Cardiologist details his own heart attack symptoms and life-saving procedure

After finishing a 12-hour workday, Dr. Naresh Mistry felt exhausted when he got home and tried to take a nap. But sleep eluded him. As he descended the stairs, he began experiencing intense shortness of breath and pain in his shoulder. The cardiologist knew exactly what was going on.

“That looked like heart attack symptoms to me,” says Mistry, an interventional cardiologist at Covenant Health in Knoxville, Tennessee, TODAY. “We said, ‘OK, let’s go to the emergency room.’ I try to get in the car and when we pull out of the garage the symptoms get worse. So I said, ‘I don’t think this is a good idea.’”

Instead, he and his wife called an ambulance. When paramedics arrived, he shared his symptoms.

“I lay down on the stretcher. (Up) until then I was able to speak and communicate, ”she said. “I fainted. I don’t remember afterwards.

Heart attack and resuscitation

When the shortness of breath and shoulder pain began, Mistry also called his partner at his cardiology practice, who urged him to go to the emergency room. But his health rapidly deteriorated and he thought he would be safer in an ambulance. Although he called 911, his wife needed to speak with them. Even though he doesn’t remember being in the ambulance, he peppered them with his health history and symptoms.

The Doctor. Naresh Mistry hoped that his mentor, Dr. Samin Sharma, could insert stents to treat his multivessel coronary artery disease. But Sharma recommended that Mistry submit

“I was telling them my story, which I don’t remember,” he said. Upon arrival at Parkwest Medical Center, doctors confirmed that he was experiencing an acute cardiac event and rushed him to the cardiac cath lab.

“They found a multi-vessel blockage,” Mistry explained. “The surgeon was called in and ultimately the decision was made to intervene in a vessel called the left anterior descending artery and the stent was placed.”

After the stent was placed, Mistry would be transferred to the cardiac intensive care unit, but he asked the technician to wait.

“I said, ‘Jamie, don’t take me off the table yet. Just keep me here for now. So he didn’t put me on a bed. I was on the cath table,” he said. “The next thing they knew I was coding – which means I was having cardiac arrest.”

Mistry’s colleague, Dr. Gregory Brewer was in the cath lab when Mistry started coding. In the back of his mind, Brewer thought about how Mistry’s father had died of a heart attack at the age of sixty-five. He didn’t want history to repeat itself.

“Dr. Mistry began to go into a life-threatening rhythm. We ended up doing code blue for about two hours with chest compressions and heart shock,” Brewer, an interventional cardiologist at Parkwest Medical Center, told TODAY. “We ended up putting in what we call the Impella, which is a specialized device, a ventricular assist device, that can support a patient even if their heart is not beating.”

Brewer said that normally someone who has not been resuscitated within 40 minutes is at risk of permanent brain damage. But they had a doctor tending to Mistry’s airway while he received compressions that helped Mistry stay oxygenated.

“It was a touch and go,” Brewer said. “Even after we do all these efforts – the recovery period – we always have to worry about losing brain function from such prolonged exercise.”

Throughout the two hours of CPR, Brewer feared that he would soon have to deliver bad news to Mistry’s family.

“You don’t know how many times I thought I would have to walk out of the cath lab and argue with his wife that Naresh wouldn’t make it,” Brewer said. “I am a personal friend of Dr. Mistry for many years and it’s hard. You just need to stay focused, identify the problem, solve the problem… you are not guaranteed anything in this world.”

After the Impella was placed, Mistry went to the cardiac intensive care unit and was cooled down, which is called a hypothermia protocol, and intubated. When he stabilized, they removed the Impella and took him off the ventilator. It soon became apparent that he did not have a brain injury from sustained CPR.

“I recovered after a few days,” Mistry said.

Helping a colleague and close friend felt “very meaningful” to Brewer.

“The whole meaning of life for me is spending time with friends and people I love,” he said. “This was given to Dr. Mistry.”

Being a patient was humiliating for Dr.  Naresh Mistry.  (Courtesy Naresh Mistry)

Being a patient was humiliating for Dr. Naresh Mistry. (Courtesy Naresh Mistry)

follow a mentor

Tests revealed other blockages in her arteries, and Mistry wanted to see what her mentor, Dr. Samin Sharma, director of interventional cardiology at Mount Sinai System, recommended.

“He advised that we should repeat the heart catheterization and go from there,” Mistry said. “After doing the cardiac catheterization, he felt I was not the best candidate for … a stent. One of the reasons was that there was a new blockage that came out of the same artery that had a stent in place, which was a more recent discovery.”

Sharma suspected that a stent would not protect Mistry from future heart problems.

“When he came to see me with the angiogram, I said, ‘You still have a few more blockages that you need to take care of,’” Sharma told TODAY. “I thought it best that he opted for a complete long-term solution because even if I put in a stent, it is likely to block again.”

Sharma said the stent likely collapsed because it was never fully opened and the calcium in the blockage weighed it down. Although it had opened enough to prevent a heart attack and help Mistry have a near-normal ejection fraction, the percentage of blood pumped by the left ventricle was not strong enough to keep the artery open.

“It was very bumpy,” Sharma said.

Mistry hoped Sharma could help him without quadruple bypass surgery. But his blocks were very severe.

“Not only did the stent block a little bit, about 70%, but the main artery, for which there was no stent, was also blocked by 50%,” Sharma said. “I found that (the stents) will not be enough for him in the long term.”

After undergoing CPR for two hours, the doctors wanted to perform a different type of bypass surgery on Dr.  Naresh Mistry to prevent further possible complications.  (Courtesy Naresh Mistry)

After undergoing CPR for two hours, the doctors wanted to perform a different type of bypass surgery on Dr. Naresh Mistry to prevent further possible complications. (Courtesy Naresh Mistry)

Sharma recommended that Mistry see one of his colleagues for a pumpless coronary artery bypass graft or open-heart surgery. Mistry met with Dr. John Puskas, chairman of cardiovascular surgery at Mount Sinai Morningside, about his options.

“The blockages in the artery that had the stent progressed and got worse, and he also had significant blockages in three other vessels,” Puskas told TODAY. “He was actually referred for heart bypass surgery.”

Puskas performs a type of bypass surgery that is “rarely” used in other hospitals. It does not stop the heart from pumping during the procedure and uses arteries in the chest rather than veins in the legs to replace the blocked arteries.

“We use a heart-beating approach. We do not manipulate the aorta. We don’t put cannulas in the heart or staples in the aorta, because that can cause a stroke and drop calcium and cholesterol inside the organ, which can embolize to the brain or elsewhere,” explained Puskas. “We don’t use vein grafts. We use arteries only because arteries, although smaller and a little harder to work with initially, mature and grow over time and are designed, of course, for high blood pressure.”

Veins deal with low blood pressure so when they are replaced in the heart, they can become stressed and wear out more easily. Puskas finds that this pump-free procedure that uses arteries means patients are less likely to need future bypass surgery. Considering Mistry had already been through so much, they didn’t want surgery to contribute to future complications.

“He’s already had a tough time this year,” Puskas said. “We wanted to minimize the risk of stroke and maximize the durability of your bypass graft.”

The Doctor.  John Puskas performs a special type of heart bypass surgery that reduces complications for patients but requires more skill from the surgeon.  (Courtesy Mount Sinai Health System)

The Doctor. John Puskas performs a special type of heart bypass surgery that reduces complications for patients but requires more skill from the surgeon. (Courtesy Mount Sinai Health System)

Life after bypass surgery

After a few days in the hospital to recover, Mistry stayed in New Jersey for a few weeks to regain strength for the trip back to Tennessee. He has yet to see patients, but he is gradually improving.

“I’m still slow. Some days are good. Some days are really not good with weakness and fatigue,” he said. “I’m recovering as well as you’d expect.”

He is grateful for the care he received from Brewer, Puskas and Sharm, whom Mistry considers “a guru” in interventional cardiology, who gave him “a light and a lesson on the profession.” His experience has changed the way he thinks about his role as a physician.

“It makes you humble about the disease process… It makes you humble about how you want to handle not only the patient, but also makes you aware of how to care for family members as well,” he said. “God was with us. He guided me to make all arrangements in the most convenient way to avoid delays and get care where I needed it most.”

This article originally appeared on TODAY.com

Cardiologist details his own heart attack symptoms and life-saving procedure

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