A Little Heart Help

August 14, 2020

Typically, we photograph every patient appearing in HealthU. Because this story was planned during the surge of COVID-19, that contact would have been too risky. Instead, our team took a creative approach and replaced photo shoots with illustrated portraits of patients.

For Michele Williams, on the night of her massive heart attack, the time, place and people seemed perfectly aligned.

“I was blessed through the whole experience,” she says. “I attribute it to my faith, to being at the right place at the right time, and to my team of nurses and doctors—every last one of them.”

The 72-year-old could have been alone at her condominium in Red Bank, New Jersey, when she first felt the pain in her arm and neck. Instead, she was in the kitchen of her good friend Cathy Sutley. Cathy is one in a tight circle of Michele’s friends who regularly help one another. While all of those friends live in the Jersey Shore area, only Cathy lives one exit down from Jersey Shore University Medical Center, which uses a promising new device known as the Impella® heart pump. Michele could have been in the car, on her way to the annual Thanksgiving dinner at her church, when she lost consciousness and went into shock. Thanks to Cathy’s 911 call, she was instead in the back of an ambulance, her vitals and status being transmitted en route.

The real-time communication between the paramedics and hospital saved precious minutes, alerting Jersey Shore’s team of Michele’s condition. “Once I saw that she was in shock, I was immediately able to notify the shock team upstairs,” says interventionalist Arthur Okere, M.D., one of several interventional cardiologists at the facility experienced with using the Impella® device. He was waiting curbside for Michele’s ambulance. “She didn’t look good. She was blue and cold.”

In the Stars, Not the Signs

That alignment of time, place and people proved critical, as other warning signs were barely existent. Michele’s mother did have endocarditis (an infection of the inner lining of the heart chambers and heart valves), and Michele herself is a former smoker. But her primary care doctor of 30 years—the same doctor who treated her mother—was a diligent monitor of her history and condition. At an annual well exam two weeks prior, Michele’s cholesterol and blood pressure numbers were the best they had been in years. “The doctor was beaming because my counts were so good,” Michele says.

What happened to Michele that late-fall evening was the result of a different set of randomly colliding factors—not the good kind, in this case. “Michele’s left anterior descending artery [LAD] became blocked,” Dr. Okere says. “It’s the vessel people call the ‘widow-maker,’ because when it’s totally obstructed, it automatically increases your chances of death.”

Heart attacks involving the LAD result in high instances of death. To avoid that, cardiovascular interventionalists often resort to invasive, high-risk procedures such as coronary bypasses, transplants and angioplasties. With the introduction of the Impella® came another option.

Self-billed “the world’s smallest heart pump,” the Impella® device takes over the heart’s pumping functions during its greatest time of need. Inserted via the femoral artery, the device suctions the heart’s left ventricle and reroutes the blood to the ascending aorta to be distributed throughout the body. “It’s kind of like taking the hand of a guy who has been in a huge fight and standing in for him until he’s able to rest and recover,” Dr. Okere says.

It’s less invasive, more protective of the heart and offers a shorter recovery period than its counterpart protocols. The device comes out after several days, at which point the patient is assessed for additional hospital stay, medication or procedures. Michele wore the Impella for seven days, remained in the hospital an additional three days and was sent home with a LifeVest on Thanksgiving. “The LifeVest is essentially an external defibrillator,” Dr. Okere says. “When your heart takes a hit like that, it’s no longer going to pump at an optimal level, which places it at risk for cardiac arrhythmias.”

“I wore the vest for three months, 24 hours a day, except during showers,” Michele adds.

Never Better

In January, Michele began cardiac rehab at Riverview Medical Center. “I was eager to get up and move,” she says. “I noticed the more I pushed myself, the better I felt.”

Since Thanksgiving, she’s seen Dr. Okere twice and will continue to do so indefinitely. “Once I’ve performed this intervention on you, unless you already have another cardiologist, you’re my patient for life,” Dr. Okere says. “We laughed the other day at how great she looks—she’s unrecognizable from the woman I saw coming out of the ambulance that evening. She’s radiant; she’s vibrant.”

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