King Edward VII Memorial Hospital doesn’t have the equipment that allows doctors to see exactly where an artery is blocked or where plaque build up on an artery wall has become so thick that it impedes blood flow.Most heart attacks happen when a coronary artery becomes blocked. In medical facilities with cardiac catherisation equipment, doctors are able to see inside the heart. This enables them to determine exactly where the blockage is and decide how best to rectify the problem.In the absence of this equipment in Bermuda, doctors use thrombolytic therapy. Carl Levick, director of Cardiology at KEMH, explained that thrombolytic medication works by rapidly dissolving blood clots. The medication is put in the patient’s intravenous drip.“The risk with this therapy is that it can cause bleeding elsewhere in the body the brain, liver and stomach. Despite this significant risk (one percent for a serious bleed), studies have shown that it is more beneficial to use the therapy than not in facilities that do not have cardiac catherisation capability.According to Dr Levick , in 70 percent of cases the medication works the artery is unblocked and blood flows freely to and from the heart again. With blood flow to the heart resumed, cardiac cell death is minimised.In cases where the thrombolytic medication does not work, getting the patient to an overseas facility becomes urgent. Dr Levick said such patients often have surgery a few hours after arriving at the overseas institution.But overseas hospitalisation is usually required even for those patients for whom the on-Island therapy worked.“After the thrombolytic treatment we transfer the patient to a hospital with a heart catherisation lab to take a picture and determine if surgery is appropriate,” said Dr Levick.Currently KEMH transfers 40 to 50 patients a year who have been admitted with heart attacks.“We have to observe the patient carefully for heart rhythm and chest pains,” he said. “It’s not safe for then to fly commercially. If the thrombolytic therapy opens the artery there’s no great urgency to transfer but we must determine how severe the plaque load is. By and large they are transferred overseas for the heart catherisation. Of the people we send overseas for this, 80 percent either get angioplasty (a surgical procedure where the artery is widened by inflating a small balloon) or they have coronary bypass surgery.”