Libby Schnell was busy getting her young family ready for church – a typical Sunday morning for this 34-year-old mother of two. Suddenly, she felt intense chest pain and began vomiting. Libby’s parents were visiting and called her brother, a physician in East Texas. He insisted they call 911 right away.
In a short time, Schnell was in the cardiac catheterization lab at Medical Center of McKinney, having stents placed in one of her coronary arteries. She had never imagined having a heart attack at 34.
Coach Michael Khoury was headed into the locker room with another coach at McKinney Boyd High School one night, preparing for a soccer game. But then he was unable to speak and lost control of his hand. The other coach led him back to the training room and called an ambulance.
All photos courtesy of Medical Center of McKinney
Dr. Ricardo Guerra of Medical Center of McKinney meets with Libby Schnell and her children.
He soon found himself in the emergency room, receiving “clotbusting” medication. At the age of 33, Khoury was having a stroke.
Heart attacks and strokes are two of the most common disorders caused by disease of the heart and blood vessels, also known as cardiovascular disease. Typically blood clots form and block an artery that supplies blood and, therefore oxygen, to the tissue it serves. In a heart attack the heart muscle is starved of oxygen and becomes unable to pump properly, putting other organs in jeopardy. During a stroke, a vessel that supplies the brain is blocked, so the affected brain region stops functioning properly.
Common and Deadly
February is American Heart Month. According to the Centers for Disease Control, one in every four deaths in the U.S. is attributed to heart disease. Stroke is the fourth-leading cause of death in the U.S., and is also a major cause of adult disability. As common as these diseases are, most people don’t think they are at risk, particularly young, healthy adults such as Schnell and Khoury.
Until Schnell’s heart attack, she had no symptoms, had plenty of energy and no reason to think she had a cardiovascular disorder. In fact, she didn’t have the typical heart attack. Her heart attack was caused by sudden coronary artery dissection. Basically the wall of her coronary artery split, allowing blood to flow between layers rather than through the vessel. The cause of her heart attack was not typical, but the results were.
Only months prior to Khoury’s stroke, he also had a heart attack. But up to that point, he had no symptoms or reason to believe he was at risk for heart attack or stroke.
Khoury and Schnell are evidence that no one is immune to cardiovascular disease.
Time Saves Lives
The other important factor that Khoury and Schnell share is the speedy treatment that they received. Quick calls to 911 certainly made a difference in their outcomes. North Texas residents are fortunate to have access to high-level, leading-edge care close to home, at facilities such as Medical Center of McKinney, where Schnell and Khoury were treated, and Baylor Medical Center at McKinney.
Baylor also offers a complete line of advanced cardiovascular therapeutic options, including both invasive and noninvasive treatments and state-of-the-art cardiac evaluation.
“Patients who experience symptoms worrisome for a heart or vascular problem should seek attention at the closest emergency room for evaluation and treatment,” said Dr. David Prewitt, a cardiologist on the medical staff at Baylor McKinney.
For heart attacks, hospitals monitor their “door-to-balloon” time – the time it takes from the moment a patient enters the emergency department to the point that a balloon is opening up any blockage in their coronary arteries. The standard is 90 minutes or less. Of course, this means that the time it takes to get to the hospital is critical, as well. Waiting to call 911 when you have chest pain or other cardiac symptoms can negatively affect your overall outcome if you are having a heart attack.
“The same is true with stroke,” said Dr. Vallabh Janardhin, director of the Texas Stroke Institute, a collaborative initiative that includes 11 North Texas hospitals. “Time is brain.”
Michael Khoury still coaches a soccer club team.
Janardhin said 1.19 million cells die per minute during stroke. Seeking timely treatment at a center with the appropriate staff and technology is critical to preserving life and preventing disability from stroke.
Even with the similarities of heart attacks and strokes – Janardhin calls them brain attacks to emphasize this point – there are some critical differences. First, most strokes cause no pain. So people who experience a stroke during sleep, then wake up with a loss of control in an arm, may simply think they slept in the wrong position and delay seeking treatment.
In addition, treatments for stroke have lagged behind treatments for heart attack for a number of reasons. For years, balloons and stents were used for heart attacks, while no such technology existed for strokes. But interventional neurology is now becoming more widely available at designated stroke centers.
In 2004, the Merci Retriever was developed. This device is fed into the blocked artery, and a corkscrew- like implement pulls out the clot. In 2008, a vacuum suction device called the Penumbra Aspiration System was developed to suction out clots.
Current standards suggest that intravenous clot-dissolving agents can be given up to three hours after stroke symptoms are noticed. Then mechanical devices such as the Merci Retriever and the Penumbra Aspiration System can be implemented at three to eight hours after symptoms develop.
Stroke centers are designated as Level 1, 2 and 3, based on their ability to diagnose and implement these treatments and technologies. Emergency medical services can redirect ambulances to a designated stroke center when needed, so that time to treatment is minimized.
Coach Khoury is no longer coaching the Boyd soccer teams, but he does work out with them frequently and coaches a club team, as well. He continues to teach psychology and sociology at Boyd, and since his stroke, he completed a master’s degree and welcomed a first daughter into his family. While he still has some voice weakness as a result of his stroke, significant disability was avoided because of his quick call to 911 resulting in efficient treatment.
Because Schnell’s heart attack was not related to typical cardiac risk factors, such as cholesterol or blood pressure, she didn’t have to make any lifestyle changes. She did wear a LifeVest for three months so her heart could be monitored for any additional cardiac events. She is back to teaching school and raising her children, in part because of the quick call to 911.
Schnell said she hopes people will learn about the importance of speedy treatment from her story. “I keep going back to the great potential of each individual,” she said. “Each of us can bless so many other lives.”
So don’t delay. If you or someone close to you experience symptoms that could be a heart attack or stroke, act quickly – and live to write your own happy ending.
FYI: Recognize the Signs
If you experience any symptoms that might be related to a heart attack or stroke, call 911 without delay. As many cardiologists like to say, “Time is tissue!”
Symptoms of heart attack:
- Chest pain, discomfort or tightness
- Upper body pain, particularly in the neck, arm, jaw or center of back
- Stomach pain
- Shortness of breath
- Anxiety, lightheadedness
- Sweating, nausea or vomiting can also be signs of a heart attack and should be taken seriously, especially if accompanying another symptom
Symptoms of stroke:
The American Stroke Association has developed the FAST acronym for stroke –
F – Face drooping
A – Arm weakness
S – Speech difficulty
T – Time to call 911 if you experience any of these symptoms
Contact your primary care physician for regular check-ups and for more information on maintaining good heart health.
About the author: Amy Rogers, M.D., is a freelance writer living in McKinney. Contact her at firstname.lastname@example.org or visit her website at amyrogersmd.com.