\&Deader's
~-
1
'\:Digest
:=.-::::=::-::=::::::=::
This
story
could
save
your
life
He Declared
War on
Heart Attacks
BY
CAROL
KR
UCOFF
T
HE
PAIN
STRUCK
SUDDENLY
In
his chest
as
George Fickus filled
a vending machine
with
sodas.
A
gleam
of
perspiration broke
out
over Fickus's
body-but
then,
all at once, the pain was gone.
I'll
go
home and
rest,
thought
the
57-year-old Baltimore
man.
Shaken,
he
walked slowly back to his van
to tell his assistant
he
was
taking
the
rest
of
the
day off.
But
Blaine
Pierce
took
one
look
at
his boss
and
said,
"No
way-I'm
taking
you to
the
hospital."
Pierce,
27,
recognized the pained
look
and
pale, sweaty
sheen
on
Fickus's face because several years
earlier his father had died
of
a heart
attack. "My
dad
was perspiring .like
that and had chest pain, but he would-
n't
go
to the hospital," Pierce told
Fickus. "Before we
knew
it, he was
dead.
I'm
not
going
to let that hap-
pen
again."
Fortunately they were near
Bal.:.
timore
's St. Agnes
HealthCare.
This
community
hospital has the world's
oldest chest pain
center-a
special
emergency service for patients
with
suspected
heart
attacks.
Within
min-
utes
of
his arrival, Fickus was hooked
up to a heart monitor, an intravenous
line
and
an
oxygen
tank.
A pulse
oximeter
(a
small clip that looks like
a clothespin) was placed on his
mid-
dle finger to measure the oxygen
reserve in his blood.
Dr. Raymond Bahr strode briskly
through the door.
The
gentle, white-
haired physician peered at the heart
monitor and studied the patient's elec-
trocardiogram.
He
saw that Fickus
was experiencing the "stuttering pres-
entation"
of
intermittent chest pain,
likely
to
mean
a
heart
attack
in
progress. Bahr instructed a nurse to
administer tissue plasminogen acti-
vator, a
drug
that dissolves clots and
prevents
damage
from
occurring.
"You're lucky," he told Fickus, lay-
ing a reassuring hand on the patient's
arm.
"You arrived
within
the first
'golden'
hour
when
our
therapies are
most effective.
You
should be fine."
Farfetched
Dream.
Working
in
an
ordinary
community
hospital,
not
a
major
academic center, Ray-
mond
Bahr
is
an
unlikely hero
in
the war
on
heart
attacks.
Yet
his
creation
and
promotion
of
chest pain
centers in hospitals nationwide are
dramatically changing the
treatment
of
people
with
suspected
heart
attacks. In addition, Bahr has pio-
neered a
program
that enables peo-
ple to
recognize
and
take
action
when
faced
with
the early
warning
signs
of
America's
No.
1 killer.
According to Bahr, half
of
the nation's
500,000
heart-attack
deaths
each
year could be prevented
if
people
sought help
right
away.
Born in
1935,
Bahr grew up in
Canton,
Md., a working-class sec-
tion
on
Baltimore's East Side. Life
became
tough
when
Ray's father, a
factory worker, died suddenly. Ray
was only six.
His
mother, pregnant
with
her
fourth
child
at
the time,
supported
her
family
by
scrubbing
floors
and
cleaning houses.
As a teen-ager, Ray
got
a job
after school at Kaminski's drugstore
to help pay for his parochial-school
education. Ray always assumed he
would work
at
the area's brewery,
steel mill or tin-can plant.
With owner
Felix
Kaminski's
encouragement,
however, the youngster set a higher
goal for himself: he attended phar-
macy school while
working
at the
store nights
and
weekends.
After
graduating first in his class
of
52
stu-
dents, he stayed
on
at Kaminski's.
One
day Bahr was busy
behind
the counter
when
Jake, the neigh-
borhood
tailor, came bustling into
the pharmacy.
There
was something
about
Jake's
skin-its
paleness
and
sweaty
gleam-that
spurred
Bahr to
ask
if
something
was wrong.
''I'm
not feeling
quite
right," Jake admit-
ted. "I
think
I have indigestion.
It
woke me early this morning, then
went away.
Now
it's back."
"You should see a doctor," Bahr
told
him.
Then
Bahr
became
dis-
tracted
with
other
customers,
and
Jake
left.
Hours
later
the
tailor
was found
dead
of
a massive
heart
attack.
Bahr then realized that Jake
must
have been in the early stages
of
a
heart attack
and
should have gotten
immediate medical help.
He
didn't
have to die. Feeling awful, the 22-
year-old pharmacist wished he could
spare others the same fate.
One
night
Kaminski
brought
up
an
idea
that
ignited
his protege's
thinking. "You know, you don't have
to stop
at
being
a
pharmacist,"
Kaminski said. "You can go to medi-
cal school
and
work
here
on
nights
and
weekends to pay for it."
Medical
school-now
that's
a farfetched
dream,
Bahr thought.
Yet
the idea
appealed to him. Fueled
by
a sense
of
responsibility for Jake's untimely
death, Bahr enrolled in the Univer-
sity
of
Maryland School
of
Medicine.
He
soon discovered he had a natural
affinity for internal medicine and a
special desire to help patients through
life-or-death struggles.
Shifting
Focus. Bahr served his
last year
of
residency in the intensive-
care
unit
at St. Agnes, across
town
from
where
he'd
been
raised.
At
the
time, a new type
of
facility was being
pioneered, the coronary intensive-
care unit, which closely monitored
people
who'd
had
heart
attacks
and
were
at
risk
of
sudden
death. So
when
administrators asked Bahr to
develop such a system for
them,
he
jumped
at the chance.
Over the next several years, how-
ever, despite the state-of-the-art
unit
B'ilhr
had set up, he still saw count-
less
premature,
unnecessary deaths.
Generally,
one-third
of
heart
attacks
proved fatal;
half
these people died
before reaching the hospital.
Those
who
survived often suffered irrepara-
ble
damage
to the heart. Relatives
would tell the doctor that their loved
ones had felt chest "pressure"
or
"tightness" for several
hours,
but
passed off the discomfort as heart-
burn
or
muscle strain. Too stoic or
embarrassed to seek help, they waited
until their symptoms became unbear-
able before
getting
medical care.
By
then,
it was often too
late-they'd
had a
heart
attack.
"If
only
they'd
come
in
when
they first experienced symptoms,"
Bahr
said.
He
felt discouraged each
time
he lost a patient.
On
one
such
frustrating
occasion he
thought
of
Jake,
who
had
ignored
the
chest
discomfort
preceding
his
heart
attack.
If
I knew then what I now
know, I could have saved
him,
he
thought.
At
that
moment
he was
struck
by a
simple
truth:
Jake's
symptoms
were like a
smoke
alarm
sounding
at
the
start
of
a fire. Heart
attacks have beginnings! Why
are
we
focusing all our energy on the time
during and after the heart attack?
he
wondered.
We
should be shifting our
focus
earlier.
Bahr
launched
his first public-
education
campaign
to
alert people
to the
little-known
symptoms
of
an
impending
heart
attack.
Nurses
spread the word
at
schools, churches
and
community
organizations.
Unfortunately,
the
medical estab-
lishment was skeptical. "We don't
want
to create heart-attack hyste-
ria" was a familiar response. Many
health
professionals
worried
that
telling
the
public
about
early
warn-
ing signs would flood emergency
rooms
with
people suffering from
indigestion.
Undaunted,
Bahr
continued
piec-
READER'S
DIGEST
PERCENT
OF
HEART
MUSCLE
SAVED
:-
FROM
ONSET
OF
GOLDEN
HEART
ATT4CK
-
TO
~
HOUR
EMERGENCY
t
ROOM
MILD
CHEST
TREATMENT
DISCOMFORT
STUTTERING
PAIN
SEVERI
CHEST
PAIN
0%
LAPSED
TIME
(in
hours)
2
3
DATA
PRO
VIDED
BY
DR.
RAY
M
OND
8A
HR
. GRA
PH
FR
O
NTIER
GROUP
ing together feedback
from
patients
and
their families
that
would help
persuade
his
colleagues.
One
common
reason people frequently
dismissed all
but
the
most
severe
pain
was a misperception
that
they
should
"tough
it
out."
Typically,
patients told Bahr, "I really
didn't
think
my nausea
and
sweating were
an
emergency."
Part
of
the
problem,
too,
came
from the hospitals. Busy emergency-
room
personnel
weren't
always
responsive to people
who
didn't have
the classic elephant-standing-on-the-
chest pain.
Then
one day Bahr had
an
idea: what
if
we started a facil -
ity with a
les
s threatening name, such
as
{{chest
pain center"? It could be
staffed by nurses and doctors trained
100%
to help people with all kinds
of
chest
discomfort.
"Red-Carpet
Treatment."
Bahr
proposed his
plan
to the St. Agnes
Board
of
Trustees in
1977,
but
the
administrators
turned
him
down.
Their
refusal merely propelled
him
to intensify his efforts, however. Twice
in
the
next two years Bahr pres-
ented
his proposal to the trustees,
each
time
offering
more
data
and
doing
a more persuasive presenta-
tion.
And
each
time
the adminis-
trators
turned
him
down.
Then,
in
1980,
when
the hospi-
tal was finishing
an
addition, Bahr
again proposed that a chest pain cen-
ter be included
in
the
new
area.
The
administrators finally gave
him
the
go-ahead. Soon the journal
Medical
4
HE DECLARED
WAR
ON
HEART ATTACKS
lfOrld News was
trumpeting
Bahr's
innovation,
noting
that
the
pioneer-
ing
physician
wants
"red-carpet
treatment"
for patients
who
may
be
having
heart
attacks.
Improving
hospital
care solved
only
part
of
the
problem,
however.
People
still
needed
to
learn
about
a
heart
attack
's "soft
symptoms
" so
they
could
get
to
the
chest
pain
cen
-
ter
early
enough
to
be
helped.
At
that
time
cardiopulmonary
resusci-
tation
was
getting
great
attention,
and
Bahr
and
his
staff
taught
it
to
people
in
the
community.
He
soon
added
a
program
to
educate
the
public
about
heart-attack
warning
signals,
calling
it
EHAC,
for
Early
Heart
Attack
Care.
"EHAC
is
the
message,"
Bahr
would
say,
"and
the
chest
pain
center
is
the
delivery
system."
A
breakthrough
came
in
1987
when
Bahr
received a
grant
from
the
National
Emergency
Medical
Association,
which
thought
EHAC
had
potential.
Bahr
spoke
of
his
two-pronged
approach
to
combat
heart
attacks
at
annual
conferences
of
emergency-room
physicians,
car-
diologists,
critical
-care
nurses,
para-
medics
and
any
group
willing
to
hear
him.
Slowly,
but
then
with
gathering
momentum,
the
concepts
began
catching
on.
And
despite skeptics'
fears, "cardiac chaos"
did
not
occur.
Instead,
an
estimated
three
million
r--------------------
.
----------~
WARNING SIGNS
OF
A
HEART
ATTACK
•
Pressure,
aching
or
burning-not
necessarily
pain-in
the
chest.
Often
it
increases
with
activity
and
subsides
with
rest.
•
Discomfort,
tightness,
squeezing
or
fullness
in
the
·
chest,
usually
lasting
longer
than
two
minutes.
Mild
discomfort
that
may
come
back
sooner,
last
longer
or
feel
more
s~vere
each
time.
•
Discomfort
in
the
teeth,
jaw,
inner
arm
(often
the
left)
or
back.
•
Dizziness,
fainting,
sweating,
nausea,
shortness
of
breath
or
weakness.
If
you're
not
sure
whether
discomfort
is
from
heartburn
or
a
heart
attack,
ask
these
questions:
Is
the
discomfort
located
in
the
center
of
the
chest?
Does
it
recur?
Does
it
increase
in
intensity?
Does
it
become
more
intense
with
exertion,
then
go
away
with
rest?
If
the
answer
to
any
of
these
questions
is
yes,
take
an
aspirin,
call
911
for
an
ambulance,
or
have
someone
drive
you
to
a
chest
pain
center
or
emergency
room.
Don't
drive
yourself.
~
L
______________________________
READER'S
DIGEST
people a year
are
evaluated
quickly
and
effectively
in
the
700 chest
pain
centers currently
operating
around
the
country.
Bahr
predicts
that
vir-
tually all
of
the
nation's 4400
emer-
gency
rooms
will
be
equipped
with
chest
pain
centers by
the
year 2000.
The
EHAC
program
is
now
taught
in
1000 hospitals,
and
half
a million
people have
learned
about
EHAC
through
Bahr's
public-service tape,
available free
at
some
video stores,
baseball stadiums,
high
schools, col-
leges
and
libraries.
EHAC
Oath.
Still,
it
was
only
last year
that
the
remaining
resist-
ance in the medical
community
began
to
crumble.
Despite
Bahr,
many
health
professionals
thought
early
heart-attack
symptoms
were
rare.
Then
in
January
1996,
renowned
Boston cardiologist
Eugene
Braun-
wald
reported
in
the
New
England
Journal
of
Medicine
that
about
half
of
all
heart
attacks have
such
early
warning
signals.
Other
doctors also
began
to agree
with
Bahr's
message.
"Early
on,
Ray
Bahr
recognized
the
important
truth
that
time
saves
heart
muscle," says Dr.
Henry
Mcintosh,
medical
director
of
the
Preventive
and
Rehabilitation
Center
at
St.
Joseph's
Hospital
in
Tampa,
Fla.
"If
we
can
treat
a
patient
within
60 to
90
minutes,
we
can
salvage
heart
muscle
and
prevent
damage.
That's
a
message
my
generation
wasn't
taught."
Last
February
Bahr
was
honored
by
the
American
Heart
Association-
Maryland
Affiliate.
When
the
crowd
rose to give
him
a
standing
ovation,
Bahr
surprised
everyone by
asking
them
to
remain
standing
and
be
deputized
as
Early
Heart
Attack
Care
Givers.
Audience
members
raised
their
right
hands
and
repeated
the
EHAC
oath:
"I
hereby
solemnly
swear
that
when
a
person
in
my
presence
is
experiencing
the
early
symptoms
of
a
heart
attack,
I will
make
every
effort
to
get
that
per-
son
to
go
to
the
nearest
hospital
emergency
room
to
get
those
symp-
toms
checked
out."
"I've
been
waiting
30 years to
do
this," Bahr told
the
crowd
with
glee.
And
from
this
heart
doctor's
record,
it's clear
he
won't
stop
deputizing
people until
he
has completely dis-
armed
America's·
No.1
killer.
To
find
out
if
a hospital in your
area
has
a chest pain center, or for a
free
video,
audiotape and booklet
on
EH
iC,
send a
self-addressed,
stamped
envelope to
Dr.
Raymond
Bahr,
St.
~nes
Health
Care,
900 Caton Ave.,
Box RD, Baltimore, Md.
21229-5299.
Or use these electronic addresses:
e-mail: [email protected]; on the
Web:
http:// www.ehac.org.
For
information
on
prices
and
availability
of
reprints
write:
Reader's
Digest,
Reprints
Department,
Bo)(
465,
Hanover,
PA
17331
or
call:
1-800-289-6457.
For
mag-
azine
subscription
information
call:
1-888-344-3782
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1997
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