23 minutes – the story of a real heart attack, Oxford

it was just totally out of the blue the faster that we are able to get that vessel open
the better the outcome will be I had a vice around my chest the typical characteristic heart attack pain
would be a tight central crushing pain in the upper chest uh… it might radiate up into the jaw and it might radiate across the shoulders the patient maybe sweaty the patient may
feel sick might even vomit not surprisingly they look pale and feel
unwell the pain just didn’t go uh… an… then I yelled out to the uh… people in
the uh… in the changing rooms and said can you
call an ambulance please If you can go straight to the back door
of the cardiac angiography suite Emma we’ve got a primary coming in I’ve told them to go straight to the cath lab
I’m just going to give them a ring to let them know so whilst the ambulance is making its way in
from the patients home our emergency team which comprises of
a radiographer a technician a nurse and a doctor to make their way in hello sir I’m Amandio Atraxion nice to meet you
I’m one of the registrars in cardiology
How are you? fine We’re going to take you inside
if that’s alright In this particular case that was
a big important vessel the bigger the vessel that blocks inevitably
the bigger area of muscle will die if you don’t get that vessel open early it was an important vessel that was
potentially a big heart attack had we not got the vessel open quickly So this gentleman came in with an anterolateral heart attack the pain
started at two today the EGC is consistent
with an anterolateral heart attack people just swung into action it was like a well oiled machine as soon as I got in the treatment was so swift
it was unbelievable so the first priority for us is to give
some anaesthetic around the wrist and to insert a tube which comes up from the wrist into the arm from the arm into the main blood vessel the aorta the aorta sits on the exit of the
heart and the main blood vessels to the heart come off the aorta on either side by inserting a small tube into those uh… coronary arteries those heart arteries we can then shoot dye down
the arteries and see where the blockage is shallow R E O to begin with see the problem there we’ve got T N E one to two
flow down the L E D R E O cranial and we can then pass a sucking catheter down uh… the
artery to actually suck out the blood clot which has accumulated on the cholesterol rich plaque which is
what caused the artery to block in the first place Ok then hold that up nice and high for us
switch it on ST’s are down through the clot there and slowly back and another pass obviously Dr Banning had found the blockage and done whatever he had to do to
clear it and obviously with the blood supply restored and
then presumably the pain went you can see the dramatic difference thats made
if you look at the screens on the right-hand side
here you can see before on the left hand screen you can see afterwards we’ve aspirated quite a lot of the clot
and you can see the flow down the vessel is fine if you look at the clock it’s now twenty past four
patient came into the lab at ten past four having sucked out the clot we can then see the area of plaque uh… area of disease within the vessel which
caused the heart attack and we might choose to put a second wire in to protect
important branches uh… then place a stent in the area of the blockage to make sure
that that vessel is widely open that that area uh… which was diseased will now heal in the presence of the stent inflating
ten twelve fourteen sixteen
and down sixteen for seven seconds
sixteen for seven thankyou A stent is a small scaffold its made of stainless steel or platinium
chromium the best analogy really is just to think
of it like the uh… the spring on a ballpen it’s about that sort of size its two or
three millimetres in diameter and perhaps nine to twenty millimetres in
length initially the stent is squashed down onto
the balloon and the stent is then passed into the body squashed on the balloon having expanded the balloon the stent
expands with it and the balloon is then collapsed leaving the
stent within the vessel and that stent acts as a scaffold to keep the artery wide-open to give a nice big round
tube for the blood to flow through thereafter as you can see that looks
very nice everybody had a function I remember
a lot of communication OK give me six there please inflating and down
six for three seconds
six for three thankyou I cannot speak highly enough of
the way I was treated and the professionalism shown it was staggering this is what we’ve aspirated
from the catheter some white platelets thrombus the base of it there this is the sort of stuff which sticks on
the uh… atheroma causing the vessel to be occluded within oxford last year the time from arrival of ambulance to the time at which the vessel was open on average in the three hundred cases
that we did was twenty three minutes that means uh… within twenty three minutes of
arriving at the door the patient has already got the tubes in
the vessel is open and heart attack is already starting to
decline and that’s a tribute really to the commitment of the team who come in at
top speed in getting organised so we can deliver
these treatments as quickly as possible Dr Banning what a man
he saved my life

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