Chest Pain - Genesis Observation Unit Efficiently Evaluates Patients in the Emergency Department    (Posted 5/8/06)

If you're having a heart attack, the experts at Genesis Medical Center, Davenport can open your heart's blocked artery with a response time that ranks among the top 5 percent of the nation.  

But sometimes, the reason for chest pain is not always so clear-cut.  When the cause of a patient's chest pain is more obscure, the Chest Pain Observation Clinic offers a dedicated area in the hospital's Emergency Department (E.D.) to evaluate chest pain using guidelines from the American College of Cardiology. 

"We offer a comprehensive spectrum of services - from a heart attack alert system that mobilizes staff to get those patients having a heart attack to the catheterization lab as soon as possible to a Chest Pain Observation Unit in the E.D. for patients needing tests and observation," says Carla Roman, Director of Trauma and Emergency Services. 

EKG Screening
An electrocardiogram (EKG) is the screening test that shows if a patient is having a heart attack needing immediate attention.  Upon the patient's arrival, the EKG is done and read by the emergency physician within 10 minutes.  Trained ambulance personnel also perform electrocardiograms in the field and notify the E.D. when a patient is having a heart attack. 

If it's a heart attack in progress, an alert mobilizes Genesis staff and the process to rapidly open the heart's blocked artery begins.  The patient receives aspirin and other needed medications in the E.D.; a cardiologist is urgently paged; and the cardiac catheterization lab staff transports the patient to the "cath lab" to open the blocked artery. 

But what happens when the reason for chest pain is not readily apparent?  The EKG is negative.  The patient doesn't meet the criteria to be taken directly to the cath lab, but his or her underlying condition could signal coronary artery disease.  Further assessment is needed to evaluate the patient's risk of having a heart attack, and that's where the Chest Pain Observation Unit comes into play. 

"Chest pain has a number of causes," says Richard Vermeer, D.O., Medical Director of the Emergency Department at Genesis Medical Center, Davenport.  "Some of those causes are easily managed and not considered serious.  Serious causes need to be ruled out to ensure patient safety.  Unfortunately, a normal electrocardiogram does not rule out the possibility of a cardiac cause for chest pain." 

ACC Guidelines
The American College of Cardiology has guidelines to evaluate patients at risk of coronary artery disease who present to the E.D. with chest pain.  They include serial testing of cardiac monitors in the blood to see if any heart damage has occurred silently and dynamic testing to determine if the heart muscle is stressed by restricted blood flow from a narrowed coronary artery. 

Before the Chest Pain Observation Unit was established nearly 10 years ago, patients complaining of chest pain most likely had to be admitted overnight for tests.  Sometimes, their hospital stay would be more than two days because that's how long it took for tests and results.  Other times, patients didn't want to stay and were subject to the risk of having a heart attack before their evaluation even began. 

The observation unit, which was funded with Gala proceeds from the Genesis Health Services Foundation, has helped expedite the test workup for patients while allowing them to be evaluated safely and in a timely manner. 

"Heart attacks are caused by a blocked artery in the heart.  If someone is having a heart attack, we want to open the blocked artery as quickly as possible," says Dr. Vermeer.  "If the electrocardiogram is negative, there are still some patients at risk for having a heart attack.  We want to find those patients and treat them. 

"The American College of Cardiology guidelines is the paradigm that we follow.  We never want anyone to go home and have a heart attack that could have been prevented." 

By following the guidelines, Genesis' chest pain unit has evaluated patients who presented to the E.D. with chest pain, underwent an electrocardiogram; and were found to have significant risk factors.  "We have found that about 10 percent of patients had coronary artery disease," Dr. Vermeer says.  "We have been able to admit those patients to the hospital for cardiac care." 

-- By Linda Barlow, Genesis 

Chest Pain Signs and Symptoms
Chest pain refers to pressure, squeezing or general discomfort in the chest area, which includes the heart, breast and neck areas.  Although chest pain is always a symptom of an underlying condition, it may not always be a heart-related illness.  Many times it is a less-serious condition, such as heartburn.  If you experience chest pain, you are strongly urged to seek medical attention immediately. 

To prevent heart disease: 

• Don't smoke.
• Exercise regularly.
• Have your cholesterol checked and managed if it is too high.
• Have your blood pressure checked and managed if it is too high.