If Dr. Duane Schuil had been at home, or even driving in to the emergency room, the patient wouldn’t have had a chance of survival.

But talk about being at the right place at the right time.

Schuil was already at the Heart and Vascular Center at Northern Michigan Regional Hospital one recent night at midnight when a female in her mid-40s was brought in suffering a heart attack. After catheterization, Schuil witnessed a dissection of an artery to the woman’s heart live on one of the monitors in the heart center.

The situation typically results in near-immediate death. In this case, Schuil was able to repair the damage and the woman survived. Had he not been there at that instant, or had she been at home when it occurred, the outcome would have been very different.

“She was that close to being dead,” Schuil said.

If there is a right place or right time to have a heart attack or life-threatening heart or vascular condition, it is indeed in Northern Michigan.

Schuil, a physician with Michigan Heart and Vascular Specialists in Petoskey and the hospital heart center’s medical director, is one of a number of talented and trained physicians working to improve outcomes and save lives in the local heart-health hub. He alone has performed thousands of artery interventions, from angioplasty (aka ballooning) to stents and bypasses.

Nationwide, more than 1.1 million people experience a heart attack each year, according to data from Cedars-Sinai. For many of them, the heart attack is the first symptom of coronary heart disease; that first attack may be severe enough to cause death or it could even be silent.

With the continual investment in the latest life-saving equipment at the Petoskey hospital, more of those patients are surviving.
 

‘The best of the best’

Inside the cardiac cath labs at the Heart and Vascular Center, completed in 2004 near the hospital’s main entrance, an amazing array of equipment helps doctors do their jobs. Once a patient is catheterized and connected to the equipment, a dozen flat-panel monitors allow physicians, nurses and techs to monitor everything from heart rate to watching an artery open and close in real time during a balloon or stent procedure.

Schuil and other physicians are able to monitor their work inside a patient as they go, improving their techniques and the patient’s chances of survival.

Part of the push in the heart center today, Schuil said, is improving “door-to-balloon” times. That means when a patient enters the hospital, the staff continues to work to reduce the amount of time it takes from door-to-procedure. National standards call for 90 minutes or less; NMRH is meeting that goal 93 percent of the time.

In a staff PowerPoint presentation, Eileen Butler, clinical supervisor of the Heart and Vascular Center, noted the average door-to-balloon time is 70 minutes, “much higher than the gold standard of 75 percent.”

Technology is even allowing for Allied EMS staff transporting a patient via ambulance to save valuable time by transmitting key data, including EKG and blood-test results, to the waiting doctors and nurses before the patient even arrives.

Once that heart attack victim hits the door, it’s go time in the heart center, with catheterization through the groin, auto-dye pumps allowing doctors to track blockages live on monitors and the most advanced technology found anywhere at their fingertips.

“This is where the action is,” said Schuil.

Access to this type of equipment and skill level of physicians, Schuil noted, allows many patients who otherwise may have needed a multiple-bypass to recover after undergoing a less invasive stent or ballooning procedure.

And this month, those procedures become outpatient, with patients sent home the same day rather than staying overnight for monitoring.

The numbers are available to demonstrate the successes of the advancements. Historically, in-hospital mortality nationwide for heart attack patients hovered around 30 percent until the advent of coronary care units in the 1960s and ’70s, when deaths dropped to the 10-15 percent range, Schuil said. Today, mortality rates have declined to 4-5 percent, and cardiac centers are treating a wide range of vascular patients, not only heart attack patients.

And still the staff strives for more, participating in national research and attracting skilled nurses and physicians to the Little Traverse Bay region.

“You have the best of the best in the world here,” said Schuil. “Now you work to keep it that way.”

Will you have a heart attack?

The good news is patients today are more likely to survive a heart attack than they were decades ago. But why even go through it in the first place?

The risk factors remain:

Age and gender. The number of people affected by heart disease increases with age in men after age 45 and in women after age 55.
Smoker. Quitting smoking may be the most important step you can take to reduce your risk.
High blood pressure.
Low HDL cholesterol. HDL, or high-density lipoprotein, is the “good” cholesterol because it helps prevent cholesterol from building up in your arteries. The higher your HDL, the better. An HDL of 60 mg/dL and above protects against heart disease. An HDL of less than 40 mg/dL puts you at major risk of heart attack.
Total cholesterol. Total cholesterol is the sum of all the cholesterol in your blood. The higher your total cholesterol, the greater your risk for heart disease. A total cholesterol of 240 mg/dL and above puts you at twice the risk of heart disease compared with someone whose cholesterol is below 200 mg/dL. Less than 200 mg/dL gives you a lower risk for heart disease.
Diabetes.
Physical inactivity.
Excessive alcohol consumption. (More than one drink a day for women, two for men.)
Stress.

The American Heart Association has an interactive risk assessment tool online; www.americanheart.org.
Source: CNN Health; American Heart Association
 

Who should be screened?

An initial screening stress test is recommended for anyone with two or more risk factors and/or symptoms of heart attack, men over age 45 and women over age 50.
While most heart attack victims are middle-aged or older — the average age for a first attack is 66 for men and 70 for women — people in their 20s and 30s suffer attacks, too.
The risk of a heart attack climbs for men after age 45 and for women after age 55.
Sources: Dr. Duane Schuil, CNN Health