23 Minutes - The story of a real heart attack, Oxford

it was just totally out of the blue
the faster that we are able to get that vessel open the better the outcome will be
I had a vice around my chest
the typical characteristic heart attack pain would be a tight central crushing pain
in the upper chest
uh... it might radiate up into the
jaw and it might radiate across the shoulders
the patient maybe sweaty the patient may feel sick might even vomit
not surprisingly they look pale and feel unwell
the pain just didn't go
uh...
an... then
I yelled out to the uh... people in the
uh... in the changing rooms and said can you call an ambulance please
If you can go straight to the back door of the cardiac angiography suite
Emma we've got a primary coming in
I've told them to go straight to the cath lab I'm just going to give them a ring to let them know
so whilst the ambulance is making its way in from the patients home
our emergency team which comprises of a radiographer
a technician
a nurse and a doctor
to make their way in
hello sir I'm Amandio Atraxion nice to meet you I'm one of the registrars in cardiology How are you?
fine
We're going to take you inside if that's alright
In this particular case that was a big important vessel
the bigger the vessel that blocks inevitably the bigger area of muscle will die
if you don't get that vessel open early
it was an important vessel that was potentially a big heart attack
had we not
got the vessel open quickly
So this gentleman came in with
an anterolateral heart attack the pain started at two today the EGC is consistent with an anterolateral heart attack
people just swung into action
it was like a well oiled machine
as soon as I got in the treatment was so swift it was unbelievable
so the first priority for us is to give some anaesthetic around the wrist
and to insert a tube which comes up from the wrist
into the arm from the arm into the main blood vessel the aorta
the aorta sits on the exit of the heart
and the main blood vessels to the heart
come off the aorta on either side
by inserting a small tube
into those uh... coronary arteries
those heart arteries we can then shoot dye down the arteries and see where the blockage is
shallow R E O to begin with
see the problem there we've got T N E one to two flow down the L E D
R E O cranial
and we can then
pass a sucking catheter down uh... the artery to actually suck out the blood clot
which has
accumulated
on the cholesterol rich plaque which is what caused the artery to block in the
first place
Ok then
hold that up nice and high for us switch it on
ST's are down
through the clot there and slowly back
and another pass
obviously Dr Banning had found the blockage
and done whatever he had to do to clear it
and obviously with the blood supply restored and then
presumably
the pain went
you can see the dramatic difference thats made if you look at the screens on the right-hand side here you can see before
on the left hand screen you can see afterwards
we've aspirated quite a lot of the clot and you can see the flow down the vessel is fine
if you look at the clock it's now twenty past four patient came into the lab at ten past four
having sucked out
the clot we can then see the area of plaque
uh... area of disease within the vessel which caused the heart attack
and we might choose
to put a second wire in to protect important branches
uh... then place a stent
in the area of the blockage to make sure that that vessel is widely open that that area
uh... which was diseased
will now heal
in the presence of the stent
inflating ten twelve fourteen sixteen and down
sixteen for seven seconds sixteen for seven thankyou
A stent is a
small scaffold its
made of stainless steel or platinium chromium
the best analogy really is just to think of it like the uh... the spring on a
ballpen
it's about that sort of size its two or three millimetres in diameter and
perhaps
nine to twenty millimetres in length
initially the stent is squashed down onto the balloon and the stent is then passed
into the body squashed on the balloon
having expanded the balloon the stent expands
with it and the balloon is then collapsed leaving the stent within the vessel and that stent acts as
a scaffold to keep the
artery wide-open to give a nice big round tube for the blood to flow through thereafter
as you can see that looks very nice
everybody had a function I remember a lot of communication
OK give me six there please
inflating
and down six for three seconds six for three thankyou
I cannot speak highly enough of the way I was treated
and the professionalism shown
it was staggering
this is what we've aspirated from the catheter
some white platelets thrombus
the base of it there
this is the sort of stuff which sticks on the uh...
atheroma causing the vessel to be occluded
within oxford last year
the time
from arrival of ambulance
to the time at which the vessel was open
on average in the three hundred cases that we did
was twenty three minutes
that means
uh... within twenty three minutes of arriving at the door the patient has
already got the tubes in the vessel is open
and heart attack is already starting to decline and that's a tribute really to the
commitment of the team who come in at top speed in getting organised so we can deliver these treatments as quickly as possible
Dr Banning what a man he saved my life