Cardiac arrest need not be end

Published August 29 2012

That particular name on the patient schedule for that afternoon lifted my spirits. I was looking forward to seeing her.

I walked into the room and greeted her with a gentle handshake. She got up and greeted me with an affectionate hug. As she was getting onto the exam table, she began chanting “four more years, give me four more years.”

It reminded me of election season. “What are you running for?” I asked.

She didn’t hold any office and she wasn’t a candidate — at least not for political office. I opened her chart and noticed her age, 96. Suddenly I got it . She wanted to live to be 100. She was a candidate for centenarian.

I am sure she will be successful. I am sure she will live to 100 and beyond. She is in good shape: Active, sharp and always happy. She is very compliant and never complains.

I met her for the first time about 26 years ago. It was 4 a.m. in the emergency room. She had just died.

You read that right. I came to the emergency room to see a patient having a heart attack. I saw the E.R. team resuscitating a patient who went into cardiac arrest in the ambulance on the way to the hospital. I went to see my patient in the next room, relieved to know that he was doing fine.

But, I overheard the E.R. physician say, “call it off.” I peeked in and asked whether I could give a hand. We were able to revive her. She became one of my heart patients and now has ambitions to hit the century mark. She has done well for the past 26 years, with appropriate treatment.

Sudden cardiac death is responsible for approximately 300,000 fatalities in the United States annually and an estimated 7 million worldwide. Most result from an unexpected heart attack.

Lack of blood flow to part of the heart muscle causes electrical irritability and causes the heart to fibrillate or quiver. It can also happen in people with a scar from a previous heart attack or in people with heart failure from a weak heart. If not restored to even rhythm with an electric shock, within a few minutes, the heart stops (cardiac arrest) and the patient dies. With each passing minute after the onset, the likelihood of survival is reduced by 7 to 10 percent. Even if the heartbeat is restored after seven minutes, without chest compressions (CPR) to maintain blood flow to the brain during that time, the patient can become brain dead.

According to the American Heart Association, half of the men and nearly two-third of the women who die suddenly of coronary heart disease have no previous symptoms.

Prevention of sudden cardiac death involves prevention of heart disease in the first place by controlling well-known risks. Early discovery and adequate treatment of heart disease with medications and interventions (stents or bypass surgery) play a pivotal role.

If sudden cardiac death occurs outside a hospital, prompt bystander CPR using chest compressions, urgent electric shock from an automatic external defibrillator and availability of an ambulance to transport the patient to the hospital improves chances for survival dramatically.

Every man, woman and child should learn to do CPR. Most sudden cardiac deaths occur at home. Every public or private place where people routinely gather should have a functioning defibrillators and trained personnel. All police vehicles and fire trucks should have them also.

After 26 years, my patient keeps praising me all these years for saving her life. I explain each time that it was pure destiny that we met at the right time, at the right place, even though both of us reached Hudson from the opposite sides of the globe.

She owes her gratitude to her maker, not to me. So, is there life after death? I have one patient who says, yes, most definitely. She has a good one, right here on Earth.

Heaven can wait. She’s still on her campaign trail for at least four more years.

This article was originally published in the Tampa Bay Times:

Rao Musunuru, M.D. Mini Bio

Dr. Rao Musunuru, who has called Pasco County his home since 1981, was instrumental in transforming a 50-bed rural hospital into a 290-bed Heart Institute at Bayonet Point/Hudson Regional Medical Center. He has received numerous awards and continually serves the community at large through education and philanthropy.