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GUEST VIEW By Dr. Michael E. Merhige

Back in 2003, the citizens of Niagara County had the dubious honor of being No. 1 in the United States, with its 3,090-some odd counties, in deaths from heart attacks. That's pretty impressive.

Clearly this constituted a public health crisis, and the question was what we were going do about it?

We really don't know why Niagara County has such high incidence. It's a mixture of the genetics of the people who live here, perhaps the lifestyle of the people who live here, perhaps the weight of the people who live here, the incidence of diabetes and high blood pressure, combined with the fact that lots of people here don't have enough money to take care of themselves. This is a microcosm of poverty in the United States. That's what Niagara County is.

That's when we at Niagara Falls Memorial Medical Center made a commitment to consider introducing very accurate, non-invasive imaging for patients who present with a suspected heart attack, to be able to do that 24/7 and make an immediate decision about what to do with that patient, as opposed to the typical standard of care.

Most often, when a patient comes to us, we don't know whether they're having a heart attack. That is where the excess mortality lies. So if it's crystal clear, and we can tell from the clinical issues what you have, the emergency room doctors and the cardiologists on call collaborate. We enact a treatment and we move forward. A heart attack is actually the complete cessation of blood flow in an artery that supplies the heart muscle. The heart muscle has to go all the time.

If you just think about doing exercise in an arm muscle, you're doing biceps curls, and after a while it hurts. It hurts because there is not enough blood supply getting into the muscle. It hurts, and then you stop and you rest your muscle.

The blood flow washes out metabolites, brings in oxygen and fuel, and everybody lives happily ever after. But here is a muscle that can't stop. So what happens is, it keeps beating, and in a heart attack, there is typically a rupture of a plaque, which then causes a blood clot in the artery.

So you get the abrupt onset of chest pain, it persists at rest, and if that blood flow is not re-established in about six hours, there will be irreversible injury and death of the heart muscle cells, which will then turn into a scar.

The good news is the scar has good tensile strength. You are not typically going to tear or rupture the heart in most cases; it simply does not pump. So therefore instead of being able to push the blood forward and feed all your organs and drain the blood that's oxygenated out of your lungs, the pressure builds up backwards, and you can't breathe. That's heart failure, and that's how you live the rest of your life.

What we don't want is the six-hour window to go without us recognizing that process is going on, because we have medications we can give to dissolve the blood clot and re-establish the blood flow. It works great if it's all done right away.

The Positron Emission Tomography (PET) scanning and Computed Tomography (CT) angiography currently available at Niagara Falls Memorial Medical Center provide us with state-of-the-art technologies available nowhere else in the state. This advanced, non-invasive technology is really what the Heart Center of Niagara is all about. This is what makes it different from Buffalo General, St. Mary's, you name it.

So if I were to have a heart attack anywhere in Western New York, my preference would be to be seen in the ER right here.

Niagara Falls Reporter www.niagarafallsreporter.com March 22, 2011