‘Time is muscle': Doctors warn delaying treatment for a heart attack

During a heart attack, "time is muscle," according to doctors. The longer a patient waits, the more damage the heart muscle sustains.

Although doctors and advocates say that Rio Grande Valley residents are more aware of the warning signs of a heart attack than in the past, many still wait too long before calling 9-1-1 or heading to the hospital, they say.

The reasons for that delay could include everything from a lack of awareness of symptoms to cultural differences to fears of a hefty medical bill, experts said.

"Some of the population here doesn't have access to medical institutions and doesn't have insurance," said Dr. Carlos Mego, a McAllen cardiologist. "That could be one reason (for delays) ... and many patients have atypical symptoms, and don't even know they're having a heart attack."

According to new research, patients who live in poor areas or who are on Medicaid seem to be more likely to delay going to the hospital to seek heart attack treatment. A few studies suggest that race also could play a role: African Americans in particular seem to delay care longer, research suggests.

Little research exists on Hispanics and delays in heart attack care, although a couple of studies have found that Hispanics wait longer to call 9-1-1 than whites.

Hispanics are more likely to minimize their symptoms and call on family members before calling an ambulance, speculated Marisa Campirano, cultural-health initiatives director for the American Heart Association's Valley chapter.

"They'll call family members first and ask for advice, putting it off," Campirano said. "They're more likely to dismiss their symptoms, and just think they're stressed or tired."

In one 2002 study, researchers examined the records of about 330 patients at a Los Angeles inner-city hospital. According to that study, whites waited an average of 32 hours before seeking care, while Latinos waited an average of 42 hours. Latinos also were more likely to use private transportation to get to the hospital rather than calling an ambulance, a move that also can cost precious minutes, the American Heart Association says.

According to AHA, patients who call 9-1-1 often are treated at least one hour earlier than patients who arrive by car. Once an ambulance arrives, emergency medical technicians can begin working on the patient right away, helping to minimize damage to the heart, the organization says.

Perhaps the most common reason for delaying treatment, though, is that patients just don't realize they're having a heart attack, doctors said. Either patients aren't aware of the typical symptoms, or they have symptoms that are anything but typical.

"Some patients have pain in the abdomen, shoulder pain, or fatigue," said Dr. James Grossman, an emergency physician at Valley Baptist Medical Center-Harlingen. "There's a lack of knowledge that some of these symptoms can mean a heart attack."

Patients with diabetes often have symptoms that are unusual, like abdominal pain, during a heart attack. Women are more likely to feel fatigue, Grossman said.

If in doubt, come to the emergency room, Grossman urged. Even if it's hours or days later, patients can still undergo treatment to clear blockages and limit damage to the heart, he said.

"I would rather have someone with atypical symptoms find out it's not a heart attack and go home than have them wait and find out later it was a heart attack," Grossman said.

Many heart attacks, as well as cases of heart disease, likely go undiagnosed here because many residents are uninsured and don't have a primary doctor, cardiologist Mego said. So they put off preventive and emergency treatment, he said.

"We have patients who have been sick for quite some time ... some don't find out they had a heart attack until days later," he said. "We can only educate patients if they come in to see us."

Because of the region's high rate of diabetes, obesity and high cholesterol, the population is at high risk and often doesn't realize it, Mego said.

Awareness campaigns by the AHA and other organizations have helped to spread the word to an extent, doctors said.

"There has been an uptick of people coming in sooner for treatment, and it cuts across all strata - more males, more females, and all ages," Grossman said.

But more residents still need to realize that every second counts when seeking treatment for a heart attack, he said.

"Any longer than immediately is too long to wait," Grossman said.