Saved from a "Perfect Storm"

Fast action by family, first responders and Monmouth Medical Center clinicians restores a heart-attack patient to health.



Thomas Williams and his wife Gayle.

There’s no good time to have a heart attack, but the middle of a blizzard is a very bad one. Fortunately, when Oceanport resident Thomas Williams suffered that fate this winter, the story had a happy ending.

Like countless other residents, the 69-year-old painting contractor spent hours on Saturday, January 23, digging out from the heavy snowstorm that was hitting our region. At the height of the blizzard, he suffered a massive heart attack. But unlike nine others on the East Coast who died from cardiac arrest while shoveling snow, Thomas survived—thanks to the quick reactions of his wife, the Oceanport First Aid Squad and a team of doctors and nurses at Monmouth Medical Center.

“I remember pushing the snow blower, coming inside and taking off my boots, and feeling short of breath,” he says. “I took two baby aspirins, and then my wife told me to lie down on the couch.”

His wife, Gayle, asked if she should call the EMT s, and when he told her, “I think you’d better,” she knew it was serious. Moments later, he suffered what is known as v-fib—ventricular fibrillation—the most serious cardiac rhythm disturbance.

“With v-fib, the lower chambers of the heart quiver and the heart can’t pump any blood, causing cardiac arrest,” says Monmouth Medical Center interventional cardiologist Michael A. Wappel, M.D., who performed emergency cardiac catheterization and percutaneous intervention that opened Thomas’ blocked artery and restored the function of his heart.

Dr. Wappel notes that while the blizzard created a “perfect storm” of conditions that led to Thomas’ heart attack—severe cold and a great deal of wet, heavy snow—an equivalent “perfect storm” of timely reactions fortunately made his recovery possible.

“Everything worked perfectly,” says the doctor.

First Gayle, a retired Long Branch high school guidance counselor, called 911 immediately and performed CPR until help arrive. (She’d been certified in the technique by the Oceanport First Aid Squad years before, when the older of her two sons was born with a congenital heart blockage.) The EMT s recognized Thomas’ lethal arrhythmia and shocked his heart to get it beating again, and then transported him to Monmouth Medical Center’s Emergency Department, where he arrived at 4:30 p.m.

Among the first responders playing key roles in his transport and emergency treatment were Oceanport police officers Matthew Cole and William Resnyk, fireman Jerry Bertekap and volunteer fireman Stuart Briskey.

In Monmouth’s ER a “Code STEMI” was begun—the process put in place to treat all heart-attack patients. Back in 2006, Monmouth Medical Center joined the American College of Cardiology in launching a national quality improvement initiative to ensure that patients like Thomas with ST-segment elevation myocardial infarction (STEMI ) undergo emergency angioplasty. (A myocardial infarction is a heart attack; the “ST segment” refers to interval between the “S” and “T” waves on an electrocardiogram, or EKG —elevation suggests that severe heart damage is possible.) The result was “Code STEMI ,” and its record has been impressive.

When a patient arrives at Monmouth Medical Center with symptoms of a heart attack, in minutes Emergency Department physicians order an EKG . It can detect signs of poor blood flow, heart muscle damage, abnormal heartbeats and other heart problems. If a heart attack is diagnosed, a Code STEMI is activated, with the on-call interventional cardiologist and the specially trained cardiac catheterization team called in for emergency treatment. The Code STEMI team that cared for Thomas, led by Dr. Wappel, acted quickly despite the blizzard, performing a lifesaving emergency angioplasty.

“Dr. Wappel did a miraculous job,” Thomas says. “All of my doctors were phenomenal.”

“My colleague, Dr. Jeffrey Osofsky, was covering the hospital, and he coordinated everything until I arrived, when Thomas was in the cath lab—prepped and ready to go,” Dr. Wappel says. “It was a huge team effort, from the moment of his heart attack through his cardiac catheterization and interventional procedure. It was truly amazing considering the blizzard conditions.”

Before the advent of interventional cardiology, says Dr. Wappel, the cardiac arrest Thomas suffered was known as a “widow maker.” “Previously, doctors wouldn’t have been able to offer his family much hope,” he says. “This is a classic type of heart attack, and with the interventional cath we were able to open the blocked artery with a stent.”

Dr. Wappel thinks that even though Thomas lost about half of his heart function as a result of his heart attack, the loss is most likely not permanent. “I think we’ll see his heart muscle recover,” he says.

A big concern in cases like this is damage to the brain, and he considered therapeutic hypothermia, which seeks to maintain a specific body temperature in a person surviving out-of-hospital sudden cardiac arrest and can improve rates of longterm neurologically intact survival. “But he was in recovery following the cardiac cath by 9 p.m., wide awake and alert, so there was no need for him to go through that,” Dr. Wappel explains. “The next morning when we checked on him, he was absolutely fine and had suffered no memory loss.”

In fact, in a conversation prior to his hospital discharge January 27, Thomas vividly recalled a visit in late November to his longtime primary care doctor, Monmouth Medical Center internist Michael Disciglio, M.D., who himself, several years earlier, had survived a “widow-maker” heart attack thanks to the Code STEMI process. Thomas had undergone a stress test during that office visit, and he says even though it yielded good results, it prompted him to finally quit smoking.

“Dr. Disciglio had been after me for years to quit smoking, and I figured my negative stress test was telling me I had pushed my luck long enough,” he says with a smile.

Dr. Wappel notes that in every snowstorm, cardiologists see the type of heart attack Thomas had in patients who have been exerting themselves clearing snow. In Thomas’ case, he explains, weather conditions combined with the blockage triggered his heart attack.

“Thomas didn’t have a severe blockage—his artery was less than 50 percent blocked—but he was out in the cold, which restricts arteries,” says the doctor, adding that there was a lot of snow, and it was colder than usual. “One reason shoveling snow can lead to a heart attack is that the sudden stress of the shoveling causes the plaque in arteries to rupture, prompting the coronary artery to develop acute thrombus (blood clot) and completely close, which starts the heart-attack process.”

What the "Cath Lab" Offers

Monmouth Medical Center’s Cardiac Catheterization Laboratory provides invasive cardiac services, offering the most advanced technology in the diagnosis and treatment of a wide range of cardiac disorders. Also offered is full-service diagnostic cardiac catherization and emergent angioplasty for heart attack. To learn more, call 732.923.6875.

To learn more about services available for you or your family at Monmouth Medical Center, call 888.724.7123.

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