An Online Wellness Magazine produced by The University of Texas Health Science Center at Houston (UTHealth)

Surviving Cardiac Arrest

How a heart emergency took a healthy Houstonian by surprise, and nearly took his life

 Surviving Cardiac Arrest

The last thing Tom*, 55, remembers about the October day that would change his life was walking to the treadmill at his Houston Heights-area gym. His regular trainer was out, so Tom headed to the machine for a quick workout to counteract the unhealthy effects of a month of business travel.

That’s when his memories — and his heart — stopped. Tom suddenly collapsed, launching a nearby nurse and doctor, both gym patrons, into action. They immediately started CPR and shocked him with the gym’s automated external defibrillator (AED), until paramedics could transport him to Memorial Hermann-Texas Medical Center, where a team of heart specialists would be waiting.

But the clock was ticking for Tom, who had suffered a cardiac arrest — an abrupt loss of heart function that kills within minutes if not treated. By the time he reached the hospital, Tom had been shocked six times, but his heart would not restart. An electrocardiogram (EKG) showed signs of a heart attack in progress. Each minute that passed without a stable heart rhythm increased the risk of irreversible brain damage or death.

Interventional cardiologist on duty, Salman Arain, M.D., rushed Tom into the cardiac catheterization lab, where he performed angiography and identified a critical blockage in the artery supplying the right side of Tom’s heart. Arain broke the clot with a small balloon and placed a stent in the artery.

Once blood flow to the heart was established, Arain and his team placed cooling pads on Tom’s thighs and chest, briskly lowering his body temperature to between 32 and 34 degrees Celsius (93.2 degrees Fahrenheit), the optimal temperature shown to preserve brain function. Tom awoke nearly two days later to see his son, who hurried home from Russia, sitting at the foot of his bed.

“They had me on a breathing machine, so I couldn’t talk to him. I gave him the signal I needed to write,” Tom says. “I asked him what happened. I had no idea.”

Healthy body masks unhealthy heart

Tom was surprised to find himself in the hospital, because he considered himself active and relatively fit for his age. A petroleum engineer by trade, he traveled frequently to the Middle East to supervise oil operations, visiting drilling sites and weathering extreme desert temperatures. When he was home, he worked out most days on his gym’s elliptical machines and lifted weights.

A routine company physical he had in Dubai last year, which included an EKG and stress test, came back normal, giving him no reason to worry. His cholesterol was a tad high, but instead of taking a statin, Tom opted to tweak his diet.

Looking back, Tom says the visit should have raised some red flags. He had a family history of heart disease and although he loved his job, international travel made eating healthy a challenge. When he returned home he and his wife moved to a new home, compounding his stress, and he slipped up on his diet.

Yet, he always made up for unhealthy lapses with exercise. And from all outward appearances, he looked healthy. That’s why his heart emergency was such a shock.

“I don’t smoke, and I don’t have high blood pressure. I’m not too far overweight. I’m in pretty good shape. I even exercise more than the normal person,” Tom says. “The guys I work with were so surprised when they heard I was in the hospital.”

A double whammy

Unfortunately, Tom’s best efforts at a healthy lifestyle weren’t enough to head off the heart emergency that nearly killed him — a double whammy of cardiac arrest and a major heart attack, likely caused by undiagnosed heart disease.

According to the American Heart Association, roughly 350,000 cardiac arrests happen outside of the hospital in the United States every year, and of that number, only about 10 percent survive. While cardiac arrest and heart attack are often confused, they are different and must be treated differently. A heart attack happens when the blood flow to the heart is cut off, typically from a blockage in an artery. Starved of blood, the heart muscle dies. It is essentially a circulation problem, whereas cardiac arrest is “almost like an electrical storm,” explains cardiologist John Higgins, M.D., associate professor of internal medicine with the McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth).

"With cardiac arrest, the (heart’s) electrical system is not telling the muscle to contract, or it tells the heart to pump blood faster than it can. Then the heart can’t pump the blood out to the body, and without the blood the body collapses,” Higgins explains.

Tom experienced his cardiac arrest that way — suddenly and without warning. But others may feel tired or out of breath in advance, or feel palpitations or chest discomfort — signs that the cardiac system is under stress and may be about to collapse. That’s the time to seek medical help, Higgins says, because every minute counts when treating cardiac arrest.

“The only way to get that electrical system back to normal is to zap the heart with a defibrillator,” Higgins says. “In the meantime, you can try and replicate the heart pumping (with vigorous chest compressions) Unfortunately, it is not as good as the natural heart, but it can keep people alive until a defibrillator arrives.”

To save Tom’s life, Arain and his team had to fix both his heart’s circulation and electrical problems. The approach required the kind of innovative, coordinated effort pioneered at teaching hospitals like Memorial Hermann–Texas Medical Center, whose Heart & Vascular Institute is staffed by UTHealth physicians. UTHealth physicians have been instrumental in refining the cooling technique used on Tom, called therapeutic hypothermia. To cool the body even more rapidly, Arain, an assistant professor of cardiovascular medicine with McGovern Medical School at UTHealth, is beginning the process in the cath lab.

“After the patient experiencing cardiac arrest arrives at the cath lab, I start by putting a cooling catheter through their IV before taking pictures of the heart arteries. By the time I am done fixing the heart (which usually takes about 30 to 40 minutes), the body’s already dropped down to a temperature of about 35 degrees Celsius. This is the fastest cooling method that I know,” Arain says.

On the road to recovery

For Tom, now nicknamed “Iceman” by friends and family, the benefits of the emergency interventions he received are clear. After an intense four months of recovery and cardiac rehabilitation, he once again enjoys a full life, with a few important differences. Exercise and eating right are a top priority — so he and his wife walk six days a week and cook healthy meals heavy on fresh vegetables and lean protein. He has lost 15 pounds — down to 200 from 215 — and his cholesterol is back to normal levels (he is taking a statin to lower his cholesterol and a blood thinner).

Tom started back to work this month and will soon travel again to the Middle East. He is thankful for Arain and his team at giving him a second chance at life, and he encourages others to start taking their heart health seriously in their 30s, instead of their 50s.

“Don’t think you have a free pass because you decided not to smoke and you’re watching your weight a bit and exercising,” he cautions.

* Last named has been omitted for privacy.

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