A STEMI call, a life saved: an hour inside WRHN’s cardiac catheterization lab
Inside Look
The call rings out through the hospital's PA system: "CODE STEMI, ETA: 20 minutes."
Inside Waterloo Regional Health Network (WRHN)’s cardiac catheterization lab, staff are preparing for the imminent arrival.
A STEMI, short for ST elevation myocardial infarction, is the medical term for a heart attack with a blocked coronary artery. When blood flow is blocked, heart muscle begins to die. Treatment must be swift and precise.
One member of the cath lab team is on the phone with paramedics, who in this case, are transporting the patient from a community outside of Kitchener.
The conversation is brief but efficient as the team member notes relevant information to the patient's condition: What are his symptoms? When did they start? Is he on medication? The paramedics send over an EKG of the patient, so an interventional cardiologist can review it before they arrive.
As the ambulance approaches, nurses and radiation technologists prep one WRHN’s two cath labs – the one not already in use to treat a scheduled case.
Tools needed to treat the heart attack are laid out on a table: the long catheter that will be fed through the patient’s wrist or groin and up to his heart, the dye that will pinpoint the blockage on an X-ray, and the balloon and stent that will restore blood flow.
The doctor greets the patient at the entrance and assesses his current condition. Then he’s wheeled into the lab, where staff and paramedics lift him onto the table.
Now, the life-saving procedure can begin.
Meanwhile, in the second cath lab, another stenting procedure is underway.
Once it wraps up, the room can be cleaned and turned over for the next patient within 15 minutes. Staff need to be quick to keep up with the day’s jammed schedule.
With both labs in use, what happens if another emergency case comes through?
"That's the multi-million dollar question," a cardiologist says. " That’s why we need a third lab."
With the STEMI patient secure on the cath lab table, the doctor, nurses and radiation technologists peer at a large screen in front of them.
The doctor uses a foot petal to turn the lights off for a split second as he snaps an X-ray image from a machine hovering over the patient’s chest. The dye, inserted into the patient's artery, allows his blood vessel to appear as a pulsating black streak amid the grey image.
The blockage is pinpointed, and the doctor and scrub nurse prep the balloon and stent. Once inside, the balloon inflates to restore blood flow. The stent will keep the artery open.
The situation in the lab is serious, but none of the staff show signs of panic.
They've been treating dozens of emergency STEMIs each month, a caseload that has increased year after year and is expected to rise further as the population expands and ages.
WRHN’s cath labs already service roughly 10 per cent of Ontario’s population, covering cases from Haldimand-Norfolk to Bruce County.
In 2025, WRHN performed roughly 6,500 procedures in its existing two labs. By 2028, that number will increase by 30 per cent to 8,500. With a third lab, WRHN would have capacity to treat roughly 11,000 patients per year.
That part is important as the population ages: over the next 20 years, it’s projected that hospital use among older adults, who are most at risk for cardiovascular disease, will increase by 170 per cent. Older patients, and more complex cases, aren’t always stable enough to undergo open heart surgery.
While WRHN can already treat many heart conditions with minimally invasive techniques, they need technology – and more room – to expand those services.
After roughly 45 minutes, the emergency patient’s STEMI procedure is over. Despite an unexpected secondary blockage, the case goes as planned.
The patient is transferred to the CCU (Coronary Care Unit) to be monitored.
"If he hadn’t come in today, something catastrophic may have happened,” says the cardiologist who worked on the patient. "But that procedure went beautifully."
"He’ll be back on his feet by tomorrow."
This heart month, give the gift of time.
Your donation helps fund patient-centred cardiac care across the Region of Waterloo and beyond. Giving online is a quick, easy and secure way to make a big impact.
