Press releases

Released September 8, 1997
Yale-New Haven Hospital news release

Chest Pain Center Opens
in Yale-New Haven Emergency Department

The newly opened Chest Pain Center in the Yale-New Haven Hospital Emergency Department will help ease the process of determining whether a patient is, in fact, experiencing a heart attack, while reducing the time a patient spends in the hospital.

Only a small percentage of patients who arrive in the Emergency Department with chest pain are actually suffering a major cardiac episode. But where the diagnosis is questionable, doctors take no chances and they admit the patient to the hospital. Now through the extra diagnostic capabilities of the Chest Pain Center, doctors in the ED can understand what is causing chest pain before they make a decision to admit the patient. For many that means the question is settled in less than a day without being admitted to the hospital.

"In the past, patients have usually moaned when we told them they had to be admitted for potential heart disease," said Edward Monico, MD, director of the Chest Pain Center. "That could mean three days in the hospital. Now we can take care of many patients in 12 hours."

Patients with chest pain still go the Emergency Department first, where evaluation and testing is done, including an electrocardiogram (EKG). If there is no "active ischemia" (a shortage of blood being pumped to the heart wall) which would immediately require being admitted for treatment of a heart attack, the patient goes to the nearby four-bed Chest Pain Center for further tests and monitoring.

"If there should be any active ischemia, we can admit them to the hospital immediately from the Chest Pain Center, otherwise if the evaluation is negative, we send them home," Dr. Monico said.

The Chest Pain Center was created as part of the extensive renovation of the YNHH Emergency Department. In addition to making physical and technical improvements in the ED, the renovation allowed the creation of the Chest Pain Center as a separate patient care unit, so patients can be in a more relaxed environment similar to an inpatient room. Patients lie in a hospital bed instead of a gurney, separated by a wall instead of a curtain, as is normally found in the emergency rooms. A technician can see each patient and monitor his or her vital signs and cardiac activity at three-hour intervals from an observation station. Part of the testing includes checking key cardiac enzymes after a blood sample is drawn. After nine hours of monitoring without incident, the patient undergoes a treadmill stress test supervised by a cardiologist.

Unlike most chest pain centers, the YNHH center has nuclear cardiac imaging technology on site, which allows doctors to obtain a three-dimensional image of the heart to look for blockages suggested by borderline or abnormal baseline EKG readings.

The Chest Pain Center represents a cooperative effort between several departments, including the ED, Pharmacy, Coronary Care Unit and Patient Financial & Admitting Services. The ED provides personnel for medical direction, nursing care and other support functions, while cardiology provides staff coverage by a fellow and assigns a cardiologist to work with Dr. Monico and staff on unit protocols, policies, procedures and quality improvement.

Heart Attack Symptoms/Warning Signs

If you think you are having a heart attack, call your emergency medical system (911) immediately.

The American Heart Association says the body likely will send one or more of these warning signals of a heart attack:

• Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes.
• Pain spreading to the shoulders, neck or arms.
• Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath.

Not all of these signs occur in every attack. Sometimes they go away and return. If some occur, get help fast.

IF YOU NOTICE ONE OR MORE OF THESE SIGNS IN ANOTHER PERSON, DON'T WAIT. CALL YOUR EMERGENCY MEDICAL SERVICES AND GET TO A HOSPITAL RIGHT AWAY!

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All information is intended for your general knowledge and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.