Heart-Attack-Blues
Call 911 if you want to live
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All The Way


A 56-year-old man named Martin awoke one morning feeling fairly well. He was getting ready to go on his daily jog. 

Martin had always been concerned about his health. Both his mother and his father needed coronary artery bypass surgery when they in in their late sixties, both after suffering mild heart attacks. 

Martin had regular check-ups with his family physician. He took medication for hypertension and high cholesterol and was strict with his diet—his doctor had  told him he had prediabetes and needed to lose some weight.

He quit smoking five to ten cigarettes a day when he turned forty. He had started smoking when he was a freshman in college.


9:30 a.m.

As  he was walking out the door to begin his jog, Martin began to notice intermittent chest discomfort. At first, it lasted just a few seconds, but soon it became more frequent and more severe. He also began to experience shortness of breath. He lay down on his bed to rest for a while, thinking that the disturbing feelings would pass.


11:02 a.m.

Instead, over the next 90 minutes, the symptoms became progressively more severe, to the point where they became sustained and intense. Martin finally realized that something was seriously wrong and that he needed immediate help. He called 911 and then went outside to his front lawn to wait for the ambulance.

11:06 a.m.

When the paramedics arrived, they found their patient collapsed on the ground. He was nauseous and his vision was blurred. He was covered with cold sweat. When asked how he was by the paramedics, the only words he could speak were, “I’m having a heart attack.” His blood pressure was 120/84 mm and his pulse was 65 beats per minute.


11:18 a.
m
.

An EKG was performed on the spot and showed that Martin was probably having a STEMI. The EMS team immediately notified the STEMI receiving center and were told to bring the patient in. The cardiac catheterization lab was activated and the interventional cardiologist on call was notified.



be better to leave them out.









11:34 a.m

On arrival at the ER, Martin was met by the cardiologist. He was awake and alert, but now the pain was unbearable, a 10 out of 10. He was very cold to the touch. No blood pressure could be measured and his pulse was rapid and thready.

 

 [SB1]Like the photo--it needs a caption.

 

 

 

 














11:38 a.m.


Martin was almost immediately transferred to the cath lab, where he was placed on the X-ray table and then prepped and draped in the usual sterile fashion. His right groin was anesthetized with lidocaine and an arterial sheath was placed in the right femoral artery. By now, his blood pressure was dangerously low at 40/10. He was immediately treated with potent intravenous medication that elevated his blood pressure to 83/38.












The initial angiogram is shown below.
The arrow shows the left main coronary artery is 100 percent closed.





The cardiologist tried to restore his coronary circulation with angioplasty to open the blocked artery. This restored flow partially, but because Martin’s coronary arteries were so diffusely 
blocked
, the blood flow to his heart muscle wasn’t sufficient.

In fact, Martin’s heart had been so extensively damaged that it could no longer pump blood well enough to sustain a blood pressure. Despite maximum doses of potent medications, Martin’s blood pressure dropped to 70/30.

An intra-aortic balloon pump, a mechanical device that augments the heart’s ability to pump out blood, was placed in Martin’s chest. It made little or no difference in his condition.







An emergency cardiac surgery consultation was called.


Luckily, the surgeon luckily was in the hospital and responded to the cath lab immediately. He and the cardiologist agreed that the only hope of survival for Martin was to take him for emergency bypass surgery. They hoped that bypassing the blocked arteries would improve Martin’s coronary circulation and help him.



12:25 p.m.


Martin was taken to the operating room.

As he was being prepped, he went into ventricular fibrillation—his heart was beating in an uncoordinated way. That caused a full cardiac arrest, with no blood pressure and no pulse. Martin didn’t respond to multiple attempts to defibrillate him with electric shocks; the numerous medications given also didn’t help. In a last-ditch attempt to save his life, the cardiac surgeon opened Martin’s chest and performed cardiac massage while he was placed on the heart-lung pump machine.



12:57 p.
m
.


On the pump, Martin stabilized. His heart was pumping enough to oxygenate his blood and circulate it to the body. The surgeon performed a double bypass, which went fairly smoothly.

However, when an attempt was made to remove Martin from the heart-lung machine, his blood pressure and cardiac output dropped, to the point where the machine had to be turned back on.

To help his heart pump, a left ventricular assist device (LVAD) was placed in Martin’s chest. This is a mechanical circulatory device that can partially or completely replace the function of a heart that has failed. This finally stabilized Martin enough that he could be transferred to the coronary care unit.






In the initial hours after the procedure, Martin’s vital signs stabilized. He had a number of complications, however, including congestive heart failure, postoperative bleeding requiring multiple transfusions, kidney failure, and left-sided paralysis, possibly from a stroke.

Nevertheless, after about eight to ten hours, things began to turn around. Martin’s urine output increased; with this, his lungs began to clear. The bleeding subsided and his blood count stabilized. He became fully awake and alert. The paralysis went away and he could move all his extremities.

The following day, things improved to the point where his doctors felt could survive—if he got a new heart. Martin met all the criteria for possible heart transplantation.

A specialized heart center with transplant capabilities was contacted. They accepted Martin as a patient and he was transferred there that evening.

The next morning, he was taken again to the operating room. His LVAD was removed and replaced with a different type of cardiac assist device called a HeartMate. The new device was much smaller and portable. It could stay in place for a long time while Martin waited for his heart to strengthen. If it didn't, the HeartMate would keep him stable while he waited for a heart to become available for transplantation.

 

Over the next few days, Martin dramatically improved. His kidney function returned to normal and he was able to eliminate the excess fluid in his lungs on his own.

His left side strengthened and he was able to get out of bed and sit up in a chair. Over the following days he began walking the halls of the hospital, getting stronger every day.

Martin is now patiently waiting for a new heart and is making plans to walk his daughter down the aisle at her upcoming wedding.