Written by John Ferrari | Photographed by Michael Neveux
Imagine you’re at the mall … or watching a concert or sporting
event … or at the gym. Then you’re being wheeled into the
emergency room. EMTs, doctors and nurses surround you. You’re confused
and you’re scared, but you’re alive.
You’ve had sudden cardiac arrest, which can be fatal in minutes.
But wherever you were, there was an automated external defibrillator (AED)
box nearby, and that saved your life.
It happens, and it happened to Torrance resident Ken Watanabe last August.
Watanabe, an active 44-year-old, was spending a Saturday morning at the
Torrance–South Bay YMCA riding the stationary cycle and swimming.
It was, he recalls, his normal routine. But about 30 minutes into his
swim, he lost consciousness.
YMCA lifeguard Priscilla Li picks up the story. “I was on the tower,
and while I was scanning I noticed Mr. Watanabe,” she remembers.
“He was [by/near] the side of the pool, not moving. I wasn’t
sure if there was something going on, but after a few seconds I went over.
I touched his shoulder. He was unresponsive.”
Watanabe was near the pool’s steps. Li and fellow lifeguard Gage
Connor moved him out of the pool and started CPR. A senior lifeguard brought
over the AED box. “We shocked him twice before he started breathing,”
Li says. “By then, first EMS responders had arrived.”
Watanabe remembers waking up briefly in the ambulance on the way to Torrance
Memorial’s emergency room, and then in the Intensive Care Unit.
“I was so surprised,” he recalls, “because nothing like
that had happened before.”
He'd had a “primary arrhythmic event,” explains J. Christopher
Matchison, MD, the cardiologist who attended Watanabe when he arrived.
“His heart spontaneously went into a fast, dangerous ventricular
arrhythmia”—an irregular heartbeat that doesn’t adequately
pump blood through the body.
“The AED absolutely saved his life,” Dr. Matchison says. “An
automated external defibrillator is a sophisticated yet very easy-to-use
medical device that has the ability to analyze the heart’s rhythm
and, if necessary, deliver an electrical shock—or defibrillation—to
help the heart essentially reset or re-establish a normal effective rhythm.”
The doctor says that was exactly what Watanabe required. “He was
in a very disorganized chaotic heart rhythm that if left unchecked results
in sudden cardiac death. Really the only therapy for this is an emergent
defibrillation shock. Thankfully, Mr. Watanabe was relatively stable at
the time I evaluated him in the ER.”
Dr. Matchison took Watanabe to the hospital’s cardiac catheterization
lab to see if his cardiac arrest had been caused by a blocked blood vessel.
Watanabe did have a blood vessel blockage, but it was an old blockage,
called a chronic total occlusion (CTO), accompanied by scar tissue.
“This develops when the heart muscle does not receive adequate blood
flow for an extended period of time,” Dr. Matchison explains. “In
the case of Mr. Watanabe, it was likely the presence of this scar tissue
that triggered his dangerous heart rhythm. I consulted one of my interventional
colleagues, Dr. Michael Wyman, who specializes in opening these chronically
occluded blood vessels. Dr. Wyman was able to masterfully open up this
vessel and re-establish blood flow to that portion of the heart.”
Michael Wyman, MD, director of Torrance Memorial’s cardiac catheterization
lab, explains the seriousness of Watanabe’s condition: “A
chronic total occlusion of a coronary artery is a complete blockage of
the artery that has been present for at least three months. They’re
caused by the same process that can narrow any coronary artery: cholesterol
plaque buildup.”
Symptoms of these occlusions range from none at all to severe chest pain
during exertion. The life-threatening irregular heartbeat Watanabe experienced
is unusual but not unheard of for individuals with CTOs, Dr. Wyman adds.
It was clear immediately upon diagnosis that Watanabe needed surgery—and
fortunate he was at Torrance Memorial. CTOs are difficult to correct using
the normal procedures for blocked or narrowed arteries: balloon angioplasty
and stenting.
In the past, Dr. Wyman says, cardiologists have relied on open surgery
to fix CTOs … or left them untreated. “However,” he
adds, “in the last 10 years or so, new techniques, some technical
advances and a lot of experience has led to very high success rates with
percutaneous [minimally-invasive] interventions. The procedure, like all
coronary intervention, involves passing a guidewire across the occlusion
so balloons and stents can be placed. The challenge with CTOs is getting
a guidewire across can be very difficult due to hard, fibrotic, calcified
tissue, and the fact there is no visualization of the occluded segment.
Use of some innovative techniques has largely overcome these challenges,
although the procedures are still sometimes very difficult.”
As Dr. Matchison notes, Dr. Wyman is an expert in these procedures. Watanabe
arrived at Torrance Memorial on a Saturday. On Monday, Dr. Wyman’s
surgery corrected his blocked blood vessel, and on Tuesday, Watanabe was
able to leave the hospital. “I feel normal, as before,” Watanabe
says. “I just feel normal.”
Torrance Memorial cardiologist Dr. Sang Ji has followed up with Watanabe
in the months since his surgery. After a three-month recovery period,
Watanabe underwent a single additional surgery to receive an implantable
cardioverter defibrillator (similar to a pacemaker). This serves to prevent
future tachyarrhythmias—dangerous, fast, heart rates. Dr. Ji adds
that a successful recovery from such a condition includes not only medical
treatment and physical therapy but also a healthy lifestyle—diet
and exercise—the same measures that can reduce the chances of heart
disease occurring in the first place.
“This was a remarkable sequence of events in which everything that
needed to happen did in a very rapid fashion, resulting in the saving
of Mr. Watanabe’s life,” Dr. Matchison says. “Unfortunately,
this is not always the case. It’s not unusual for physicians to
see cases where patients develop these dangerous ventricular rhythms and
do not receive immediate timely defibrillation. These patients suffer
severe neurologic insult due to hypoxia (not enough oxygen) and hypoperfusion
(not enough blood flow) of the brain. In my opinion, there are no downsides
to using an AED given the fact these are so user-friendly and, as in this
case, can absolutely save a life.”
Dr. J. Christopher Matchison, Dr. Sang Ji and Dr. Michael Wyman are with
COR Cardiology and can be reached at (310) 257-0508.
Don’t Be Afraid of the Box!
Ken Watanabe’s cardiac arrest was a serious health issue, but modern
medicine—an automated external defibrillator (AED) box and Torrance
Memorial’s expert cardiologists—turned a life-threatening
event into a three-day hospital stay. We can’t all be lifesaving
surgeons, but we can all be lifesavers if we know how to use an AED.
AEDs have become ubiquitous in public places and offices.
Locally, Torrance Memorial has distributed close to 200 of the devices
throughout the community—at locations including the YMCA, schools,
Parks and Rec facilities, churches, gyms and pools—through its Public
Access Defibrillator Program, made possible by a generous donation from
the Lundquist family.
“Anyone in the community should be able to use them,” says
Cathy Hargrove, RN, MSN, Torrance Memorial’s health education manager.
“The AED gives you instructions.”
The devices are designed to be as simple to use as possible, she explains—by
anyone, even in an emergency. AED boxes literally tell the user what to
do. “Once the pads are on, it does the rest,” Hargrove says.
“You just need to listen to the prompts.”
The AED automatically analyzes heart rhythms. If a shock needs to be given,
it will administer a shock. If a shock doesn’t need to be given,
it won’t give a shock. It’s as simple as that.
“Anytime someone stops breathing, you know something’s going
on,” Hargrove says. “I definitely tell people, ‘Don’t
be afraid to use the AED. You can’t do anything wrong—and
that time you spend could affect someone’s life.’”
Offered five times a year, Torrance Memorial’s Heartsaver AED course
teaches single-rescuer adult CPR, foreign-body airway obstruction with
responsive or unresponsive victim, and use of an AED.
Partnership to Save Lives: Torrance Memorial supplies and manages nearly
200 AED boxes in the South Bay, including the one that saved Ken's
life at the Torrance YMCA.
For more information, visit
torrancememorial.org/HeartSaverAED.