February 12, 2020
On March 1, 2019, Alfredo Fresnedo had a weird feeling in his stomach on the way to work as a real estate agent. He dismissed it as lingering effects of the stomach virus he’d had the week before that had left him unusually weak. As the symptoms faded away, he drank some water, got to work on the computer and proceeded with his busy day.
That evening while enjoying happy hour with his friends, the symptoms came back with a vengeance. The friends insisted on taking him to the Mary V. Black Emergency Pavilion at Jersey Shore University Medical Center—and just in time.
“Alfredo was suffering from a massive heart attack complicated by cardiogenic shock, a state where the heart is severely weakened, resulting in multi-organ failure and carrying a high mortality rate,” says Alaeldin Eltom, M.D., the cardiologist who first saw Alfredo when he arrived at the hospital.
Hope with the Impella Device
Alfredo remembers eight people suddenly appearing and being attached to an electrocardiogram (EKG) machine. His spouse, John Kennedy, was sent out of the room. Entering the cath lab was the last thing Alfredo remembers.
“We had put Mr. Fresnedo in a medically induced coma, then performed a cardiac catheterization, which revealed an occlusion of the left anterior descending artery, known as the ‘widow maker,’” Dr. Eltom says. “We used a stent to open the blocked artery.”
Even with that help, Alfredo’s condition continued to worsen. Dr. Eltom then inserted an Impella® Ventricular Assist Device to support his severely weakened heart and aid in recovery.
“The protocol we’ve established for patients who come in with massive heart attacks and no blood pressure involves inserting the Impella heart pump from the patient’s femoral artery in the groin area, up through the blood vessels and into the ascending aorta where the device pumps blood to enable time for the patient’s heart to heal,” says Aditya C. Mehra, M.D., director of the Cardiogenic Shock Program at Jersey Shore.
Hospitals can dramatically increase heart attack survival rates in patients suffering from cardiogenic shock with the Impella device, Dr. Mehra says. In the pilot study of shock patients across in the Detroit Cardiogenic Shock Registry, survival rates at 30 days after the heart attack went from 50 percent without mechanical circulatory support to up to 75 percent with early mechanical support. Jersey Shore has 46 interventionalists who are qualified to do this procedure.
After Dr. Eltom inserted the Impella device, Alfredo spent six days in the intensive care unit where the device was slowly turned down as his heart became able to beat effectively. Since the device is only about as big around as a drinking straw, Dr. Eltom was able to retrieve it from Alfredo’s heart by reversing the process he used to put it in.
The Road to Recovery
Alfredo spent another six days on the cardiac unit before being discharged to Hackensack Meridian Health Subacute Rehab at Wall. He spent two weeks as an inpatient there, receiving physical and occupational therapy.
He went home wearing a LifeVest, a garment containing a personal defibrillator designed for patients at risk for sudden cardiac arrest. It monitors the patient’s heart continuously, and if the patient goes into a life-threatening arrhythmia, the LifeVest delivers a shock treatment to reestablish the normal heartbeat.
Alfredo was also provided with visiting nurses and physical therapists until he was strong enough for outpatient cardiac rehabilitation visits. Because his heart did not gain sufficient strength in the first 90 days after he was released from the hospital, Dr. Eltom recommended the insertion of a permanent implantable cardioverter defibrillator into Alfredo’s chest to protect him from sudden cardiac death. This was inserted by his colleague Edmund Karam, M.D.
Today, Alfredo is back to his busy life, but better than ever. “I’m a type 2 diabetic, and since my heart attack, I’ve changed my entire way of eating. Now I do the cooking at home—extremely low sodium, no carbs or sugar, and I use a lot of garlic and lemon. I don’t really miss the salt,” he says. “I also exercise now. I consider myself fortunate to feel like I’m 100 percent back to normal so soon!”
Jersey Shore is among only 50 hospitals nationwide to be accepted as a research site for the Detroit National Cardiogenic Shock Initiative to improve mortality in patients suffering from cardiogenic shock. Learn more.
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