ND doctor: Harvest and heart attacks connected
CASSELTON, N.D. — During harvest season and even when farmers are gearing up for harvest, rural areas see a large number of heart attacks, said Dr. Thomas Haldis, an interventional cardiologist and medical director of the Cardiac Catheterization Laboratory at Fargo’s Sanford Health.
Farmers might push through their symptoms because they want to get their harvest in, he said, but symptoms are warning signs.
“When you have chest pain out in the tractor, that can be a disaster,” he said. “Don’t ignore symptoms during harvest.”
On a hot, humid day in September 2011, Ryan Radermacher was working on some equipment on his 4,000-acre wheat, soybean and sugar beet farm near Casselton when he suddenly became sweaty.
He thought he was suffering from heat stroke or heat exhaustion, he said, so he went inside to cool off and asked his wife to call the 24-hour nurse phone line.
“She looked at me and said I was a pale gray and didn’t look good at all,” Radermacher said.
While she was on the phone with the nurse, Radermacher started feeling pressure in his chest and his arms started to ache. His wife hung up and called 911.
Ambulance crews arrived and gave him medication, oxygen and administered an electrocardiogram to assess for a heart attack.
It turned out Radermacher had a blockage in his right artery. He was 45 at the time.
Sanford LifeFlight took him to the hospital, where he had an angioplasty to clear the blockage and a stent was inserted to help keep the artery open.
It took 38 minutes between the EKG in his driveway to the stent placement, Radermacher said.
Many heart attack victims die within one hour of the first symptoms, according to the American Heart Association. That makes it especially risky for people in rural areas.
This year an estimated 1.4 million people will suffer a heart attack, and about 400,000 of them will experience a STEMI, the deadliest form of heart attack, according to the American Heart Association.
ST-elevation myocardial infarction is a type of heart attack caused by a prolonged period of blocked blood supply that affects a large area of the heart. (An ST segment is the line on an EKG that when elevated, indicates a STEMI heart attack.) It has a substantial risk of death and disability and calls for a quick response, the association states.
“When you have that kind of a heart attack, 90 percent of the time your artery is 100 percent blocked,” Haldis said. “When it’s 100 percent blocked, we’ve got to open it.”
The guidelines say the blockage should be opened within 90 minutes of first medical contact, he said. Yet there are only six percutaneous coronary intervention, or PCI, centers in the state — in Fargo, Grand Forks, Bismarck and Minot.
PCI, which uses procedures like stents, balloon angioplasty or surgery, is the preferred therapy for treating STEMI, according to the American Heart Association.
The association is working to improve heart attack patients’ outcomes in rural areas through a national initiative called Mission: Lifeline.
It’s a collaboration between regional hospitals with PCI centers, smaller medical centers and emergency medical services to make sure plans and protocols are in place to transport and treat heart attack patients.
“You have to have a plan,” said Haldis, co-chair of the North Dakota Mission: Lifeline program. “You must have a plan to make this work because of these huge distances.”
Haldis started a similar program at Sanford five or six years ago based off a STEMI program started during his fellowship in Pennsylvania, he said. Haldis then became involved with the American Heart Association’s Mission: Lifeline program.
The North Dakota project started in 2011, followed by the Minnesota program in 2013. A statewide STEMI protocol was adopted in 2012 in North Dakota. It’s being shared with the Minnesota task force.
The program, Haldis said, has made a huge impact in people surviving heart attacks in the state.
Before the program, he said there were about 150 deaths per 100,000 people from STEMI. Now, he said, there are about 20 deaths per 100,000 people from STEMI.
“There are still some counties that are way, way out there where we’re just not able to get them quickly,” he said.
“It’s still something that we struggle with in the far-out rural counties.”
Thirty-four North Dakota counties are designated medically underserved areas, and 13 additional counties have some part of them designated medically underserved, according to the American Heart Association.
Rural areas are heavily dependent upon volunteer ambulance services and the capabilities of small hospitals to receive STEMI patients and transfer them quickly, the association states.
Radermacher served on the Casselton Volunteer Ambulance squad for more than 25 years and was also a member of the Casselton Fire Department for 25 years, so when he started to feel chest and arm pain, he took it seriously.
“I knew better than to play Mr. Tough Guy when you’re not feeling right,” he said.
Calling 911 instead of having his wife drive him in was also crucial.
“I didn’t hesitate to call 911, and I have no heart damage,” he said. “Listen to your body. If you’re not feeling right or you’re feeling symptoms, get it checked out.”