (GTN / nitroglycerin)

Severe and persistent shortness of breath



You should inform your doctor as soon as possible if you experience:


Increasing shortness of breath


Frequent awakenings due to shortness of breath


Needing more pillows to sleep comfortably


Rapid heart rate or worsening palpitations


And you should discuss any of the symptoms below with your doctor or nurse.


Rapid weight gain


Progressive swelling or pain in the abdomen


Increased swelling of the legs or ankles


Loss of appetite/nausea


Increasing fatigue


Worsening cough


To help you monitor your symptoms, please click on the links below to find useful resources that you can download, print and fill in. You can then take these with you when you see your doctor or nurse and discuss your symptoms.


Symptom and event diary


Monitoring your heart failure chart


Warning signs leaflet




Exercising with heart disease

Start slow and add a little more over time. Make it feel  as if when finished feel like you could have done more easily. Begin exercising at this intensity for several sessions before making large increases in your intensity or effort required to be physically active. . Remember the whole goal is to adapt, and by doing so the body is changing how it responds. In the early recovery stage  the exercise prescription is very light. Do you know What exercise prescription is best for you?

Since exercise should be part of your everyday routine in order to make it a lifelong habit  injury avoidance is important to be aware of overuse signs and symptoms, to rest those muscles when needed.  Occasionally cardiovascular disease patients develop Peripheral Artery Disease and symptoms can present similarly to overuse. Pain should signal the body to be aware that something is going on.  Take some time to evaluate that pain, what happens with it, does it always come on at a certain time or point of the exercise or activity? How long does it take to go away? Can it be avoided while being active by another means for instance switching from walking to biking?  Make sure you communicate these findings with your healthcare practitioner as they could be signals of other health conditions related to heart disease and it’s recovery.

Some exercise and activity is better than none, so start slowly. Even a warmup is better than no exercise session here is why  warming up before strenuous activity helps your heart.

Don’t expect results overnight, but do take small steps each day. Move that blood around, push it through the muscles. Make the muscles use the oxygen in the blood  more efficiently. Exercise helps the the heart recover and stay strong.

You might not notice any big changes—especially in your weight—for a few weeks or even months. It is still good for your heart health! It is not all about weight loss. Forget the scale for a while. In fact many who initially start to exercise following hospitalization are  Sedentary at the start and will gain a couple of pounds. It is their muscles getting pumped up, holding and utilizing more blood flow. Generally the focus on how you feel.

 When not to exercise is if you are presenting with Signs and symptoms of heart problems. Exercise should be avoided if  if you are presenting with congestive heart failure, or are presently sick. When returning to exercise following illness 

Symptoms to be alert for include these.

What people with heart conditions need to know about Atrial Fibrillation

This progressive and debilitating disease can lead to stroke, heart failure, and Alzheimer’s disease, and can double your risk of death. Afib takes a physical toll, an emotional toll, and a financial toll on those who are living with it—not just the patient, but the family, too.

Although atrial fibrillation itself usually isn’t life-threatening, it is a serious medical condition that sometimes requires emergency treatment.

It can lead to complications.

Symptoms of A Fib

• Skipping, fluttering,or quivering of heartbeat
• Heart beating too hard or fast
• Dizziness or lightheadedness
• Confusion
• Shortness of breath
• Chest pain or pressure
• Tired when resting or when active
• Swelling of feet, ankles,and legs
• Feeling anxious

Here is a short video Do you know what Atrial Fibrillation feels like?

What Causes Atrial Fibrillation?

Atrial fibrillation (AF) occurs if the heart’s electrical signals don’t travel through the heart in a normal way. Instead, they become very rapid and disorganized. With atrial fibrillation (AFib),the electrical signals of the heart are abnormal.

• The top and bottom parts of the heart don’t work together as they should
• The heart beats very fast and irregularly
• As a result,blood is not properly pumped to the bottom part of the heart and the rest of the body

Damage to the heart’s electrical system causes AF. The damage most often is the result of other conditions that affect the health of the heart, such as high blood pressure and coronary heart disease.


Understanding the Electrical Problem in Atrial Fibrillation

In AF, the heart’s electrical signals don’t begin in the SA node. Instead, they begin in another part of the atria or in the nearby pulmonary veins. The signals don’t travel normally. They may spread throughout the atria in a rapid, disorganized way. This can cause the atria to fibrillate.

The faulty signals flood the AV node with electrical impulses. As a result, the ventricles also begin to beat very fast. However, the AV node can’t send the signals to the ventricles as fast as they arrive. So, even though the ventricles are beating faster than normal, they aren’t beating as fast as the atria.

Thus, the atria and ventricles no longer beat in a coordinated way. This creates a fast and irregular heart rhythm. In AF, the ventricles may beat 100 to 175 times a minute, in contrast to the normal rate of 60 to 100 beats a minute.

If this happens, blood isn’t pumped into the ventricles as well as it should be. Also, the amount of blood pumped out of the ventricles to the body is based on the random atrial beats.

The body may get rapid, small amounts of blood and occasional larger amounts of blood. The amount will depend on how much blood has flowed from the atria to the ventricles with each beat.

Most of the symptoms of AF are related to how fast the heart is beating. If medicines or age slow the heart rate, the symptoms are minimized.

AF may be brief, with symptoms that come and go and end on their own. Or, the condition may be ongoing and require treatment. Sometimes AF is permanent, and medicines or other treatments can’t restore a normal heart rhythm.

Major Risk Factors

A good question to ask your healthcare provider is what is the cause of my AFib?

Atrial Fibrillation  is more common in people who have:

  • High Blood Pressure
  • Coronary Heart Disease (CHD)
  • Heart Failure
  • Rheumatic heart disease
  • Structural heart defects, such as mitral valve prolaps
  • Pericarditis;  a condition in which the membrane, or sac, around your heart is inflamed
  • Congenital Heart Defects
  • Sick sinus syndrome (a condition in which the heart’s electrical signals don’t fire properly and the heart rate slows down; sometimes the heart will switch back and forth between a slow rate and a fast rate)

AF also is more common in people who are having heart attack or who have just had surgery. The risk of AF increases as you age. Inflammation also is thought to play a role in causing AF.  Drinking large amounts of alcohol, especially binge drinking, raises your risk. Even modest amounts of alcohol can trigger AF in some people.  Sometimes, the cause of AF is unknown.


Treatment Goals

• Slow heart rate
• Regain normal heartbeat
• Treat causes
Lower risk of stroke and heart failure

Warning Signs of Stroke

• Numbness or weakness of the face, arm, or leg ,especially on ONE side
• Confusion
• Difficulty speaking or understanding
• Trouble seeing in one or both eyes
• Trouble walking or with balance
• Dizziness
• Severe headache

Warning Signs of Heart Failure

• Shortness of breath
• Trouble doing usual activities
• Difficulty breathing when lying flat
• Weight gain
• Swelling in legs, ankles, or feet

Treatment options

 Heart Procedures

  • Cardioversion

Cardioversion is done two ways: An electrical procedure,  in which your heart is given low-energy shocks to trigger a normal rhythm. You’re temporarily put to sleep before the shocks are given. This type of cardioversion is done in a hospital as an outpatient procedure. “Outpatient” means you can go home after the procedure is done.

Cardioversion through use of medicines. Using medicines to correct arrhythmias also is a form of cardioversion. This type of cardioversion usually is done in a hospital, but it also can be done at home or in a doctor’s office. It is known as a rhythm controller

  • Catheter ablation

During catheter ablation, a series of catheters (thin, flexible wires) are put into a blood vessel in your arm, groin (upper thigh), or neck. The wires are guided into your heart through the blood vessel.
A special machine sends energy to your heart through one of the catheters. The energy destroys small areas of heart tissue where abnormal heartbeats may cause an arrhythmia to start.

Catheter ablation often involves radiofrequency (RF) energy. This type of energy uses radio waves to produce heat that destroys the heart tissue. Studies have shown that RF energy works well and is safe.

Lifestyle changes

  • Do I need to change my eating habits?
  •  Should I change my activity level?
  • What else can I do to lower my risk?
  •  Stopping smoking
  •  Limiting/avoiding alcohol
  •  Limiting/avoiding caffeine


Living with Atrial Fibrillation patient educational materials

Learn about Atrial Fibrillation here

A heart away from stroke documentary  Discovery Channel explores the connection between atrial fibrillation and stroke – in order for patients to learn about the importance of stroke prevention