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A Life Saved
It was a beautiful June day and 44 year-old John Villesvik was taking advantage of the good weather by working in his yard. After lifting some heavy bags of soil, he began to feel short of breath. When it continued, he decided to call 911. "I'd always been one of these really healthy guys, so I was almost embarrassed to call the paramedics" says John.
"When we arrived, John was still short of breath and sweating profusely," says Russ White, a Shoreline Medic One firefighter and paramedic. "He looked pretty ill, so we knew we needed to get him to the hospital right away."
As they were loading John into the ambulance, his heart suddenly went into ventricular fibrillation (VF), a condition in which the heart muscle flutters, but cannot contract or pump blood to the body. Out of nearly 300,000 sudden cardiac deaths in the U.S. each year, 75 - 80% are caused by VF. The survival rate ranges from only 2% to 25%.
Russ and the other paramedics immediately used a defibrillator, a device that delivers an electric shock to the heart to help restore it to normal rhythm. Then they began CPR.
After the first shock, John woke up. "I opened my eyes and someone was doing heart compressions on my chest," he says. "I asked him, 'Did I just die?' and he said yes. All I could think of to say was, 'cool.'"
En route to the Northwest Hospital emergency room, medics continued CPR and administered drugs to help John regain a normal heart rhythm. They had to shock him an astonishing nine more times. By the time they arrived, John was unresponsive and still in ventricular fibrillation.
At Northwest Hospital, emergency physician Dr. Warren Fisher had assembled a team of expert ER nurses and technicians. The medics had alerted them while they were still in the field, and had sent ahead copies of John's electrocardiogram (EKG). Dr. Fisher had also called cardiologist Dr. David Warth.
"It was immediately clear that John was in a very unstable state and would require quick and appropriate interventions if he was to survive," says Dr. Fisher. "Given his cardiac instability I felt the most likely diagnosis was a blocked coronary artery, and had called Dr Warth in even before the patient got there."
The team sprang into action. Because John was in an almost constant state of cardiac arrest, he required CPR, additional cardiac medications and 11 more defibrillator shocks while in the emergency room.
"From his EKG, we knew that the blocked artery was on the front wall of John's heart," says Dr. Warth. "The blockage was caused by a blood clot that had formed on a piece of plaque in the artery." According to Dr. Warth, this type of blockage is what often causes heart attacks in younger people like John.
Dr. Warth decided the only option for John's survival was to take him to the hospital's cardiac catheterization lab to try to remove the blockage and open his artery to restore blood flow.
Recently, Northwest Hospital doubled the size of its catheterization lab, and invested in the newest state-of-the-art equipment and technologies for interventional cardiology and interventional radiology procedures.
In the catheterization lab, specially-trained nurses and technicians had everything ready. "Our team is excellent. They were critically important in getting things coordinated quickly so we could treat John," says Dr. Warth. First, he did an angiogram, an x-ray that helped determine exactly where the blockage was. He also gave John "clot-busting" medication to help break up the clot, and then installed a balloon pump, a device that helps the heart pump more easily and maintain adequate blood pressure support. The procedure succeeded. Finally, John had a stable heart rhythm and good blood flow.
The next day, Dr. Warth put a stent in the artery. A stent is a slender tube that will help keep the artery open and prevent further blockages. Dr. Warth also checked John's other arteries for problem areas.
John doesn't remember most of what happened. "My next memory after the ambulance was looking up at a white ceiling. It's almost like I just blinked. I learned later that that 'blink' was actually about two and half days."
John spent six days in Northwest Hospital's ICU/Special Care Unit, where the expert nursing staff cared for him. "Everyone was so professional, responsive and courteous," he says. "They understand that a patient is also a person. They're phenomenal."
After a few weeks' rest, John started Northwest Hospital's cardiac rehabilitation program. "Cardiac rehabilitation is extremely important, because it provides a foundation for ongoing exercise, nutrition education, and the opportunity to meet and share support with others who've had similar experiences," says Dr. Warth, now John's cardiologist.
John's ongoing care will include medical therapy. His high cholesterol and triglyceride levels will need to be controlled with diet and medication for the rest of his life to lower his risk of having another heart attack. "Since John has had at least one significant heart attack, we need to be vigilant with his care," says Dr. Warth. "He needs to be evaluated periodically, whether it's with a stress test or angiogram."
"I have to have a completely different lifestyle now," says John. "Having a heart attack is kind of like having your arm cut off. You don't really ever get past it. Instead, you have to adapt to the new way things are."
Although heart disease is still the nation's number one killer, heart attack deaths have declined more than 30% in the past decade. Studies point to better prevention, better medications, technologies and life-saving procedures, and better management in the hospital as key reasons for the drop in deaths.
Dr. Warth says it's critical for people to be familiar with cardiac warning signs and risk factors. Risk factors include smoking, high blood pressure, high cholesterol, family history and diabetes. Warning signs include chest pressure or pain, shortness of breath with exercise, and an inability to exercise or physically function as you used to. In women, symptoms are even more variable and complex.
"The key is to change the risk factors you can change, through diet, exercise and medical management," he says. "Be your own best friend, and if you think you're having symptoms of a heart attack, call 911. Don't wait. That's what saved John's life."
"A huge focus of the training we get as Medic One paramedics is getting hearts started in the field," says Russ
Dr. Greg Schroedl, an emergency room physician and Northwest Hospital's vice president of medicine, also points to the outstanding teamwork in the emergency room and cath lab. "This is exactly why we spend so much time on preparedness and training," he says. "We know what needs to be done and we can do it quickly. In John's case, everything came together the way it was supposed to."
A week or so following his heart attack, John returned to the hospital and to the Shoreline Fire Department to meet many of the people involved in saving his life. The meetings were emotional. Everyone who cared for John felt they were part of something special.
"To give CPR and to work on a patient as long as we did in John's case, and then to accomplish complete neurologic and cardiac recovery, is perhaps a once-in-a-career occurrence," says Dr. Fisher. "I was happy to have been able to play a role in such a positive situation."
"Every morning I wake up and think, 'I'm still here, so I better do something with what I've got," says John. "People tell me, 'you're obviously here to do something.' I have two great girls. Perhaps that's what my focus should be – being the best father and the best husband I can be. That's a great start right there."