Quick interventional procedures help heart attack patient

During one recent summer, Terry Stemen, 71, and his wife, Janet, made the six-hour drive to Shenandoah National Park for a weeklong stay. The first day, they hiked to a waterfall near Big Meadows. Terry had spent a lot of time outdoors in his life, but since his retirement nine years before his activity level had decreased. During the hike, he began to feel his chest tighten.

“I told Janet, ‘Hey kid, I don’t know if I’m going to make it this time,’” says Terry. “I thought I was going to die right there on the trail.”

Terry was having a heart attack, and he knew it. He had one about 20 years before, after which a cardiologist opened his blocked coronary arteries and implanted stents, small mesh tubes, to keep the arteries open.

One of Terry’s stents was failing during the couple’s hike.

A Shenandoah National Park ranger provided oxygen, but it would be another three hours before Terry would be off the trail. Because of the remote location where his heart attack occurred, park rangers, who are trained emergency responders, had to carry Terry out on a stretcher to a park service ambulance.

“That was the last thing I remember,” Terry says. 

A harrowing trip

He had gone into cardiac arrest. The team on the ambulance worked to help him as an area was cleared nearby so that a medevac helicopter could land.

Before it could arrive, Terry’s heart stopped again. The ambulance crew once again helped him.

When Terry arrived at the Sentara RMH Medical Center emergency department, staff members rushed him to the catheterization lab. 

Relief 

“If I had looked at a person’s medical record who went through everything he did, and didn’t see the outcome, there is no way I would think he survived,” says Dr. Geloo, cardiologist. “It was amazing to see him come into the center still alive.”

Once a heart attack patient is in the cath lab, interventional cardiologists place a catheter, a long, thin plastic tube, into an artery in the leg or arm, and guide it inside the artery until it reaches the heart. Longer catheters are inserted and manipulated to reach different areas of the heart. Contrast (also called dye) is then injected into the individual arteries feeding the heart muscle to allow the cardiologist to see the blood flowing through the heart.

When a blockage is found, the cardiologist inserts an inflatable balloon to open the blocked artery and allow blood to flow freely. If needed, the cardiologist can then place a stent in the reopened artery to keep it open.

All of this happens within minutes.

“Interventional procedures done quickly can produce amazing results,” Dr. Geloo says.

At about 7:30 p.m., nearly five hours after he collapsed, Terry’s blocked arteries were open and blood was again flowing to the starved muscle. After three days in the coronary care unit, he was released —sore, but with no long-lasting problems.

“It’s unusual for someone to take that long to get to the hospital, have cardiac arrest en route, have 10 minutes of CPR and be left with no neurological defects and no physical disabilities,” Dr. Geloo says. “He’s an extremely fortunate man to walk away from this.”