Coronary Patients Get Latest In Tests

May 08, 1992

Everything gets quieter and you relax a little as they roll you into the intensive coronary care unit.

It sort of reminds you of a library without the books.

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Sharron Gray, director of ICCU, explains the tranquil atmosphere of the ICCU this way, ``You already have an area of the heart that is not getting enough oxygen, so if there is more demand, you are going to have a bigger heart attack and you are going to do badly.

``So in ICCU we try to keep a very calm and quiet environment for these patients, and then watch the heart rate. We call the doctor for immediate intervention if the heart rate starts picking up."

Certified nurses monitor the patients 24 hours a day in ICCU. The nurse-to-patient ratio is maintained at one-to-two.

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In the ICCU, you are put in your own room and reacquainted with your new friends, the electrodes and the heart monitor.

Your wife appears. You can tell she has been crying.

You find out that your thrombolytic therapy will be continued in ICCU.

Also, cardiac enzyme tests will be given.

The enzyme, called creatinine phosphokinase (CPK), is given off in the blood if muscle damage has occurred. The amount of enzymes present can help determine the amount of damage. The more enzymes, the more damage.

A further test called the CPKMB screen (MB stands for myocardial bands) can determine if the muscle damage is to the heart.

CPKMB screens are given at admission into the ICCU, at 12 hours, at 24 hours, at 48 hours and at 72 hours.

According to Gray, ``This tells us where we are. If they are high and then begin to go down you know the patient came in at a certain point in his heart attack. If they are small and continue to incline you know there is a risk."

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After 24 hours you are told your CPKMBs are considerably lower and that it is a good sign. You don't know what the nurse is talking about, but you smile.

On the other hand, your wife, who has been learning everything she can on the subject of heart attacks, rattles off an explanation, that you again don't understand. She proceeds to explain how EKGs, which show the electrical impulses of the heart, can also reveal if there is muscle damage or threatened heart muscle damage.

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Gray says, ``If a patient is unstable and continuing to have chest pain and EKG changes those patients are sent to Riverside or elsewhere for angioplasty, to open up that vessel.

``If they have no EKG changes in a day or so, they would go to the cardiac cath lab and they would determine exactly what was going on."

Once stable, the patient will be moved to telemetry, a less acute area than ICCU, where the patient will be mobile but closely monitored. ICCU patients typically head for the 12-bed telemetry unit 48 to 72 hours after the thrombolytic therapy has ended in the ICCU.

Diagnostic tests, ending with the cardiac catheterization, will be given during this time.

Gray says, ``We give the thrombolytic therapy (in ICCU) and hopefully dissolve the clot. Then we look to see what condition the vessels that feed the heart are in to see if there is going to be another clot.

This process is done with the cardiac catheterization procedure.

``Because if they don't look, if they get rid of the first clot, they could send the patient home and a few days later another clot would form," says Gray.

``The first step is to get rid of the clot. Then nitroglycerine is given to keep blood vessels dilated, so if there is any narrowing it keeps them open. ``Then they go to the cath lab and they look at what kind of blockage there is. Then they determine if they are going to do an angioplasty or if the blockage is so severe they will have to perform bypass surgery.''

Angioplasty and bypass surgery are not performed at Mary Immaculate.

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You are not real excited about any of these proposed test, especially this catheterization business, but as a realist you like to know what the facts are. From what you can deduce from your wife's lectures, this procedure not only will give you the facts of your heart problems, it will give them to you in moving pictures.

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Mary Immaculate's cardiac catheterization lab has the most up-to-date equipment on the Peninsula, according to Wally Ching, the lab's director.

A cardiac catheterization is a special X-ray study of the heart. A soft narrow plastic tube, called a catheter, is inserted into a vein or an artery of an arm or leg (groin), which has been anesthetized. The catheter is then passed through the blood vessel into a heart chamber or to a coronary artery. Special X-ray dye, called contrast, is passed through the catheter. This contrast allows the doctor to see the chambers, valves or coronary arteries in the heart on an X-ray movie screen.

The imposing, futuristic-looking camera looms above the patient. The moving picture will help the cardiologist determine if and where blockages are occurring.

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