The Free Press, Mankato, MN

March 19, 2014

Mankato woman living proof of EKG's value

Grant will get EKG machines to rural rescuers

By Robb Murray

---- — Sitting in a rocking chair with her 6-year-old grandson on her lap, the boy asked, "Grandma, can we rock?"

So Mary Styndl obliged. They rocked. And then she felt it: a quick, sharp pain in her chest.

"I had thought that maybe the back of his head hit my chest," she said.

She thought little of it. In fact, she walked her grandson to Kennedy Elementary School.

And then the pain came back. And got worse.

Her husband Vance Stuehrenberg, a Blue Earth County commissioner and former Mankato police officer, came home around 8:30 a.m. that February day and noticed immediately something was very different about his wife.

"He said, 'Do you want to go to the ER?' I said 'Yes.' And that just wasn't me," Styndl said.

Stuehrenberg called 911 and asked if he should bring her in himself. They answered with an emphatic 'No,' and an ambulance crew dispatched immediately.

Styndl, 57, was in the middle of a heart attack. But working in her favor was a new way of doing things that gave her extra time and got her care team working as soon as the call to 911 was made.

When paramedics arrived, they were able to assess her heart condition with a 12-lead EKG machine, which places 12 electrodes on the torso. Once a heart attack was confirmed, a special team began assembling so that when she arrived she could bypass the Emercency Room and head straight to the catheter lab where the blockage causing the heart attack could be removed.

The use of 12-lead EKG machines by emergency medical service crews is relatively new. It's been around in Mankato for just a couple of years. Now, thanks to a $108,000 grant from the American Heart Association, such technology will be made available to more rural ambulance services and hospitals.

When it comes to heart attacks, nothing is more important than time: As the old saying goes, "Time is muscle." If a blocked artery isn't opened quickly, the part of the heart nourished by that artery begins to die. Opening that artery quickly is key to reducing the amount of damaged muscle.

That's why medical professionals are always trying to reduce the so-called door-to-balloon time — the time it takes from the minute a patient comes through the door until doctors are able to unblock the artery using surgical balloons.

But now, as in Styndl's case, the playing field has been extended to the homes of patients.

When parademics arrived at Styndl's East Main Street home, they knew from her husband's 911 call that it could be a heart issue. This gave paramedics a heads-up to start there immediately. In her case they did the 12-lead EKG and were able to notify the hospital. Once that notification was made, the cath lab team assembled quickly. By the time she arrived, they were waiting for her.

Nationally, the goal for door-to-balloon time is 90 minutes. Styndl's time was 29 minutes. Overall, median door-to-balloon times at Mayo Clinic Health System have improved from 2012 to 2013 from 60.5 minutes to 48. Cardiology nurse Kim Brunmeier says the decrease is due largely to EKGs being done at home, or wherever the patient may be when the heart attack occurs.

The median door-to-balloon times in situations where EMS personnel do EKGs before getting to the hospital is about 30 minutes.

"Her care started the moment her husband called 911," Brunmeier said.

And that fact isn't lost on Styndl.

Before she even left the hospital, her heart went into cardiac arrest and she needed to be revived. Luckily, she was in a hospital room surrounded by doctors and nurses. That event earned her an extra day in the hospital.

"Every day when I walk up for cardiac, it's never very far from my mind," she says of the lesson in mortality the incident gave her.

She credits the expertise of the first responders, dispatchers, nurses, doctors — and that 12-lead EKG the paramedic did when he got to her house — with saving her life.

"I wouldn't be here without it all," she said. "I know I wouldn't. And now I'm here. And I get to enjoy my grandkids. I'm really glad I'm here."

When all was said and done, a doctor revealed a little bit of grim trivia about her case. The artery that was blocked was the left anterior descending artery, known morbidly among medical professionals as "the widow maker."