Acute stent thrombosis

Back in Calgary, there's no better feeling than stepping out into the fresh air after a long shift and the same goes for here in Qatar. I finished at 10 p.m. last night and went downstairs to the lobby to wait for Tanis and Natalia who were also finished at 10 p.m. I actually wanted to stand outside for a few minutes to warm up because it's so cold on the unit (future Qatar exchange students: bring a sweater for the unit!)

If you look closely, you'll see a small group of people in purple uniforms - those are the nurses. All the female nurses wear the same uniform: white shirt with pink and red hearts, light purple pants and jacket. Male nurses usually wear green scrubs. The Hamad Medical Corporation provides free accommodations for nurses and transportation to and from the hospital, a small bus will pick them up after work and take them home.
It was a bit of an intense shift today. When I arrived, my preceptor, Soumya (I'll introduce her later) and I were assigned the same patient as the previous day. I completed my assessment, and my patient was stable and resting comfortably when.....
All of a sudden I heard a commotion across the hall. I stepped outside just in time to see about half a dozen nurses and doctors rush into a patient's room. I wandered over, trying to catch a glimpse of what was happening but the curtain in front of his bed had been pulled shut. A young woman wearing a chador (a black, traditional full-body cloak) was crying outside the patient's room, surrounded by several other women. Inside, a middle-aged man lay flat on the bed with his eyes open, blinking slowly. The nurses were hooking him up to an ECG as the doctors checked his vital signs. I quickly slid into the room and stood behind some of the nurses to observe what was happening. I learned that he had been speaking to his daughter when he lost consciousness. His heart rate dropped to 45 beats per minute (normal heart rate is 60-100 beats per minute). What's interesting is that this patient was supposed to have been discharged that morning and was just waiting for the final papers to be signed before he could go home. Earlier in the week he had had an angioplasty to open the blocked arteries in his heart. He'd had three bare-metal stents (see photo) inserted to help keep the blood flowing through his arteries.

Bare-metal stent

The doctors decided that the patient needed to have an emergency angioplasty performed and within 10 minutes he was being wheeled to the cath lab to have this procedure done. Soumya told me I should follow him and watch the procedure, so I did. About half a dozen doctors and nurses accompanied the patient, along with his family. I remember thinking how calm his wife appeared as she kissed her husband's forehead right before he was wheeled into the procedure room.
I sat in the control room and watched everything on a large screen and through a window where I could see doctors and nurses in blue scrubs prep the patient for the procedure.

The nurses explained everything and answered all of my questions about what was happening and, most importantly, what exactly I was looking at on the screen. I can only describe it as looking at an x-ray: I could definitely make out the man's spine, that's the easy part, and I could see the image rise and fall with each breath. After staring at the screen for a long time, I realized there was another large almost transparent structure moving there as well, THE HEART! I could just barely make it out, or I could see something pumping but couldn't really see the heart itself, if that makes sense.  Several minutes later and the man's arteries had been injected with a special radioactive dye. The procedure room goes dark and, ah yes, there's the heart! Actually I could only see the arteries and veins surrounding the heart. The right coronary artery, which I learned should usually look like a large "C" from this particular angle, was showing a 100% block where a stent had been inserted earlier in the week, something called acute stent thrombosis. After some time, a very fine wire was visible on the x-ray machine, slowing winding its way up the artery toward the blocked stent. This fine wire was inserted into the man's femoral artery (beside the groin) and carefully threaded up to his heart. How crazy is that? This is how they reopen the blocked artery. Amazing! One thought occurred to me: how the heck did doctors ever figure out that they could perform this procedure? Science, always amazes me!
Afterwards, the radioactive dye could be seen flowing throughout the entire artery as it was no longer blocked. The man, who was awake for the procedure, returned to the CCU shortly afterwards, where his family was waiting for him.

In other news, a recent heart-friendly article from the Globe and Mail.