Why is the ER Wait so Long?
Patients often ask why it takes so long to diagnose a heart attack. A hospital stay can sometimes last the better part of a day, or longer. The steps taken by the ER staff are described below and help exlpain why the process takes time.
When you arrive in an emergency room with symptoms suggestive of a heart attack an ECG and blood draw for cardiac enzymes (or biomarkers) are done within minutes. A severe heart attack known as an STEMI can be diagnosed immediately with the ECG alone. Other types of heart injury can take longer to diagnose. For example, the diagnosis of a less severe type of heart attack known as an non-STEMI relies on cardiac enzymes which become elevated approximately six hours after the start of symptoms. Hopefully you arrive in the emergency room less than six hours since your symptoms started. The initial cardiac enzymes will likely be normal but do not exclude, or "rule out," a myocardial infarction. The blood test is repeated eight to twelve hours since symptom onset. In some cases a third blood draw is ordered several hours later to be absolutely certain no heart damage occurred. If you're doing the math, this process can take the better part of a day.
A heart attack is "ruled out" once all the cardiac enzymes are normal. The evaluation process, however, does not end there. Although no infarction is detected, symptoms may be due to unstable angina which requires close follow-up.
What Happens if all the Tests are Normal?
A stress test will usually be ordered to increases your heart's demand for oxygen in a monitored setting and help diagnose coronary blockage. The stress test can be done within 72 hours in the emergency room, chest pain unit, or outside the hospital if you are stable. If you show up on Friday, you may have to wait until Monday to have the appropriate test done in many institutions. An alternative to stress testing in some people is a new technology called CT angiography which takes images of the heart and can diagnose a coronary blockage.
Spending a day, or even a weekend, in the hospital only to be told that nothing is wrong may sound like a waste of time. The risks if you are sent home without a thorough evaluation, however, are significant and to a large part preventable. The inconvenience of staying in the hospital is worth avoiding the serious and life-threatening complications of a heart attack.