Speed, collaboration key in saving patient in midst of a heart attackDec. 12, 2023, 10:15 AM
by Matt Batcheldor
Lenny Leedy, 73, was at a law enforcement conference in Nashville, an 11-hour drive from his Florida home, when the retired police officer thought he might be having a heart attack.
He was talking with another attendee when he noticed a tightness in his chest, then his stomach. He returned to his hotel room to take an antacid and lie down, thinking maybe it was the hot chicken he ate the night before, and he started researching his symptoms on the internet. About that time, he felt pain radiating from his underarms to his elbows.
He quickly decided he needed to go to the hospital but was unsure which one. A friend at the conference, Tennessee Bureau of Investigation assistant director Darryl Richardson, offered to drive him. “We’re going to Vanderbilt,” Leedy recalled him saying.
Leedy’s quick thinking, his friend’s recommendation, and a fast-moving Vanderbilt team would save his life that October day.
From his arrival at the Emergency Department (ED) at 4:34 p.m., events moved quickly. At 4:39 p.m., nurse Abbey Ward, RN, conducted an electrocardiogram (ECG or EKG). “Instant,” Leedy recalled. ED attending physician Colin O’Shea, MD, MPH, read the results: Leedy was having a particularly dangerous type of heart attack called a STEMI (ST-elevation myocardial infarction). In lay terms, his heart had a complete blockage in the blood flow to the myocardium, his heart muscle. Without blood flow, the muscle would quickly die.
Leedy recalled asking if he had a heart attack, and O’Shea said, “No, you didn’t have one; you are having one now. Things are going to start happening very quickly; we’re going to tell you what’s happening step by step.”
Just as soon as O’Shea read Leedy’s EKG results, diagnosing him with a heart attack, he picked up the phone to a dispatcher who sent a STEMI alert, a special page for just this situation that coordinates a medical team, 24/7. Because the call came during regular hours, the team assembled from inside VUMC. After hours the team responds within 30 minutes.
Leedy likened the experience to a NASCAR pit crew, a group of people working quickly and seamlessly to fix him and get him back on the road. “It went so quick; I had two IVs in me before I even knew they started.”
Leedy was whisked away to the catheterization (cath) lab, and by 5:23, a lifesaving stent was placed — just 49 minutes after he went in the Emergency Department door.
“That’s so impressive,” said Wendy Daigle, MSN, RN, CCRN, acute care and STEMI coordinator for Vanderbilt Heart and Vascular Institute. She said treating a heart attack quickly makes the difference between having little to no heart damage and chronic heart problems leading to death. The STEMI team’s goal is 90 minutes or less to diagnose and treat a heart attack. It’s common for the team to treat in about 60 minutes, she said; Leedy was treated in just 49 minutes.
“The goal is 90 minutes because all the data has shown the bulk of the damage happens to the heart within the first two hours,” she said. “So, we want to open it up as quickly as possible to preserve that heart function.”
After receiving his heart stent in the cardiac catheterization room, Leedy’s care was continued in the Vanderbilt Cardiovascular Intensive Care Unit (CVICU) where medical director Andrew DeFilippis, MD, associate professor of Medicine, and his team of experts titrated oral and IV medications to maximize heart recovery, monitor for and prevent complications from his heart attack.
In this specialized hospital unit, Leedy also received counseling on lifestyle changes that will promote his recovery from specialized nurses, nutritionists, physical therapists, exercise physiologists, social workers, and case managers. His medication regimen was specifically designed for his body’s biology and medical condition by his heart doctors, nurses and cardiovascular pharmacist.
Leedy was discharged from Vanderbilt two days after he arrived, just in time to give his scheduled presentation at the conference. He will never forget the experience, from the Emergency Department to the cath lab, the cardiovascular ICU to the patient floors.
“I didn’t know anything about Vanderbilt Hospital,” Leedy said. “I’m not from here. I probably saw six or seven different doctors. Most of them were accompanied by four to five students. I then realized this must be a university teaching hospital. I didn’t sleep well the first night and got my phone out. I noticed that less than an hour passed from the time I texted the family that I had had a heart attack and when I was on my way to recovery. It just amazed me. I’m so glad that my driver knew about Vanderbilt and took me there. I was wondering why we passed two other hospitals to go to Vanderbilt; I now know.”
Leedy’s interventional cardiologist that day was Colin Barker, MD, associate professor of Medicine, director of the Section of Interventional Cardiology and director of the catheterization lab. He stressed the danger that Leedy was in, and why quick action was so critical.
“On the spectrum of heart attacks, the STEMI is the most serious because it has the highest mortality rate, the highest risk for cardiogenic shock and development of congestive heart failure, arrhythmias, etc…,” he said. “It’s the pinnacle event for a lot of what ends up leading to either death or morbidity and heart disease. If someone has a STEMI, it means one of the three main arteries around the heart has become 100% blocked, and there’s no redundancy. That part of the heart is not a very big organ or muscle. So, when that part of the muscle’s blood supply, which is oxygen and nutrients, is compromised, within 30 minutes the heart muscle begins to die, and then that progresses.”
The medical team can achieve the best outcomes when heart attack patients or bystanders recognize the warning signs of a heart attack and get to the hospital quickly for the team to intervene, Barker said. But not everyone recognizes the signs, and many confuse them with other minor medical issues.
Classic heart attack symptoms include chest pain or tightness and pain radiating from the chest to the jaw or the arm, Barker said. Sudden fatigue or sweating can also be signs. For women, chest pain can be a symptom, but they more commonly experience nausea and back pain, Daigle added.
But how do you know that it’s not heartburn or asthma? Barker said the severity of the symptoms is one indication.
Bottom line: When in doubt, go to the hospital.
Barker said because Leedy was treated early, his prognosis is excellent. He was released with a normal ejection fraction, the amount of blood the heart pumps at each heartbeat, a key measure of heart health. It appears he won’t have lasting scarring or injury to his heart, and he can resume normal activities. “He will be on some medications, and he will be followed proactively to prevent this from happening again,” Barker said.
“Mr. Leedy’s case illustrates a lot of hard work and multidisciplinary effort,” Barker continued. “We have made a very complex, sometimes cumbersome process incredibly efficient, which has resulted in us providing some of the best care for STEMI patients — not only in the region, but in the country as well.”