The Telegraph
Since 1st March, 1999
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Breath of air for fresh lifeline

At 65, he has got a new lease of life. And he is enjoying every moment of his ‘rebirth’.

Doctors at a city super-speciality heart hospital have performed “an extremely challenging and high-risk cardiac procedure to salvage a hopeless situation”, holding out hope for patients suffering from cardiogenic shock, a dreaded condition with high mortality.

O.P. Dalmiya was brought to the Rabindranath Tagore International Institute of Cardiac Sciences (RTIICS) on November 6 with acute shortness of breath combined with frequent chest pain. “He had pulmonary oedema, or congestion in the lungs with accumulation of fluid, and had to be put on the ventilator,” says J. Naik, director, interventional cardiology services, RTIICS.

The patient, who was suffering from coronary artery disease for some time, was also a diabetic and had a history of a heart attack. By evening, he had slipped into a state of cardiogenic shock, with blood pressure plummeting to 60-70. “This is a dangerous condition which can lead to multiple-organ failure,” Naik explains.

He was not responding to inotrope treatment and his heart was not pumping enough blood. “The left ventricle ejection fraction had dropped to just 25 per cent, while the normal range is somewhere around 65-75 per cent. We realised something had to be done fast, since the patient was sinking.” Initial support to the circulation was given by an intra-aortic balloon pump (IABP) from the left artery to improve the perfusion pressure. His condition stabilised with the measures.

“Then came the critical part, since we had to explain to the patient’s kin that it was a case of multiple blocks and that any intervention would be highly risky,” says Naik. The relatives gave Naik and his team the go-ahead and the doctors set about their task of getting back the coronary flow into the myocardium to improve the heart’s pumping power.

Coronary angiography showed total occlusion or block in the left anterior descending (LAD) artery and a 95 per cent block in the right coronary artery (RCA). “It was obvious the LAD was the culprit vessel and we knew we had to open it up since it is the mainstay of the heart.”

A stent was put in the LAD and the RCA was angioplasted. “We had to do the entire procedure very swiftly, since patients succumb fast in these situations,” declares Naik. The condition of the patient began to improve and his blood pressure started increasing. Inotropic support was withdrawn the same day and IABP support the following day. The patient was taken off the ventilator after the ejection fraction in the left ventricle improved to 40 per cent.

“It seems like a miracle that I am back home. I am amazed by the speed at which they took the decision and conducted the procedure,” says Dalmiya, who recently retired as deputy manager of the Oriental Insurance regional office. He was discharged from the hospital on Thursday.

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