July 24, 2009

Heart patient earned nickname the hard way

Featured Image

James “Nine Lives” Nadolski, third from right, with members of his VHVI care team, from left, Mary Lou Haynes, R.N., Mark Wigger, M.D., Steve Hoff, M.D., Rashid Ahmad, M.D., and Kristie Walker, A.C.N.P. (photo by John Walker)

Heart patient earned nickname the hard way

When cardiac patient James Nadolski was admitted to Vanderbilt in March, he was given a nickname that he embraced with pride: “Nine Lives” Nadolski.

Thanks to the collaborative effort of Vanderbilt cardiac surgeons and cardiologists and an arsenal of cool technology, Nadolski may just beat the odds that were stacked against him.

He suffered his first heart attack 14 years ago at the age of 37 while working as a homicide investigator in Wisconsin. While his heart suffered significant damage, Nadolski regained his stamina by working part-time officiating high school and college sports. He moved to a community south of Nashville three years ago and admits that he fell off his exercise regime.

In January, after playing a basketball game, he went home and began to experience chest pain. He called 911 and was taken to the closest community hospital where doctors confirmed another heart attack and placed two stents in his cardiac arteries, which were 80 percent blocked. Within three weeks he was back at work as an investigator for the South Central Prison facility. He was hiking two to three miles a day on the Natchez Trace and feeling stronger.

In March, he was taken to the community hospital again when one of his stents collapsed. This time he was in real trouble.

“There was nothing they could do for me,” Nadolski said.

He lingered near death in the ICU until cardiac surgeon, Betty Kim, M.D., assistant professor of Cardiac Surgery, decided there was hope for him if she could get him to the Vanderbilt Heart & Vascular Institute, which had all of the resources of a large academic medical center. She placed a call to Steve Hoff, M.D., assistant professor of Cardiac Surgery, who agreed to take the case.

Nadolski was admitted to Vanderbilt on March 16.

“He was sent to us on death's doorstep,” Hoff recalls.

Nadolski immediately went to the cardiac cath lab and was placed on extracorporeal membrane oxygenation (ECMO), a modified form of cardiopulmonary bypass. ECMO helps to support the function of the heart temporarily. While in the cath lab, he coded, meaning his heart stopped working. He was resuscitated and taken to the cardiovascular intensive care unit.

In the CVICU, John McPherson, M.D., assistant professor of Medicine, used the relatively new therapeutic hypothermia protocol to cool Nadolski's body temperature to 86 degrees in order to help preserve his brain function.

Cardiac surgeons Hoff and Rashid Ahmad, M.D., and cardiologist Mark Wigger, M.D., evaluated Nadolski for heart transplant. A few days later, Hoff and Ahmad put Nadolski on the Centrimag biventricular assist device to take over the pumping of his heart while he waited for a donor heart to become available.

It was after this surgery that Nadolski woke up for the first time.

“I saw the four tubes coming out of my chest and that I was connected to a heart pump. That's when it really hit me,” Nadolski said.

Nadolski developed multiple life-threatening problems, including a severe allergic reaction to heparin, which required emergency removal of his ventricular assist device. It would be up to his heart to pump on its own.

“We were unsure that we could get him through with medicines alone,” Hoff said.

Nadolski slowly improved over the next two months to the point where he could go home on milrinone infusion. Milrinon is a medication that improves hemodynamics and biventricular function in patients with congestive heart failure. Nadolski is hooked up to an IV that is stored in a backpack that he wears 24 hours a day.

“His heart has continued to slowly improve, and we are now weaning his milrinone as an outpatient,” Wigger said. “It's possible he may get off IV medicines altogether. We're not certain that he is stable enough that he won't need a heart transplant, but he is remarkably better.”

Nadolski returned to the CVICU last week, but this time as a visitor. He greeted many of the doctors and nurses who helped care for him.

“I feel awesome. I get stronger every day. These people are miracle workers. The staff in the CVICU is incredible,” Nadolski said.

“A lot of people put a lot of effort into his remarkable recovery,” Hoff added. “This is a big success story if James continues to do as well as he is.” q