My heart attack story, Part 4 - the procedure

 Because of where the coronary artery blockages were located, the odds of being able to replumb around them and the risks involved in open-heart surgery, the cardiac surgeon decided that even though the original plan was to pillage some veins from my leg and a spare artery in my chest to run new arteries around the 6 blocked arteries that feed my heart muscle, the potential outcome wasn't worth the risk.

Instead, the team chose to install a series of stents.

Stents are little non-ferrous wire woven things that look like the "Chinese finger cuffs" things that you used to win at the games at carnivals. They are inserted into the blocked area in a flattened state with a tiny balloon in the middle after burning away the blocked part with a laser. Once in place, the balloon is inflated to jam the stent into place and it will then hold open the previously blocked area.

This is some real space-age level science. It is essentially like relining a worn out rifle barrel or installing sleeves in the cylinder of an engine. The big difference is that in this case, the engine (the heart) is running during the process and the machine tools & replacement parts are installed via a brake line.

One of the blockages were in such a location where there was no realistic way of opening it up and stenting it without potentially causing problems. Stuff like this is all about calculated risk. That one feeds a y-shaped little branch circuits and it was left 90% blocked. I was told that the body would compensate for the blockage by developing "collaterals", which are new blood vessels that develop out of tiny, somewhat dormant ones when other vessels are not working right. I had no idea that the body could do this.

Another small branch circuit was blocked off by one of the stents, but again, it was calculated risk. Opening up one of the three main arteries that feeds the heart was deemed more important to life than the branch circuit, and it is assumed it will be replaced by collaterals.

This time around, there was more discomfort than the emergency procedure that I underwent upon my arrival at the hospital. Perhaps because when I got there I was literally dying of a heart attack and the discomfort of the catheterization paled in comparison to the chest pain from the heart attack. Maybe there was just more time to think about it the second trip to the cath lab.

The staff was awesome. They were great to talk to and worked together like a machine. The guy leading the show is a professor who teaches this stuff at Dartmouth medical school and co-authored three books on the procedure. He is a former Marine.

You are wide awake for this, so I was in constant communication with the team. They want to know how you are feeling, whether you are hot, cold, etc so feedback is very important because things can happen fast.

At one moment, the nurse asked if I was hot or cold, I told her cold, then what seemed like seconds later I was hot and felt like I was about to break out in a sweat, the Dr asked if I was feeling hot, the nurse noted my coloration and someone else whom I could not identify said "He's crashing, BP is 54", the Dr, in the middle of conversation with the other Dr who was feeding the gadgetry to my heart via my wrist artery, through out some change to whatever medication I was on and it was instantly adjusted.

What I felt was a weird feeling because there is a foreign object shoved through my arm plumbing, then a lot of pressure across my chest. While I COULD feel some weird stuff going on in the heart area, there must not be many nerve endings there because I couldn't really pinpoint it to describe it.

Now an then, you'd hear "EEEEEEEEEeeeeeeeeeee...SNAP" which I understand was something to do with the laser or perhaps the inflation of the tiny balloons that installed the stents. I'll have to go back and read the case notes.

I was on the table for about an hour and they installed 12cm of stents in total, which seems like quite a bit of relining of the arteries.

Tis procedure is performed 4 to 6 times per day by this team. There are a whole lot of blocked arteries out there!

Everyone on the team I spoke to about causation said the same thing: genetics.

I'm about 20lb overweight, do physical labor with no issues or shortness of breath, generally throw myself around like a 20 year old, climb ladders, split logs, lift heavy weights etc. For the most part, I live on whole foods and avoid processed foods with things you can't pronounce in the ingredients. I don't drink. I don't smoke. This whole thing came as a complete surprise to me. My LDL cholesterol is just a hair over "ideal". It was all fine...until it wasn't.

After the procedure, I was wheeled to a recovery area where my fentanyl drugged self got to converse with a different group of staffers who were hopefully entertained by me but I can only vaguely remember them. After checking on the tourniquet at my wrist a few times every 5 minutes, they wheeled me back to my room.

Then began the ritual of slowly bleeding the air out of the tourniquet over the course of 4 (maybe 6?) hours. They kept on checking my vitals, and 24 hours later they let me go home.

Unfortunately, there was a shift change and for my going-home day, most of the nursing staff were new faces so I didn't get to say goodbye and thank you to the folks who had been taking top-notch care of me all week.

I will continue this tale in the next post.