Instinct Saves Life
Quick Thinking and Top-Notch Emergency Care Gives 59-Year-Old Heart Attack Patient a New Lease on Life
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 life-saving care.
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 heart attack.”
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 her procedure.
“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.”