A character in American author Alyson Noel’s young adult novel “Blue Moon” observes that the heart and mind “…aren’t always friendly. And in my case, they’re barely speaking.” The disconnect between emotion and reason she speaks of produces emotional turmoil. But the conflict between heart and mind can also play out in the physical arena – with potentially disastrous flesh-and-blood results.
James Glen Andrews can speak to this battle, and he wants others to pay heed to it. Andrews, 56, (he goes by Glen) is a paramedic with nearly a quarter century of experience in the field working to keep the seriously ill and injured alive while they’re rushed to the hospital for emergency care.
Many of those people have suffered heart attacks. Even as he applied advanced cardiac life support skills he not only maintains but also teaches, Andrews knew in some cases that the victims had waited too long to call for help. The blocked arteries that starved their hearts of blood – meant they would suffer serious debilitation or death.
Andrews, who has been a paramedic at UCHealth University of Colorado Hospital on the Anschutz Medical Campus since 2004, says that too often people who have heart attacks delay because they deny warning signs – a broad range of symptoms that they may brush off.
As a stroke kills brain cells, a heart attack destroys heart tissue. Neither can be regenerated. “As time goes on during a heart attack, there is structural damage to the heart,” Andrews said. “Tissue is dying.”
The person who acts quickly to summon help has a much improved chance of survival and limited cardiac damage, thanks to cardiopulmonary resuscitation and defibrillation, basic and advanced emergency medical services, and advanced life support – from professionals like Andrews.
Mind vs. body
Yet even with all his knowledge and experience, Andrews found himself in the early-morning hours of July 21 locked in a struggle between his heart and his mind. He now has a greater appreciation for the power of denial when heart attack victims face life-threatening challenges.
He’d completed a 12-hour shift on July 20 and capped it off with a ritual mounting of the 15 stories from the ground-level Emergency Department to the two floors above the building’s helipad. As always, he took colleagues with him for an unhurried stair summit.
“It’s not a race,” Andrews said. “I do it to try and clear my head and get some exercise.”
Returning home, he was puzzled when he felt some back pain and a “zing” between his pectoral and deltoid muscles. He’d continued regular workouts at home after COVID-19 closed his local gym. But he shrugged off the twinges, instead looking forward to climbing Mount Trelease near Loveland Pass with his younger son on the 21st.
Warning signs of a heart attack
Around 2 a.m. Andrews awoke with discomfort that he initially chalked up to his GERD (gastroesophageal reflux disease). He drank some Mylanta, but it didn’t ease the crushing feeling in his chest that was different from what he experiences with GERD. He suddenly realized he was gripping the back of his head with his left hand.
“I thought, ‘Why do you have your head in a half-nelson?’” Andrews remembered. His worried response: “Because my left arm is killing me.”
He reluctantly awoke his girlfriend, Wendy Wilson, a nurse at UCHealth Broomfield Hospital who had to work later, took some aspirin and hauled out a Zoll monitor, with the intention of doing a 12-lead electrocardiogram to check his own heart rhythms. He got to the third and fourth leads on his torso, saw suspicious activity on the monitor and turned it off. Ominous questions again popped up.
“What were you expecting?” Andrews asked himself. “Why did you turn if off?”
Submitting to reality
With that, the realization that he could be having a heart attack struck him. He told Wendy to call 911, observing the caution he gives others: don’t drive your stricken family members to the hospital yourselves. Let the trained professionals take over.
A cascade of thoughts, enveloped in a sense of unreality, descended.
“I thought, ‘This can’t be happening to me,’” Andrews said. “As a longtime health care provider, I take care of people that this happens to. I’m going hiking above tree line in the morning. I work. I do stairs. I feel good. I’m not what you think is someone who would have this event.”
These denials of his body’s warning signals actually began before the 911 call, Andrews now recognizes. “The whole time I spent getting the monitor out was a big part of the denial,” he said. “It gave me comfort and validation to do it, but I knew I was having classic symptoms of a heart attack.”
Why battle what his heart was telling him? The answer lay in the stubborn power of his mind, especially for someone dedicated to delivering care, not receiving it.
“It’s very difficult to relinquish power and call EMS,” Andrews said. “You’re calling for help. You will be submissive to them. Switching sides was very hard to do.”
Still, the time he delayed was relatively short: about 40 minutes. An Arvada Fire Station 7 crew rushed him to Lutheran Medical Center, which had called a cardiac alert in preparation for his arrival. In short order he was in the cardiac catheterization unit, where providers used a stent threaded through his wrist to open a 90% blockage in the left anterior descending (LAD) coronary artery, which is responsible for feeding blood to the heart.
The LAD is notorious for deadly blockages dubbed “widow makers,” but Andrews was fortunate in that his obstruction occurred near the end of the artery, toward the tip of the heart, said Dr. John Messenger, an interventional cardiologist and director of cardiac catheterization labs at University of Colorado Hospital. Messenger now manages Andrews’ post-procedural care at the UCHealth Heart and Vascular Center. Dr. Messenger is also a professor of medicine-cardiology at the University of Colorado School of Medicine.
“There was not a ton of heart muscle downstream from the blockage where [his providers] put the stent in,” said Messenger, who praised Lutheran Medical Center’s rapid work. “The resultant heart function was normal after the quick stent.”
After two days at Lutheran, Andrews returned home and is working light duty. Messenger’s treatment plan for him includes aspirin, anti-platelet medications to prevent blood clots, beta blockers to control his heart rhythms, cholesterol-lowering and anti-inflammatory medications, diet counseling and cardiac rehabilitation three times a week for up to 16 weeks.
Andrews acknowledged that he asked Messenger if he really had to do cardiac rehab. Messenger said he replied that he strongly recommends the therapy, which has been shown to reduce rehospitalizations and mortality in patients after a heart attack.
“I encourage everyone to do it,” Messenger said. “Cardiac rehabilitation after a heart attack is a great way to have a team watching how you do and being an early alert system to any problems, like abnormal blood pressure or heart rhythms, that we need to move on.”
Lessons learned from his heart attack
For his part, Andrews is happy to be alive, chastened by even the relatively brief time that he denied his symptoms, and intent on helping others to learn from his experience. He hardly fits the image of someone who ignored his health. He got involved in emergency services in the 1980s with Alpine Rescue in Evergreen and still works with the Ski Patrol in Loveland, in addition to teaching lifesaving skills for professionals getting recertification through the American Heart Association. He’s an avid international traveler who most recently spent time in February touring the Basque country of northern Spain.
Nor has Andrews turned a blind eye toward the mechanics of heart attacks. He and Messenger met years ago while handling cases in the emergency department at UCH. Messenger went over the fine points of reading EKGs with him, and Andrews often wheeled Messenger’s patients to the cath lab and sometimes lingered to watch his interventional procedures.
“I had a great working relationship with him,” Messenger said. “He had an interest in EKG findings in patients with ischemic heart disease. He was much more interested than many other folks.”
Yet in that pre-dawn morning of late July, Andrews battled the warning signs of his heart attack before “surrendering to the system” of emergency care and getting the care that may have saved his life.
“My gratitude for EMS can’t be expressed,” he said. “It makes me humble, and it’s also a source of pride.”
Listen to your heart
He’s now determined now to “give back” for the help he received. He recently delivered cookies to Arvada Fire Station 7 as thanks and plans to reach out to the cardiology team at Lutheran. He tells the story of his close call in the hopes of encouraging others to listen to the signals their hearts give them.
“Even if people have vague symptoms, they should call for help early and activate an emergency response,” Andrews said. “This can happen to any of us. I was within a half-shift of my heart attack happening at work, or it could have happened on the stairs [above the Emergency Department].”
Messenger said that he understands that people may be fearful of a “false activation” of emergency services and “feel like they are wasting people’s time.” But he prefers to encourage their vigilance.
“I look at it as an opportunity for people to be screened for heart disease,” Messenger said.
As for Andrews’ specific case, Messenger said, without being flip, that “he’s a 50-something dude with coronary artery disease, the number-one thing that takes men and women off the planet in the United States.” That fact underscores the importance of people monitoring their heart health as they age and also paying attention to genetics (Andrews said he has a maternal uncle who needed two heart stents at age 59). But Andrews’ situation raises other important points about heart disease, Messenger said.
Multiple risk factors for heart issues
During his February trip to Spain, Andrews said he needed to get care twice for ear pain and a persistent cough. After returning to the States, he tested positive for COVID-19 antibodies and quarantined for a couple of weeks. Messenger said it’s unlikely the coronavirus exposure played any role in Andrews’ heart problems. However, he noted that with the spread of the pandemic, at least one study concluded that during the COVID-19 pandemic, patients with ST-elevation myocardial infarction (STEMI), a serious type of heart attack, took significantly longer to proceed from symptoms to hospital admission than did patients before the pandemic.
Messenger noted that a campaign by the Society for Cardiac Angiography & Intervention aims to remind people that hospitals have processes in place to protect them against exposure to the coronavirus and encourages them to seek care quickly for early signs of heart attack and stroke.
In addition, Messenger acknowledged that stress can play a role in exacerbating heart disease. That’s a particular risk for health care workers like Andrews who are on the front lines battling the COVID-19 pandemic. Stress triggers inflammation, which in turn can rupture built-up plaque in the coronary arteries and cause blockages, Messenger explained.
It’s a complicated picture of disease, but Andrews has a simple message, which he delivers as both a provider and a patient: don’t delay evaluation of heart attack symptoms.
“I was lucky my denial was short,” he said. “Now I’m able to present the risks to people as having knowledge of both sides.”