Twenty shocks and a tiny heart pump help save heart attack patient

April 26, 2018 | by Edward-Elmhurst Health
Categories: Healthy Driven Hearts

Heart disease plagued James Bulawa’s father, who experienced his first heart attack at age 47. So when James’ doctors recommended an angiogram when he was 37, he was anxious to learn how his risky family history and high cholesterol might be affecting him.

The test showed that James had a moderate (30 percent) blockage in a coronary artery.

He says, “They told me to eat a healthy diet and I should be okay.”

Bulawa, who lives in Chicago, says he wishes he had seen the doctor more regularly after that incident because over the next six years his coronary artery disease worsened.

“At 42 I started to feel pain in my arm and my gut didn’t feel quite right,” he recalls.

A cardiac catheterization led to placement of a stent to prop open his LAD (left anterior descending artery), which had become 99 percent blocked. The LAD is considered the most important of the coronary arteries as it typically supplies more than half of the heart muscle with blood.

Bulawa did well following the 2005 procedure. He stayed fit and continued his active life of regular workouts and frequent travel for his job as a regional sales manager. But that changed in the middle of a workout on March 12, 2018, when the now 54-year-old experienced the same symptoms he had during his 2005 heart attack.

An Oak Brook Fire Department ambulance arrived at his gym about two minutes after being called and took Bulawa to the Elmhurst Hospital ER.

There, emergency physician Matthew Pisano, M.D., noted a suspicious pattern on Bulawa’s EKG (electrocardiogram) and called Pratik Parikh, M.D., an independent cardiac interventionalist and a member of Elmhurst Hospital’s medical staff, to discuss a cardiac catheterization.

Shortly after that, Bulawa went into cardiac arrest. Dr. Pisano says the staff had to administer about 20 shocks to revive him. Bulawa was given medication to stabilize his heart’s electrical activity and was transferred to the cath lab.

Dr. Parikh says the arrest was caused by ventricular fibrillation, the most serious kind of heart rhythm disturbance, in which the lower part of the heart quivers and can’t pump blood effectively.

What caused the heart attack that struck Bulawa at the gym was a clot blocking the artery that was stented in 2005. The problem needed to be fixed promptly, but Bulawa’s weakened heart would need help to effectively move blood to critical organs during the procedure.

Dr. Parikh used Impella, the world’s smallest heart pump at 5 mm in diameter (about 1/5 in.), a device that’s been available for about five years.

“The Impella is threaded up to the heart, from a small incision in the groin,” says Dr. Parikh. “It’s also attached outside the body to a machine that pulls the blood and takes over ejecting it.”

This allows the heart to rest and recover during the procedure.

With the Impella device in place, Dr. Parikh cleared out the obstruction and placed two new stents at the site.

Says Dr. Parikh, “The use of Impella was lifesaving. It allowed us to focus on the repair (at a reasonable rate), rather than having to do anything hastily. As a result, his heart function was able to recover rapidly. His ejection fraction improved from around 10 percent to 70 percent within one-two days.”

Ejection fraction is a number that describes how well your heart’s pumping chambers pump blood with each beat.

Ejection fraction is a number that describes how well the heart’s pumping chambers pump blood with each beat.

“I’m happy to be alive and that I was in the right place at the right time,” says Bulawa.

Dr. Pisano says, “The fact that he went into cardiac arrest in the ER with pads for defibrillation already on him meant everything could be done in seconds versus minutes. The defibrillation was done at a point that made it possible for him to have the lifesaving procedure in the cath lab. The message is when you feel something serious may be going on, get to a hospital as quickly as possible.”

Bulawa gave thank you cards and gifts to the paramedics and Elmhurst nursing staff.

“They took good care of me. And the ER folks came up to see me (in my hospital room). A couple of their interns talked about how glad they were to see me revived. It made them appreciate the purpose in what they do.”

To find out if you’re at risk for heart disease, take an online HeartAware assessment. You can also call 877-45-HEART to schedule a heart scan or make an appointment online.

Learn more about heart and vascular services at Edward-Elmhurst Health.

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