Written by Michelle Abt
For 59-year-old Nancy Affinito, March 16, 2018, started just like any other
day. She had no inkling that morning that within hours of arriving at
work she would suffer a serious heart attack and be rushed to Torrance
Memorial Medical Center’s Emergency Department, where she would
be revived — not once, not twice, but multiple times — by
the emergency room physicians and staff.
It was that expert emergency care — provided by everyone from the
paramedics who took her to Torrance Memorial to the emergency room doctors
and nurses — that kept her alive long enough to have the heart catheterization
procedure she needed to remove the blockage in her artery that was killing her.
Nancy has now fully recovered from that heart attack, and has returned
to her normal daily life without any residual neurological damage —
an amazing outcome for someone whose situation was so critical. What made
Nancy’s outcome so successful? Quick thinking on her part, and top-notch
emergency care from a team of skilled providers.
A Life-Saving Decision
Around midday on the day of her heart attack, Nancy, a Senior Information
Systems Analyst at the County of Los Angeles Department of Health Services,
realized she was feeling a “bit off” and told her supervisor
she was going to leave early. A Torrance resident, Nancy wanted to be
closer to home if she started getting sicker, so she began the long commute back.
During the drive toward her house, Nancy began feeling short of breath
and found that she was unable to speak. Nine years ago, Nancy had a heart
attack and received a stent to open a blocked artery, so she decided to
take the nitroglycerin and baby aspirin that she always carried with her
in case of emergency.
“I knew I needed to get off the road, but I don’t remember
having any chest pain,” Nancy said. “Even though I had been
carrying nitroglycerin for years and never needed it, something just told
me that I should pull over, take the medication, and call 911.”
That decision saved her life.
When the paramedics arrived, Nancy was already in serious distress. She
was able to answer a few questions and told the first responders about
her stent and the medications she had taken. After that, the next thing
she remembers is waking up in the hospital.
Heroic, Life-Saving Emergency Care
Beginning in the ambulance and over the next several hours, Nancy became
unresponsive. During that time the paramedics — as well as the emergency
physicians and cardiologists at Torrance Memorial — took heroic
steps to save her life.
On the way to the hospital, Nancy developed a dangerous heart rhythm problem
called ventricular fibrillation (or v-fib, for short) and went into cardiac
arrest, meaning that her heart stopped beating. The paramedics used a
defibrillator to deliver a shock to Nancy’s heart and restore a
normal heart rhythm. They also used a bag-valve-mask to provide her with
oxygen and performed cardiopulmonary resuscitation, or CPR.
When Nancy arrived at Torrance Memorial’s emergency department,
Brian R. Miura, MD, an emergency medicine specialist, stepped in and continued to provide
During the next 30-40 minutes, Nancy went into v-fib several more times.
Dr. Miura and his team performed CPR, used the defibrillator, and administered
medication to help restore Nancy’s heart rhythm. Nancy’s care
team also used an airway tube to establish better ventilation.
“We got a normal heart rhythm a few times, but Nancy kept going into
v-fib,” said Dr. Miura. “We tried several different medications
to correct Nancy’s heart rhythm, but we knew she was having a serious
State-of-the-Art Cardiovascular Treatment
Dr. Miura knew that Nancy needed advanced cardiovascular care and contacted
L. Douglas Carlson, MD, an interventional cardiology specialist. The two doctors worked together
to stabilize Nancy’s condition so she could be moved to a cardiac
catheterization suite for emergency treatment. Nancy went into v-fib several
more times on the way to the cardiac catheterization suite and during
“We weren’t even sure we were going to be able to get Nancy
to the cath lab,” Dr. Carlson said. “She kept going into v-fb,
which made it difficult for us to move her. After we got her to the cath
lab, it took a while to get her stabilized so we could establish the arterial
line that would allow us to access to the blockage.”
After Dr. Carlson stabilized Nancy’s condition, he put in the arterial
line and began the catheterization procedure. He then asked
James Christopher Matchison, MD, another interventional cardiology specialist, to assist.
Dr. Matchison found that Nancy’s existing stent was blocked. He was
able to clear the blockage in her right coronary artery and put in new
stents to re-establish blood flow. Dr. Matchison and Dr. Carlson worked
together to put in a temporary dynamic support pump called an Impella®
to help circulate Nancy’s blood. The pump was removed the next day.
“Nancy experienced multiple rounds of v-fib in the cardiac catheterization
suite, but her condition stabilized as soon as the stents were put in,”
Dr. Matchison said.
A Miraculous Outcome
After spending five days in the hospital, Nancy was discharged to continue
her recovery. According to her doctors, Nancy’s story is nothing
short of a miracle.
“When patients come in with cardiac arrest, we are only able to regain
a pulse about 30-40 percent of the time — and a significant number
of patients who survive end up with serious brain damage,” said
Dr. Miura. “To have prolonged cardiac arrest for 30-40 minutes and
be up and walking in 3-4 days with no deficits is very rare.”
The team at Torrance Memorial attributed Nancy’s amazing outcome
to several factors: the immediate action the paramedics took to restore
a normal heart rhythm; the vigilance of the doctors and hospital staff
when performing chest compressions and other interventions; and the interventional
cardiology techniques and technology used to quickly restore blood flow
to her heart.
“So many things had to go right in order for Nancy to survive,”
Dr. Carlson said. “The chance of survival in situations like Nancy’s
is so low — for her to be alive and well is remarkable.”
And Nancy’s team agrees that she played a critical role in saving
her own life — and probably the lives of other drivers on the road, too.
“Nancy’s high degree of awareness set the whole thing in motion.
Getting off the road, taking her medications, and calling 911 —
combined with the timing and quality of the medical interventions and
CPR — made all the difference,” said Dr. Matchison.
“Back to Baseline”
Dr. Matchison, who is now Nancy’s cardiologist, said that she made
a remarkable recovery.
“She’s back to baseline. She’s exercising and has no
deficits,” Dr. Matchison said.
When Nancy first woke up after her ordeal, she said she didn’t understand
how serious her condition was when she arrived at the hospital. But now
that she has had time to look back on her experience, she wants to make
other people aware that heart attacks don’t always cause common
symptoms such as chest pain.
“I had a few of the common symptoms with my first heart attack, but
the second heart attack was totally different,” Nancy said.
“Nancy’s story is a perfect example of how important it is
to call 911 or go to an emergency room if you feel that something is wrong
— even if you aren’t exactly sure what it is,” Dr. Miura said.
Now that Nancy has a new lease on life, she’s going to do some traveling
and focus on spending time with her two adult children and three grandchildren.
“I’ve been seeing my cardiologist for follow-up, and I plan
to get as healthy as possible through diet and exercise,” Nancy
said. “I’m going to try to enjoy life more now because I know
that there are no guarantees.”