A Beating Heart & A Ticking Clock – The Story of Mr. B
Every single day, doctors face situations where they are required to make decisions that impact the life and death of people. Let us tell you about one such situation that Dr. Swaroop Bharadi was confronted with.
Mr. B migrated to Hyderabad from Dadar. He works in an electrical company and is the main breadwinner of the family. He is also supported by his children who are currently studying and working. A few days ago, Mr. B began experiencing chest pain and shortness of breath at work. Not thinking much of this, he didn’t seek immediate medical attention. A couple of hours later when he went to a nearby hospital for a check-up, he was informed that he had suffered a major heart attack and was referred to CARE Hospitals.
Mr. B rushed to CARE, where he collapsed at the door of the emergency room. Gasping for breath, Mr. B’s pulse rate was around 40 bpm and his blood pressure was not even recordable. He was suffering from a cardiogenic shock, which means more than 40% of his heart was affected by the heart attack.
CARE Hospitals’ round the clock internationally trained emergency team jumped into action as soon as they saw Mr. B. He was intubated and put on a ventilator. Emergency drugs were administered but his condition seemed to be worsening. Luckily, Dr. Swaroop Bharadi, a renowned cardiologist was on call when Mr. B came in. He swiftly briefed the family, and assured them that they’d be supported completely by CARE Hospitals.
For such conditions, primary (emergency) angioplasty is the gold standard of treatment. Mr. B was shifted from the ER to the cath lab (where emergency angioplasty and stenting procedures are performed) within minutes. He was diagnosed with Left Main Occlusion, the survival odds of which are terrible. People who are diagnosed with Left Main Occlusion only have a 10% – 20% chance of survival. The expert team of doctors and staff at CARE Hospitals knew that there was no giving up. A Balloon dilation was done and a stent was deployed, which restored blood flow. BP could finally be recorded. The patient was given blood thinners to deal with the clot in his heart. This procedure was completed in under 10 minutes.
The expert cardiac team was supported by ultra modern technology, ensuring that no time was wasted while administering treatment. Intra-aortic balloon was inserted via Mr. B’s left thigh to support circulation.
Now, one major fall out of cardiogenic shock, is that the kidneys are affected adversely, leading to an accumulation of acid and potassium in the body, which in turn affects the already weak heart. To take the pressure off the kidneys, an advanced form of dialysis (CRRT) which acts slowly, without straining the patient’s blood pressure, was started by the in-house Critical Care and Nephrology team. The CRRT was set up in under 2 hours.
Although this did provide some relief to the patient, the effects of this acidosis continued even the next day, leading to a lot of acid being accumulated in the body. There was also fluid around Mr. B’s heart. The doctors drained the fluid, and the dialysis helped in reducing the accumulated acid which in turn improved blood pressure. After a 48 hour rollercoaster ride of highs and lows, Mr. B’s condition stabilized and he started responding to treatment. As is typical, the medications which were administered to increase and maintain blood pressure were stopped by day 5. Majority of the heart was pumping once again, and there was minimal damage to the heart muscle despite the severity of the heart attack. Day 6 saw him being taken off the ventilator.
Things were looking up until Mr. B’s condition suddenly started deteriorating. He became uncomfortable, and entered an altered sensorium. A CT scan was conducted of his brain, but all results were normal.
The team also checked with Mr. B’s family if he was a heavy smoker or drinker to rule out substance withdrawal symptoms. All precautions were taken and questions were asked before the in-house psychiatrist diagnosed Mr. B with ICU psychosis. He was treated for this and soon began showing remarkable improvement. Once he was physically fit to be moved, he was shifted to a room.
Mr. B was discharged 14 days later, after making a remarkable recovery, and he is doing very well now. The disease took a very aggressive course with Mr. B, and he credits CARE Hospitals with saving his life.
When a heart related crisis arises, the topmost priority is to salvage as much of the heart muscle as possible. The most critical factor in this endeavour, is what we call “door-to-balloon time.” Door-to-Balloon time is the time period between a patient’s arrival at the hospital and the opening of his blocked artery by the cardiologist, and the global standard for door-to-balloon time is 60-90 minutes. CARE Hospitals, however, has a door-to-balloon time of 30 minutes or less.
Our door-to-balloon time is consistently among the lowest in the country thanks to our prioritization of patient care over financials. When an emergency strikes, we act immediately, and our in-house interventional cardiology team combined with well-oiled multidisciplinary teamwork empowers us to move at lightning speed. In the case of Mr. B, our door-to-balloon time was under 10 minutes.
Since his socio-economic background was an obstacle, CARE Hospitals intervened to give Mr. B all the financial support he would need to complete his treatment. In the words of Dr. Rajeev Menon (Medical Director, CARE Hi-tech), “All patients who come to CARE hospitals with heart attack are offered primary angioplasty which is the gold standard of treatment, irrespective of their financial status.” Our strong culture of second opinion, the presence of multidisciplinary teams, in-house interventional cardiology team and involved interaction with the family, enabled us to deliver accurate treatments and restore peace of mind to the family.
CARE Hospitals understands people. We understand the importance of proper multispecialty treatment. Mr. B is alive and amongst us because life saving protocols were activated immediately and treatment was rendered in a timely manner. It is important to trust your doctors, which is why you should trust CARE.