United States | WISE study of woman and heart disease yields important findings on frequently undiagnosed coronary syndrome
Editor’s note: This study was released in 2006 however it bears a re-release of the original article if there’s a chance just one prehospital provider takes a hard look at the study results – lest any one us find ourselves dealing with a female pt c/o of atypical chest pain.
Additional resources for healthcare professionals are available on this website:
http://www.herheartcommunity.com/professional/resources/index.php
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In as many as 3 million U.S. women with coronary heart disease, cholesterol plaque may not build up into major blockages, but instead spreads evenly throughout the artery wall. As a result, diagnostic coronary angiography reveals that these women have “clear” arteries—no blockages—incorrectly indicating low risk. Despite this, many of these women have a high risk for heart attack, according to newly published research from the National Institutes of Health.
In women with this condition, called coronary microvascular syndrome, plaque accumulates in very small arteries of the heart, causing narrowing, reduced oxygen flow to the heart, and pain that can be similar to that of people with blocked arteries, but the plaque does not show up when physicians use standard tests. As a result, many women go undiagnosed, according to findings from the National Heart, Lung, and Blood Institute’s (NHLBI) Women’s Ischemia Syndrome Evaluation (WISE) study. Insights from the study are published in a special supplement to the February 6 issue of the Journal of the American College of Cardiology, available online January 31.
“When a diagnosis of this condition is missed, women are not treated for their angina and high cholesterol and they remain at high risk for having a heart attack,” said NHLBI Director Elizabeth G. Nabel, M.D. “This study and the high prevalence of coronary microvascular dysfunction demonstrate that we must think out of the box when it comes to the evaluation and diagnosis of heart disease in women.”
The National Institutes of Health initiated WISE in 1996 to increase scientific knowledge about ischemic heart disease in women. WISE aimed to develop accurate diagnostic approaches for ischemic heart disease detection in women, to better understand the ways in which heart disease develops in women including the significance of ischemia without coronary blockages in women, and to evaluate the influence of hormones, on ischemic heart disease development and diagnosis.
“So much of our understanding of the underpinnings of heart disease and heart attack, and the basis for our standard methods of diagnosis and treatment are the result of research conducted on men,” said C. Noel Bairey Merz, Cedars-Sinai Medical Center and the WISE study chairperson. “Through clinical experience, many critical questions arose about how the disease may manifest differently in women, and how diagnostic techniques may need to be used differently in order to prevent more heart attacks and save lives.”
WISE investigators found that the majority of women with “clear” angiography who are not diagnosed will continue to have symptoms, a declining quality of life, and repeated hospitalizations and tests.
“Through WISE, we have made tremendous progress toward better understanding of heart disease in women. Too often women are tested again and again, go untreated, and still have high risk for heart attacks, “ said George Sopko, MD, NHLBI project officer for WISE. “As clinicians we must systematically examine women for evidence of any blockages and initiate intensive treatment for their risk factors.”
Authors of six review papers providing insight on WISE conclude that the study has provided the groundwork for additional controlled clinical studies of diagnostic tools and treatments in women with ischemic heart disease.
Additional study conclusions from WISE appear in the same JACC edition:
- Identifying Candidates for Exercise Stress Testing: Using the evaluative tool Duke Activity Status Index (DASI) in women with heart disease symptoms prior to stress testing can help determine who would be eligible for an exercise stress test versus a stress test using intravenous medications to increase the heart load instead of exercise. Current guidelines offer physicians little guidance on how to identify women who would not be able to sufficiently complete the exercise test. The DASI has been previously validated as a useful tool for determining functional capacity.
- Low Coronary Flow and Scores on Function Test Indicate Poor Outcomes: Women who have low DASI scores also have lower coronary flow velocity, a combination which may explain the poor outcomes seen for women with heart disease but no blocked arteries.
- Role of Pre-menopausal Hypertension in Disease Risk: Women who have high blood pressure before menopause, especially high systolic blood pressure, should be considered at a higher risk and treated accordingly.
Alberta | One person treated by EMS after CFD responds to carbon monoxide call in NW Calgary
2600 block 34 Avenue NW | 19 Feb 2012
- Leave the house immediately.
- Call 9-1-1 or the local fire department from a neighbour’s house.
- Do not go back into the house until the fire department says it is safe to do so.
- Seek professional medical help; indicate that you suspect carbon monoxide poisoning.
California | Two killed, three critically injured in shooting followed by major emergency fire in Hollywood
517 North Harvard Boulevard | 17 Feb 2012
Gun-shots fired in a relatively quiet neighborhood today, resulted in multiple victims, a Major Emergency Structure Fire and two deaths. No Fire or Police were injured.
At 12:41 PM on Thursday, February 16, 2012, LAPD Officers accompanied by Los Angeles Firefighters responded to a reported shooting at 517 North Harvard Boulevard. Upon arrival, they were greeting by three adults: one 34 year-old male and two 38 year-old females, all suffering from apparent gunshot wounds. A domestic dispute in the nearly 100 year-old single family dwelling, may have precipitated the gunfire. Acting without hesitation, the Officers and Firefighters rapidly extracted all three individuals from the residence, before discovering a quickly developing fire at the rear of the structure.
Adding to the chaos, were reports that the shooter was still in the residence and may have been holding one additional victim. The potential of this incident brought a swift and heavy response, with 150 Firefighters pouring into the Hollywood neighborhood.
The inherent risks of the incident were carefully considered by the Unified Command. With a reported shooter-at-large and a now, fully-developed structure fire, the safety and security of all personnel became the primary objective. With Firefighters unable make an interior fire-attack and untenable conditions in the structure eliminating the probability of survival, it was determined the best course of action was to let the fire burn itself out.
Hoselines were placed on each side of the approximate 2,600 square-foot home, as were armed LAPD Officers to provide force protection to Firefighters. The strategy was to prevent the fire from extending to the adjacent exposures by simply controlling it.
Full-extinguishment came 2 hours and 30 minutes later. Unfortunately, the discovery of two bodies also came, by way of our LAFD Cadaver Search Dog and its handler. They were aided by two others canines from Ventura County Fire Department. One of the bodies is believed to have been the shooter, of unknown age. Both bodies will be positively identified by the LA County Department of Coroner, as will the exact cause of death.
The three injured adults were all transported in critical condition to local hospitals. Both the fire and the crime scene are part of an active, joint investigation by the LAFD’s Arson/Counter-Terrorism Section and the LAPD. While dollar-loss estimates were not yet available, the structure was a total loss. There were no reported injuries to LAFD or LAPD personnel.
Dispatched Units:
E11 RA6 RA20 T29 E29 E229 EM11 BC5 E61 RA82 RA41 RA56 EM2 EM9 E82 E235 T35 E227 BC11 BC2 BC13 DC2 E27 T27 UR3 RA3 HR56 UR88 BC1 UR27 RA827 E211 T11 E6 E15 E220 T20 SQ21 CM3 RA4 AR7 RA52 RA78 H2 E21 E3 E12 E202 T2 E226 T26 EA1 RT59 E56 AR1 RA867 RA867 E90 AR3 AR10 E91 RM2 SU1 AR36 E2 T12 E212 T3 E203
California | Arrest of man alleged to be responsible for death of LA firefighter
Los Angeles | 21 Feb 2012
One day shy of the one year anniversary of the line of duty death of Los Angeles Firefighter Glenn L. Allen, an arrest and filing of charges against a suspect was made.
The fatal fire occurred in the late evening of Wednesday February 16, 2011 at 1546 North Viewsite Drive in the Hollywood Hills area of Los Angeles. Firefighters arrived to find fire in the exterior wall of the structure, which then ran the walls and entered a concealed space in the ceiling. During the firefighting operations failure of the ceiling assembly constructed of drywall, wood framing, and water soaked insulation, resulted in a partial ceiling collapse, causing injury to four Los Angeles Firefighters and two Los Angeles County Firefighters, trapping three.
Sadly Firefighter Allen later succumbed to his injuries at 12:15 PM on Friday, February 18, 2011 at Cedars Sinai Medical Center. Glenn L. Allen was a Firefighter/Paramedic for over 36 years and last served at Fire Station 97. He was just two years away from retiring.
The Arson Investigation determined that the fire started at a gas fed fireplace type burner assembly.
A formal and detailed investigation ensued and now a year-long joint investigation between LAFD’s Arson Unit that also included the assistance of the Bureau of Alcohol Tobacco Firearms and Explosives (ATF) along with LAPD’s Robbery-Homicide Division (RHD) has now been capped off with a recent arrest.
In the evening of Saturday, February 11th 2012, Los Angeles Police Department (LAPD) detectives with the assistance of agents from the Federal Bureau of Investigation (FBI) arrested Gerhard Albert Becker, 48 of Palma De Mallorca, Spain as he exited a flight at Los Angeles International Airport. Becker, a German national, was identified as the suspect in the death of Firefighter Glen Allen, due to improper construction of the home and appliances. Mr. Becker the architect, home builder, and homeowner has been charged with one count of 192(b) PC, Involuntary Manslaughter, and is being held on 2 million dollars bail. He has plead not guilty.
At a press conference on Wednesday, February 15, 2012, LAFD Fire Chief Brian Cummings stated, “I want to thank the members of the LAFD Arson Counter-Terrorism Section, Los Angeles Police Department Robbery Homicide Division, the Bureau of Alcohol, Tobacco, Firearms and Explosives, and the FBI for their diligence in pursuing this case and filing these charges.”
California | Oxy abusers turning to heroin in San Diego County
San Diego County | 21 Feb 2012
On the streets, an OxyContin tablet can cost as much as $80. The steep price may be driving Oxy abusers to turn to a much cheaper alternative: heroin.
In the last five years, the number of heroin addicts at County-funded treatment centers increased by 57 percent. Heroin abuse skyrocketed especially among people between the ages of 18 and 25: a whopping 229 percent increase.
“While we’ve seen decreases in other drugs, there’s been a scary increase in heroin abuse,” said Susan Bower, Director of Alcohol and Drug Services for the County Health and Human Services Agency. “We are seeing more, younger men coming into treatment because of heroin.”
In 2007, heroin users represented 9.5 percent of all treatment admissions, about 12,000 annually. By 2011, the figure had jumped to nearly 17 percent.
County treatment centers are not the only places where heroin is becoming more noticeable. The County Medical Examiner’s Office has also reported an increase in deaths related to the drug.
According to statistics from the Medical Examiner, people under 30 are dying in higher numbers as a result of abusing heroin.
In 2010, there were 71 deaths due to heroin; 23 were younger than 30 years old. Six of those who died were just in their teens, a higher total than the number of teens killed by heroin in the past decade.
Source: San Diego County Health and Human Services Agency
“These are kids with no other health problems,” Dr. Jonathan Lucas, Deputy Chief Medical Examiner, has said. “For every kid who dies, how many others are using?”
Given the alarming increase in heroin abuse, County health officials are reminding the public that help is available at dozens of treatment centers throughout the region.
“Anyone can access treatment services, regardless of their ability to pay,” Bower said.
Parents who believe their child might have a drug problem and adults with substance abuse issues should call the County’s Access and Crisis Line at (888) 724-7240.
Washington | Innovative program trains firefighters as Community Medical Technicians
Issaquah | 21 Feb 2012
Beginning this month, Eastside Fire & Rescue is partnering with Public Health — Seattle & King County’s Emergency Medical Services on the Community Medical Technician (CMT) pilot program. The CMT program utilizes firefighter personnel to serve as a single-person response unit that can be dispatched to patients requesting assistance through the 911 system, but who may not necessarily need full emergency medical response.
For several years, Public Health has recognized that all medical situations do not necessarily meet the present criteria in sending a full medical response typically answered by local fire departments. Costly fire department equipment and personnel are often sent to patients experiencing minor medical conditions, and through present criteria and protocol, a fire engine and/or aid unit must be sent to answer the call. Once these fire department units respond to such patients, they are unavailable to respond to other more severe and emergent situations in their area.
The CMT unit is staffed with one skilled firefighter/EMT that is dispatched to less-severe patients, and these units can spend more time discussing the patient’s non-emergent medical or other social needs. “The objective of the pilot program is to help in reducing non-emergent responses, identify patients who can be served by social-service assistance or other local resources, and to promote medical stability in our communities,” says Deputy Chief of Operations Greg Tryon with Eastside Fire & Rescue.
“Programs such as the Community Medical Technician project illustrate efforts by local fire departments and Public Health to utilize personnel and EMS funds in potentially more cost-effective ways, while also increasing options for assisting patients,” said Dr. Mickey Eisenberg, Medical Director for King County Emergency Medical Services Division of Public Health – Seattle & King County.
Fire and emergency medical service 911 calls have increased nearly 3% a year prior to 2009. As our aging population increases, so will the demand for emergency and non-emergency medical assistance. The CMT pilot program is meant to provide a cost and resource-efficient alternative to the typical non-emergent response calls. Eastside Fire & Rescue is one of two fire departments that will be participating in the pilot program this year. The CMT unit will be located at the Headquarters Station in downtown Issaquah where the response area will be limited to a 20-minute response radius.
Washington | King County opens Flood Warning Center to monitor rivers as heavy rainfall hits region
King County | 21 Feb 2012
The King County Flood Warning Center opened at 1:30 p.m. on Tuesday, Feb. 21, as persistent rainfall brought flows on the Tolt River up to a Phase II flood alert level.
As of 1:30 p.m. Tuesday, the Tolt River was flowing at 3,600 cubic feet per second (CFS), slightly higher than the Phase II flood alert threshold of 3,500 CFS for that river. Typically, only minor flooding in low-lying areas along the Tolt River would be expected at this flow, with the potential for water over a few roads.
A Phase II flood alert level is the level of the County’s four-phase warning system at which the Flood Warning Center activates to monitor conditions. The Flood Warning Center will remain open as long as flood conditions persist.
Flood Warning Center staff will monitor stream gages and weather reports, and will provide updated information on river conditions as necessary. Real-time river level information is available online at http://www.kingcounty.gov/flood.
Updated information on flooding will also be posted on the King County website at www.kingcounty.gov, and via RPIN, the area’s regional website at http://www.rpin.org. A recorded flood-information hotline is also updated each hour for citizens wanting information on flood conditions. The number is 206-296-8200 or 1-800-945-9263.
Citizens who need help interpreting flood information should call 206-296-4535 or 1-800-768-7932. Problems on County maintained roads can be reported by calling 206-296-8100 or 1-800-KC-ROADS.
Oregon | Woman pulled from burning car by three Good Sams after RTC on Highway 47
Photograph courtesy of Oregon State Police
Highway 47, Pebble Creek Road | 21 Feb 2012
A 22-year old Milwaukie-area woman received non-life threatening injuries Tuesday afternoon when her car rolled down a steep 40-foot embankment along Highway 47 north of Highway 26. The woman was pulled from her smoking car by a Washington County transportation department employee and two citizens before the car became fully engulfed.
On February 21, 2012 at approximately 12:15 p.m. a 1996 Toyota Camry driven by ANDREA L. HAMMOND, age 22, from Milwaukie, was traveling southbound on Highway 47 near Pebble Creek Road when it traveled off the highway negotiating a curve. The car went down a steep embankment, rolling at least twice before it came to a stop.
HAMMOND remained inside the car as it started smoking. Larry Elverud, a Washington County Lane Use & Transportation Department employee, and two citizens went down to the vehicle, removed the driver and helped her up to the road. About one minute later the car was engulfed in flames.
HAMMOND was transported to Oregon Health & Sciences University for treatment of non-life threatening injuries. She was using safety restraints.
Oregon State Police troopers from the North Plains work site are continuing the investigation. Senior Trooper Mark McDougal is the lead investigator.
OSP was assisted at the scene by Washington County Sheriff’s Office, Banks Fire District and ODOT. Highway was closed for over 30 minutes. The vehicle was destroyed by the fire.
Oregon | Two women injured in RTC on Highway 30 near Multnomah/Columbia County line
Photograph credit Oregon State Police
Highway 30, Multnomah County, Columbia County | 20 Feb 2012
A 63-year old St. Helens-area man was arrested by Oregon State Police (OSP) following a two-vehicle injury traffic crash Monday afternoon on Highway 30 near the Multnomah/Columbia County line. Two people were injured in the crash that restricted traffic along the highway to one lane for about 3 hours.
On February 20, 2012 at approximately 12:15 p.m. a 2005 Dodge pickup driven by EDWARD J. BROWN, age 63, from St. Helens, was traveling north on Highway 30 near milepost 18 when, according to witnesses, it collided into the rear of a 2008 Nissan Versa at a high rate of speed. The impact forced the Nissan off the shoulder where it crashed into a tree.
Two female passengers in the Nissan were transported to Legacy Emanuel Medical Center with non-life threatening injuries. The male driver accompanied them to the hospital. Their names are not available for this release.
BROWN was not injured and was arrested by OSP on the following charges:
* DUII
* Reckless Driving
* Recklessly Endangering Another Person
* Assault in the Fourth Degree
He was lodged in the Columbia County Jail.
OSP was assisted at the scene by Scappoose Police Department, Scappoose Fire Department and Columbia River Fire & Rescue.
Oregon | Portland FD responds to fatal hazmat incident on barge
5949 M Basin Ave | 20 Feb 2012
At 10:05 a.m., Portland Fire and Rescue was called to rescue a man who had fallen into a chemical holding tank on a barge at 5949 N Basin Ave. Station 24 (Overlook/Swan Island) arrived first at 10:10 a.m. and determined that a 57 year old male was missing from the barge.
Due to the nature of the emergency, Portland Fire and Rescue’s Hazmat Team and Technical Rescue Team were called to help.
Firefighters found a rope that led into an open hatch that covered a chemical holding tank. The other employee on the barge indicated that he had seen the man near the hatch and then turned away. When he looked back, the man was missing.
The tank was approximately 40 x 50 feet and approximately 20 feet deep. There was 12 feet of liquid Lignin Amine in the tank. This is a toxic and corrosive material used in agriculture.
The air above the liquid inside the tank had an oxygen level of less than 1 percent and a level of CO of 108 ppm. That level of oxygen will cause a person to pass out within a minute and die soon thereafter(outside air has 21 percent oxygen). With this information, Portland Fire and Rescue determined that this was going to be a body recovery, not a rescue.
Portland Fire and Rescue worked with the remaining employee to pump the liquid from the tank into another holding tank. This process took about an hour. In the meantime, firefighters confirmed that the male had not left the work site or fallen into the river.
The Technical Rescue Team and Hazmat Team worked together to create and implement a plan to enter the tank if necessary.
After approximately 40 minutes, firefighters could see that the man was in fact in the tank and deceased. The employee finished pumping out the hazardous liquid and firefighters readied to enter the tank and recover the victim.
At 1:03 p.m., the first technical rescuer entered the tank in a hazmat suit put on by the Hazmat Team. The rescue team consisted of two people trained in Confined Space Rescue. The second rescue team is available to rescue the firefighters who first entered the tank. The Hazmat Team prepared to decontaminate the rescue teams and the victim once they exited the tank.
Due to the hazardous nature of the recovery, both specialty teams needed all trained personnel to accomplish the mission. Besides the hazardous liquid, the hatch into the tank was only approximately 20 inches across. The rescue team was in the tank for 44 minutes to recover the man. The incident was over at 1:49 p.m.
The victim’s name is John Michael Summers. He was 57 years old.
Other agencies that responded to the incident are Portland Police, Multnomah County Sheriff’s Office, United States Coast Guard and Oregon OSHA, and AMR.
All the hazardous liquid was contained on the barge and none entered the lagoon.
No other injuries occurred during this incident to either civilians or firefighters.