Column: Racing Against the Clock When Heart Attack Strikes

Column: Racing Against the Clock When Heart Attack Strikes

About every 34 seconds, someone in the United States has a heart attack. On Nov. 18, 2011, that "someone" included Leesburg resident Richard Fleeman. One week shy of his 51st birthday, he had just settled into his workday as a wholesale parts manager at BMW of Alexandria.

"All of a sudden, I wasn’t feeling right, like the flu was coming on," said Mr. Fleeman. "I started having severe back pain in my lower back, my upper back and then my neck. It dawned on me: I’m having a heart attack."

A co-worker drove him to Inova Alexandria Hospital’s Emergency Department, where Mr. Fleeman spoke the two words that launched a well-rehearsed, race against the clock involving multiple hospital departments, physicians, nurses and technical staff: "Chest Pain."

A heart attack occurs when one or more of the coronary arteries that supply blood to the heart become partially or completely blocked, starving the heart muscle of blood, and causing possible heart damage or death. For patients like Mr. Fleeman with the most severe type of heart attack involving complete blockage, the American College of Cardiology (ACC) and the American Heart Association (AHA) recommend patients receive life-saving balloon angioplasty — an emergency artery opening procedure — within 90 minutes of hospital arrival. Known as "door-to-balloon" time or D2B, the ACC and AHA launched a nationwide initiative in 2006 to educate hospitals about the 90-minute goal.

The Inova Heart and Vascular Institute at Inova Alexandria Hospital joined the nationwide effort and committed resources to improving our D2B times. Those resources included state-of-the-art technology upgrades to five labs in our Cardiovascular and Interventional Radiology (CVIR) Department — where angioplasties are performed — and additional beds in the CVIR admission and recovery area. In addition, staff in our Emergency Department and CVIR developed joint protocols to quickly identify and treat heart attack patients within 90 minutes or less. They also worked with EMS providers in the City of Alexandria to establish communication protocols that flag incoming heart attack patients, enabling the hospital to mobilize an angioplasty lab team before the patient even arrives.

Today, I am proud to say we have exceeded the 90-minute goal, but we aren’t done yet. We review every heart attack case for areas of improvement; we participate in a national hospital registry that shares best practices for reducing D2B; and, we work with the AHA’s Mission: Lifeline project to train healthcare providers in the field.

For Mr. Fleeman, it took only 29 minutes from door-to-balloon. An interventional cardiologist performed an angioplasty and inserted a stent to open his one blocked artery. Two days later he went home in time to celebrate his next birthday and a Thanksgiving holiday that, no doubt, held extra precious meaning this time around.

Read more about our cardiac services at

By Christine Candio, RN, FACHE

CEO, Inova Alexandria Hospital