Teamwork helps heart patient Published Dec. 15, 2010 By Steve Pivnick 81st Medical Group Public Affairs KEESLER AIR FORCE BASE, Miss. -- It wasn't post-Thanksgiving indigestion. The patient, who prefers to remain anonymous, woke up a little after 1 a.m. Nov. 26 with tightness in his chest. This, coupled with vomiting, caused him to realize he was suffering a heart attack. "Being a 'diehard Air Force guy,' I got into my truck and 45 minutes later arrived at the Keesler hospital. I walked in the front door (clinic entrance) and asked the Airman at the desk for directions to the emergency room. I walked there, gave the lady at the desk my ID, told her I believed I was having a heart attack and was rushed into the back." Maj. (Dr.) George Dockendorf, emergency medicine physician on duty in the Keesler emergency room, recalled, "It was a pretty slow night. The patient arrived shortly after 1 a.m. I saw on the computer he was complaining of chest pain" ER protocol calls for patients reporting with chest pain to have an electrocardiogram within five minutes of arrival. After receiving the EKG, he was taken back to Dr. Dockendorf. "The EKG results were textbook, exactly what you see for an acute heart attack, formally referred to as an ST (from the EKG) elevated MI myocardial infarction. I immediately asked the charge nurse (Capt. Daniel Damitio) to get Dr. (Lt. Col. Steven) Kindsvater (chief of the 81st Medical Operations Squadron's Cardiovascular Services) on the phone. While he was doing that, I went in and talked to the patient. After identifying myself, I wanted to get a quick medical history before telling him he was having an acute heart attack. "He told me he woke up with chest pain and had been vomiting, both symptoms of a heart attack. He gave the classic presentation of someone having a heart attack: pressure- like chest pain radiating to the left arm, sweating and vomiting. We immediately gave him a full dose of aspirin and sublingual nitroglycerine a total of three times which eventually resolved his chest pain. I then let him know I was concerned he was having an acute heart attack and would have to go to the cardiac catheterization lab where they would look at him and treat whatever they found. "Dr. Kindsvater arrived (from his Ocean Springs home) within 15 minutes of my calling him and went into the patient to explain what was going on. Within another 15 minutes, having evaluated him as having an acute heart attack --the most serious type--he was admitted to the cath lab." Dr. Dockendorf stated, "The event couldn't have gone any smoother, considering it was Thanksgiving night. Everyone worked as a unit, from the medical technicians to the nurses, to ensure the patient received the best possible care." Dr. Kindsvater observed that if this type of condition was left untreated or treatment was delayed, there is 20 percent likelihood the patient would not survive. He noted the national standard for care from the time a patient arrives at the emergency room to the point of an open blood vessel in the cath lab is less than 90 minutes. "If the heart attack occurs during a hospital's normal duty hours, 90 minutes is an achievable goal 90 percent of the time," Dr. Kindsvater pointed out. "After duty hours, very few hospitals are able to meet the goal. I'm very proud that through the professionalism of everyone involved -- both the ER and cath lab teams -- we were able to reach the open vessel stage within 75 minutes. This was better than is expected during normal business hours, let alone after duty hours." Dr. Kindsvater said, "We placed two stents into the large vessel going to the left side of the patient's heart." Three days later, they fixed the vessel leading to the right side. After recovering in the hospital's intensive care unit, the patient was discharged Nov. 30, getting into the truck he drove here in the early hours of Nov. 26. "Dr. Kindsvater said to get out and 'get with it' so that's what I'm going to do plus lose the weight I gained over the past 10 years," the patient said. "I figured I made it here with a heart attack so I sure can drive myself home. I have to admit that driving myself with a heart attack was a risky move that I wouldn't recommend anyone to attempt." The patient retired from the Air Force in 1988 after 23 years and the U.S. Postal Service in November 2009. The 63-year-old man said his father had died of a heart attack at 54, but his mother lived into her 90s. "I prefer military, particularly Air Force, hospitals," he said. "If I have the choice, that's where I go. They absolutely should be proud of the work they are doing, andeveryone I met was helpful, friendly and smiling."