Minneapolis Heart Institute® at Abbott Northwestern Hospital physician says deadly aortic dissection treatment delays could be avoided
MINNEAPOLIS, Minn. 11/01/2011--Ron Stellmaker, 43, of Victoria, Minn. is passionate when talking about aortic dissection and how he almost died from it, despite being young and healthy.
"I told my wife not to call 911. I didn't have pain in my arm. I didn't think I was having a heart attack," he said. His wife called 911 anyway.
Treating him for a heart attack, the paramedics could not stop the extreme crushing in his chest. They took Stellmaker to the Minneapolis Heart Institute® at Abbott Northwestern Hospital.
Stellmaker had a CT scan and emergency open-heart surgery to repair a torn aorta. "I learned later that I had a 15- to 20-minute window for not making it," he said.
Aortic dissection is a life-threatening tear in the aorta, the major blood vessel that comes out of the heart. Typically patients develop abrupt and severe chest or back pain.
Well-known people who have recently died from dissection include Richard Holbrooke, John Ritter, and Jonathan Larson. Local Minneapolis singer and radio personality Patty Peterson suffered an aortic dissection and survived.
Kevin Harris, MD, is the lead investigator of a study published today in Circulation that provides new information about why there are delays in treatment of aortic dissection. Harris is a cardiologist with the Minneapolis Heart Institute® at Abbott Northwestern Hospital and a researcher with the Minneapolis Heart Institute Foundation.
The study found that women; people with atypical symptoms, such as the absence of pain; patients whose pulse and blood pressure seemed normal; and people who went to non-tertiary hospitals had the longest treatment delays.
About half the time, the diagnosis took more than four hours. Plus, more than four more hours passed before the patients had surgery.
"For every hour in the delay of treatment there is a one percent increase in mortality, so it’s important for us to understand why delays happen. We can see that there are plenty of opportunities for improvement," said Harris.
"We need to continue to educate emergency personnel on how to identify these patients and quickly transfer them to centers where they can be treated. The symptoms can resemble those of coronary disease or other conditions, so dissection is an important condition to keep in mind," Harris said.
People with bicuspid aortic valve, known thoracic aortic aneurysm, family history of aortic aneurysm, or have had cardiac surgery are at a relatively high risk for aortic dissection and need to be tested by imaging of the aorta with a test such as a CT scan, Harris said.
The study is based on the International Registry of Acute Aortic Dissection that includes patients from 24 aortic referral centers in 11 countries who were treated between 1996 and 2007. The study group consisted of 894 patients with a median age of 62 years. About one-third of the patients were women.
Researchers analyzed each patient’s onset of symptoms, hospital arrival, inter-hospital transfer, diagnosis, surgery and clinical outcome.
The Minneapolis Heart Institute® regional aortic dissection program established in 2005 was designed to address the specific issues of timely diagnosis and treatment. For patients presenting to outlying hospital, this program has led to a six-hour reduction in the time to definitive treatment and a substantial reduction in mortality at the Minneapolis Heart Institute® at Abbott Northwestern Hospital, Dr. Harris said.
The study can be found online at circ.ahajournals.org.
About the Minneapolis Heart Institute® at Abbott Northwestern Hospital
The Minneapolis Heart Institute® is recognized internationally as one of the world's leading providers of heart and vascular care. Abbott Northwestern, the largest hospital in the Twin Cities, is recognized nationally and locally for its exceptional expertise and care. Abbott Northwestern is part of Allina Hospitals & Clinics, a not-for-profit system of hospitals, clinics and other health care services, providing care throughout Minnesota and western Wisconsin.
About the Minneapolis Heart Institute Foundation
The Minneapolis Heart Institute Foundation is dedicated to creating a world without heart disease through groundbreaking clinical research and innovative education programs. MHIF’s mission is to promote and improve cardiovascular health, quality of life and longevity for all.# # #