Surviving a Heart Attack

Sunday, January 16, 2005, started as a pretty ordinary Sunday. My wife and I had gone to the early service at church, then to Sunday School. Since it was only then 10:30 when we got out, we decided to go shopping for a while before heading home, so we drove the few miles to Trexlertown where there was a shopping center with a Kohl’s in it. I was fortunate to find a parking spot right in the first slot outside the door and eagerly grabbed it.

I initially went in the store with her and accompanied her as she shopped around in several departments. But shopping is not one of my preferred activities, so I told her I was going back to the car to take my typical mid-day Sunday nap. I slept for perhaps a half-hour, but when I awoke I was not feeling rested like I normally would. In fact, as I lay there with my eyes still closed, I was feeling decidedly uncomfortable and as the seconds ticked by even more so.

I was particularly feeling bad around my left upper chest, like someone was pressing on it. And as I waited – perhaps only for an additional minute or so – I remember thinking, “this feels like the symptoms of a heart attack.” I then realized that if it was, that I should take immediate action and not wait for my wife to return to the car. I pulled out my cell phone (ah, the wonders of technology!) and dialed 911.

The 911 operator answered and I calmly told her, “I think I’m having heart attack.” I then told her that I was parked at the Kohl’s in Trexlertown, gave her instructions where in the parking lot I was parked, and said, “Come and get me.” I also told her that my wife was in the store shopping.

Although the Goodwill Fire Company was only a mile down the road to the west, I knew that most cases like mine would more likely get assigned to the Cetronia Ambulance Company about 4 miles to the east as they have an advanced life support ambulance for cases like this. So I estimated that they would arrive in less than 10 minutes. While I was waiting for them to arrive, my wife came out of the store and I told her what was going on. (I later found out that the 911 operator had called Kohl’s and they had paged my wife in the store, but she was already on her way out when this happened and so didn’t hear the page. But the next time I visited the store I stopped at the customer service desk and thanked them for their efforts.)

By the time the ambulance pulled up, my symptoms had worsened. I was diaphoretic (i.e. perspiring profusely) and was unable to exit the car on my own. (FYI – I had heard this term on a number of occasions on the TV show Emergency, but had never known what it meant. But now it was me being described that way!) The EMTs pulled me from the car and loaded me onto their gurney, then pushed me into the back of the ambulance. They told me wife that they were taking me to the Lehigh Valley Hospital on Cedar Crest Blvd and that she could follow (at a safe speed) and meet me there.

During the relatively short trip to the hospital a number of things happened. In order to relieve any constriction caused by my clothing, they cut off my shirt, my t-shirt, my belt, and my trousers. No time to waste with buttons, etc. – just a sharp pair of shears! They attached a couple of electrical leads to check heart rate, EKG, etc. They also first gave me two baby aspirin to chew, then a couple of nitroglycerin tablets to hold under my tongue. They also asked me a number of questions.

Despite all of this going on, and the increasing pain in my chest/shoulder, I was surprised at how calm I remained. I remember thinking that it was quite possible that I might not survive this, but there was no sense of panic at all. I had given my life to God and trusted Jesus as my Savior a number of years before, so I knew that if I did not survive that I would immediately be taken into His presence. I had always wondered how I would react if I were confronted with a life/death situation, and now actually being in one, I knew!

Meanwhile, there were other things going on in the ambulance that I later found out were relatively new technology at the time. The results of the EKG were being transmitted directly to the ER over the EMT’s cell phone. The ER doctor was looking at the results and could confirm not only that I was having a massive heart attack, but what kind it most likely was. As a result, I was being given priority and things were being prepared for my arrival.

It was now perhaps 30 minutes since I had experienced the initial symptoms and the ambulance was backing up to the ER and I was taken inside. They initially placed me in one of the ER bays, but they told me that I would only be there long enough for them to finish cleaning up the cath lab from the last procedure, then I would be going right in for surgery. They asked me what my level of pain was on a scale of 1-10 and my response was, “I need to tell you that I’ve had a kidney stone, so that’s my basis for comparison. That was a 10, so this is only 8-8.5.” Meanwhile, my wife arrived and was escorted into the bay. They let her know what was going on as well and gave her a paper bag containing my shoes, socks, underwear, and what was left of the rest of my clothes that they had unceremoniously cut off me. Only a few minutes later the gurney arrived to take me into surgery.

Heart attack patients are not allowed to contribute much to avoid any unnecessary movement. So any transfers from one bed/gurney to another are by them rolling you onto your side, putting a board under you and rolling you back onto it, then sliding the board from one bed/gurney to another. After pushing me down a couple of halls, then a trip up the elevator to the surgical floor, then a few more halls, I found myself in the “cath lab” where the operation to unblock the obstructions in my heart would take place.

I need to insert here some specifics on the exact type of heart attack that I had. There are a number of arteries and capillaries that service the heart. The right side of the heart is supplied by the Right Coronary Artery. The left side of the heart is serviced by the Left Coronary Artery which divides part way down that side into the Left Anterior Descending Artery (the LAD) which services the front and bottom part of that side of the heart and the Circumflex Artery which services the left side and back of that side of the heart. Because the left side of the heart is the largest side, the two arteries on this side are responsible for about 2/3 of the heart. A complete blockage near the top of the LAD is called a “widow maker”.

I had two blockages – one was a 100% blockage of the LAD, the other was a 75-80% blockage of the Circumflex Artery. The chances of survival from the first is 5-10%, primarily because without any blood flow that part of the heart muscle begins to die. 25% of those with this type of blockage die almost immediately. So my heart attack was about as serious as they come! (See http://myheart.net/articles/the-widowmaker/ for details.)

Continuing my story, the operating table in the cath lab has a large x-ray machine positioned directly over your chest. The surgeon is not operating directly on the heart, but through incisions made generally in the artery that is near the surface in your groin and by threading instruments, etc. up that artery, through the aorta then into the arteries which supply blood to the heart.

You are basically naked on the operating table, then the OR nurse liberally coats the area of your groin with an orange-colored antiseptic (it seemed like about gallon of it), then lays cloths around the area where the incision will be. There are three large monitors for the surgical team. One is a continuous display of the area around your heart, another can be “frozen” with a view of that same area, and the third displays your vital signs (EKG, heart rate, blood pressure, etc.).

I was not aware of much of this that Sunday afternoon, as I was too involved dealing with the pain in my chest. I only am filling in the facts here from the second procedure which I’ll outline further below.

After making an incision in the artery in my groin and clamping off the lower portion (so you don’t bleed to death!) the surgeon can thread his instruments up that artery. When the instruments reach the area of the heart, he can squirt a small amount of dye which can be easily seen on the monitor, then freezes that image so he can see where everything is, including the blockages.

He first verified the location of the two blockages, then directed the instrument, with a small balloon on the end and a stent around the deflated balloon, through the blockage, inflated the balloon which compressed the blockage against the artery wall and expanded the stent to hold the artery permanently open. This all took only a few minutes. The stent was a “drug eluting” stent (see https://en.wikipedia.org/wiki/Drug-eluting_stent for a better description.)

As soon as that artery was opened up and blood could once again flow to that side of my heart muscle, the pain that I had been experiencing just vanished. It was an amazing feeling of relief! The surgeon made the decision to only place the one stent during that procedure and to schedule the placement of the second stent in the circumflex artery a few days later – after all that one was only 75-80% blocked!

They then extracted the instruments, stitched the end of the cut artery together, released the clamp on the lower part of that artery, and sewed the incision back up. The emergency surgery having been successful, I was moved to a room in the coronary ICU for observation for the next few days.

The coronary ICU is a pretty interesting place too. The ratio of nurses to patients is pretty high. Each patient is connected to a continuous heart monitor – initially to one plugged in the wall, then later to a wireless unit so you can have a limited amount of mobility. There are monitors in the hall outside your room as well as at the nurse’s station. Any significant variation or measurements result in alarms going off and immediate visits to your room by the staff.

I only had one incident while I was there. Occasionally the incision in the artery in your groin will “leak” and blood begin pooling under the skin in the area. This can be particularly problemsome with men as if the blood gets into the scrotum (which is only a few inches away), it can cause painful swelling. Mine never made it that far, but the treatment is to “express” the area to spread out the pooled blood (which eventually gets reabsorbed into the body) and to put heavy sand bags over the area of the incision to prevent further leakage (meaning that you also have to lie very still and on your back until the leakage stops). It’s a little embarrassing to have a nurse massaging this private area, but better than the alternative of having “black balls”. Instead I just had what looked like very bad bruising for several days until the excess blood got reabsorbed.

By the following morning, all was under control and I was converted to a mobile monitor so that I could slowly shuffle around the ICU with my monitor and other various items on a wheeled pole. I was the only mobile patient in the ICU for those few days. I also received a visit from one of the nurses in the administrative area who asked if I would sign a release so they could use my case as an example of how the technology in the ambulance transmitting my EKG to the ER was so helpful.

On Wednesday I made another trip back down to the cath lab for a second procedure, this time going in through the other side of my groin and getting another stent inserted in the circumflex artery. But this time I was not in pain at all and very much aware of all that was going on. By craning my head to the side I could see around the unit positioned over my chest and observe the three monitors which were guiding the surgical team. It was an interesting exercise in geometry, translating what I could see on the monitors to what was happening inside my chest. While I don’t recommend anyone having to go through this, this second operation was actually somewhat enjoyable in adding to my education.

The following morning, with no additional leakage on that side of my groin, I was able to be released from the hospital and driven home (I had one of our pastors pick me up as my wife was busy teaching preschool that day). I had significant restrictions – no driving for six weeks, no returning to work until I was cleared to do so, and nine weeks of visits to the coronary rehab unit for monitored exercises. What was also interesting was that I was back in church the following Sunday, with most people never even having missed me.

I saved all the medical bills that I received for that week – ambulance, hospital, two surgical procedures, etc. In total that week of care cost nearly $120,000! Not a small amount to be sure, but one that was totally covered by my medical policy at work.

But the best news of all is that I could call myself a survivor. Since over 90% of those who have this type of heart attack do not live to tell about it, I feel very fortunate indeed. I attribute my survival to three things. First, and most important, I recognized what was happening and almost immediately called 911 on myself. Quick response is critical to survival. Second, I was fortunate to live in an area where there is a hospital only a few miles away. And third, not only is this hospital a regional hospital with a full-equipped cath lab, and a heart care group onsite, but they were already experimenting with the latest in technology and procedures so that my EKG was being transmitted to the ER before I arrived, saving precious minutes in diagnosis.

Because of my quick response, I have ZERO long-term effects from this incident. That is just one of the blessings. But I also feel quite blessed to have the certainty that my faith in God and my Jesus is so real to me that I know that He will be with me no matter the circumstances I might find myself in in the future! To HIM be the glory!