heart attack Archives - The Inside Press

Dr. James Dwyer, Chair of Emergency Medicine at Northern Westchester Hospital (NWH), discussed the alarming decline in visits to the ER among patients with serious, life-threatening medical conditions, including heart attacks, strokes, and appendicitis.

“We are seeing similar scenarios over and over again,” said Dr. Dwyer in an interview this week. “A patient, for example, who has abdominal pain is afraid to come into the Emergency Department, so they tough it out and think: ‘it will go away, it will go away..,’ and then by the time they realize it won’t, they come in with a ruptured appendix as opposed to catching the appendicitis before it’s ruptured and getting to the operating room earlier.”

Dr. James Dwyer, Chair of emergency Medicine (standing) with Michael Pancoast (seated) at the triage station just inside the emergency room at Northern Westchester Hospital.
Photo courtesy of NWH

According to Dr. Dwyer, ERs around the country are seeing a drop in overall patient volume due to patient fears about COVID-19. As a result, untold numbers of people may be dying at home or risking long-term health consequences by ignoring serious symptoms.

Meanwhile, “when appendicitis (removal of the appendix) is performed as a routine procedure, the outcomes are outstanding; most of the people are out the same day,” said Dwyer. In contrast, a life-threatening rupture can spread infection in the abdomen requiring more involved surgery and longer recovery times.

Since the pandemic started March 11, about 50% of the appendicitis cases have presented as ruptured–a normal scenario is 5-10 percent,” he elaborated. “1 in 2 ruptured versus 1 in 10… people are definitely waiting to get this taken care of.”

NWH is seeing about a 50 percent drop to their usual ER volume, Dr. Dwyer said. At NWH, the ER typically sees more than 80 patients per day and is now seeing as few as 30. “The decline in ER visits among people with serious, life-threatening conditions, including heart attacks, strokes, infections and trauma, is taking a toll on the health and wellbeing of people in the United States and around the world.

Dr. Dwyer said some patients experiencing symptoms may not be calling their doctors because they are afraid their doctors will tell them to go to the Emergency Department. “It’s possible not enough people experiencing symptoms are reaching out to their primary doctors,” he said adding that the many excellent practitioners in the area could properly discern symptoms and steer patients to the ER, as needed.

“I saw a patient who had been short of breath for six days before he decided to see his primary doctor; when he finally saw him, he found a very rapid heart rhythm, an atrial fibrillation. We immediately admitted him to the hospital.”

“We need people to understand that it is safe to go to the ER, and far more dangerous to stay home and wait for serious symptoms to disappear.”

Before coronavirus, 12% (just over one in 10) people with stroke symptoms waited one day before visiting the ER; now, 25% (one in four) wait at least one day, despite symptoms that can include loss of vision, speech, sensations and weakness on one side.

Surviving stroke, he explained, is very time dependent. “For those who present early– within 4.5 hours–we can give medication that breaks up the clot. The window for treating more severe stroke–via an endovascular procedure to open up the blood vessel–is traditionally within six hours, and in a small minority of cases, up to 24 hours.”

“The earlier you get these therapies, the more successful they are at preventing a bad outcome,” he said.

“We want people to know that it’s safe to visit the ER,” he emphasized. “At NWH, people are screened at the front door of the Emergency Department, everyone in the entire institution wears a mask, and patients are treated in private rooms.”

Dr. Dwyer added: “The precautions we take here are working. Very few staff members have been diagnosed with COVID since this started.” Dr. Dwyer also pointed out that only a small number of visitors are allowed in the hospital so as to protect overall populations. These include partners of women giving birth, parents to a pediatric patient, and close family members to those dying of COVID-19 or any other condition.

As of this morning (May 13), NWH was caring for 19 COVID-positive patients in the hospital, which is significantly down,” Dr. Dwyer said. “We were up in the 80s at the beginning of April, so it has come down quite a bit. We still have 10 people on ventilators who are COVID positive. Some of these critically ill people require an extended period of time for their lungs to recover on the ventilator.”

“We happen to have had some success treating patients on ventilators. The 10,000th discharge from Northwell in fact was from Northern Westchester Hospital, someone who was severely infected who is now recovering.”

“From our institution alone, we have had 247 live covid discharges. That’s very encouraging.” There have been 58 COVID-related mortalities.

Dr. Dwyer elaborated: “We have worked very, very hard to make sure this is a safe environment, and in the ER, especially. When you come into the ER, you are screened at the door, and given a surgical mask and then escorted to one of 26 private rooms–there is very little chance of being exposed to COVID at NWH.

He pointed out that his nine-year-old nephew was a patient recently. “He had a laceration. He had cut his ear on a branch outside running around–he came into the ER, and one of the nurse practitioners sewed his ear up. I feel comfortable having my own family here.”

Dr. Dwyer urges people to recognize the signs and symptoms of the following life- threatening conditions:

Heart attack

People who survive a heart attack may have weakened heart muscles and are at risk for life-threatening complications including another more serious heart attack. Go to the ER immediately if you have any of the following symptoms:

Chest pain, including tightness, and pain that spreads to the arms, neck, jaw or back;
Sudden onset of shortness of breath, sweating, dizziness or lightheadedness;
Unexplained nausea, indigestion, or heartburn.

Strokes

When caught early, immediate treatment may prevent death and minimize the long-term effects of a stroke. Even if a stroke is minor, it is important to receive an evaluation and treatment in order to prevent another, possibly devastating, stroke: Go to the ER immediately if you have any of the following symptoms:

Body weakness, especially on one side;
Facial droop;
Difficulty speaking or finding words;
Sudden loss of vision;
Numbness or loss of sensation;
Unsteadiness on your feet.

Appendicitis

When caught early, a surgeon can remove the appendix and often send you home the same day. If the appendix ruptures, a patient will spend days in the hospital and be at risk of life-threatening conditions that include peritonitis and sepsis. Go to the ER if you have the following symptoms:

Pain in the right lower quadrant of the abdomen (which typically increases when you move and intensifies over 24 to 48 hours), sometimes with
Loss of appetite;
Nausea and vomiting;
Fever.

By Rich Monetti

Amanda Gisonni and her grandfather, Charlie Monetti

When we think of hearts and holidays, our default is undoubtedly February 14–Valentine’s Day. But, with the current holiday season upon us, I find myself thinking about how much health matters and how good health is a gift we give ourselves and families. When we wish friends and neighbors “a happy and healthy holiday,” we’d do well to take those words to heart.

My father is one of those rare people whom everyone loves. He gives definition to the term “good guy.” Why? Simple. He’s got a huge heart. I’m talking end-of-Grinch-story huge; the kind of heart that knows no boundaries. Until it did. Until that day in 1985 when, at the (relatively young) age of 52, he suffered a heart attack. Luckily, a full recovery followed.

Why did it happen? Hard to say. There was no history of heart disease in the family. He didn’t smoke, he didn’t drink. Diet? Well, admittedly, his could have been better. Stress? Certainly could have played a part. The downside to a huge heart is its susceptibility to emotional stress.

To find out more, I spoke with cardiologist Dr. Dina Katz of Phelps Memorial Hospital. Dr. Katz is adamant that smoking is “the most modifiable cardio risk factor” and should be change number one. Explaining that heart attacks usually occur as plaque narrows the arteries and blood clots ultimately close them, Dr. Katz suggests that it doesn’t take her advanced degree to make the connection. “Smoking causes clotting,” she asserts.

Katz usually doesn’t get involved until people are motivated to stop. “Otherwise, she says, “forget it, all bets are off.” Instead, she tells patients to come in when they are ready to set a quit date. Katz then becomes highly pro-active, administering drugs like Chantix and referring patients for hypnosis, acupuncture and other modalities.

Another oft-mentioned risk, alcohol, is less all-or-nothing restrictive. “Everything in moderation,” Katz says, and shares that one or two daily drinks can actually be beneficial.

In terms of diet, Katz recommends less red meat and processed food to cut down trans- and saturated fats; she suggests, instead, fish at least twice a week with lots of fruits and vegetables.

Lastly, and unfortunately near and dear to all Monettis (yeah, we get worked up pretty easily), is stress. Katz suggests meditation, acupuncture and Yoga as great stress-reducers, but firmly believes exercise stands above everything else. And she says that exercise works either in 20-30 minute daily sessions of light-to-moderate activity for a total of 150 minutes a week, or more vigorous activity approximately three times a week for a total of 75 minutes.

Additionally, statins and baby aspirins work wonders. “Their introduction 25 years ago has meant a dramatic decline in heart disease,” she says. When I asked about the side-effects, a question Katz gets asked regularly, she was quick to reassure, “Long term data shows them to be safe and effective.”

While prevention is vastly preferred, it’s not always enough. Everyone should be aware that crushing chest pain, arm pain, tingling in the fingers, nausea, indigestion, sweating and vomiting are all classic heart attack symptoms.

Unfortunately, there can be many more (and diabetics may not experience any as their condition affects the nerves going to the heart). That said, doubt isn’t a dirty word for doctors. “If there’s ever any question, don’t feel silly, go to the E/R. We’d rather know,” Katz concludes.

Rich Monetti lives in Somers. With the help of Zocor and a very active lifestyle, his annual stress and cholesterol tests show excellent results.

Advice from CVAC (Chappaqua Volunteer Ambulance Corps) Captain Joseph Gentilesco

•Dial 911 first–before anything else–when heart attack symptoms (see above) or stroke symptoms (sagging facial droop, slurred speech) occur.

•If the patient is conscious, have him/her sit down and take prescribed medications. But if cardiac arrest renders the patient unconscious, the 911 operator will talk the caller through CPR.

•For a stroke, note time of patient’s last normal appearance and speech. Medication given within a four hour time frame can greatly reduce the adverse effects.

•The police should arrive first to take over. Make sure lights are on, front door open and, if more than one person is home, try to clear a path for eventual evacuation. Meet the police at your home’s entrance.