Untreated Heart Attack Leads to A Stroke
Lying on a stretcher at Abington – Lansdale Hospital, Craig McAnally caught a glimpse of a clock. It was 3:48 pm on October 25. He vaguely remembered ordering lunch at Wawa, then being rushed to the hospital via ambulance. He was pretty sure nothing was seriously wrong. He was only 43, and he was healthy. perhaps he could still make his evening meeting at work.
Around him, a team of emergency physicians and nurses were also watching the clock. Every second was critical, because Craig was having a massive stroke.
Craig, a Havertown resident who serves as township manager of Lower Gwynedd, had been ordering a late lunch at Wawa. “All of a sudden, I lost my balance and fell backwards into a rack of potato chips,” he says. “I realized that my right arm and leg had gone limp, and I couldn’t speak.”
Astute bystanders quickly called 911, and the ambulance crew alerted the Abington – Lansdale Hospital’s Emergency Department, including emergency physician Deno Gualtieri, DO, that a potential stroke victim was on the way.
“Time is of the essence when treating a stroke, ”Dr. Gualtieri says. “Every minute that bloodﬂow to a large part of the brain is blocked, over a million neurons can die.”
Dr. Gualtieri quickly conﬁrmed that Craig was having an ischemic stroke caused by a bloodclot in one of the major blood vessels in his brain, the middle cerebral artery. Results of a CAT scan and blood test helped determine the safest treatment.
Within 23 minutes of Craig’s arrival, Dr. Gualtieri had administered the gold-standard “clot-busting” drug, tPA. But he knew that it wouldn’t be enough, and the size and position of the clot would prevent the medication from dissolving it completely. He quickly alerted the neuroscience team at Abington Hospital – Jeﬀerson Health.
By 4:23 pm, just 35 minutes after arriving at Abington – Lansdale, Craig was on a JeﬀSTAT medical helicopter on his way to Abington Hospital. In the midst of this ﬂurry of activity, Craig still wasn’t sure exactly what was happening. “The idea that I could be having a stroke never entered my mind,” he says. “I thought I was young and indestructible.”
A Surgical Extraction
At Abington’s neurovascular laboratory, Osman Kozak, MD, associate director, Neurointerventional Care, threaded a catheter into Craig’s brain and deployed a “stentriever,” an expandable mesh stent, to capture and remove several clots. Dr. Kozak notes that Craig’s age worked in his favor. “In a younger patient, the blood vessels are still relatively smooth and not as twisted as they are in older patients,” he says. “Also, the stentriever we used has a narrow bore that enabled us to reach the smaller vessels.”
Soon after the 90-minute procedure, Craig regained the use of his right arm and leg, but he still couldn’t speak, not even to express his astonishment when Dr. Kozak told himwhat had happened. Over the next two days, he worked with speech therapists to gradually regain what he’d almost permanently lost. Bit by bit, his speech returned, and he was able to help the doctors understand why this had happened, seemingly out of the blue.
Pinpointing the Cause
Craig lacked all the typical risk factors for stroke and heart disease: He had no family history, he wasn’t overweight and he didn’t smoke. But an EKG revealed an abnormal heart rhythm pattern, and subsequent testing revealed telltale damage of a recent heart attack.
That’s when Craig remembered the awful bout of “heartburn” he’d had about a week earlier. “I’d actually joked to a colleague that I might behaving a heart attack,” he says. “Then I popped some antacids and it went away, so I didn’t think anything of it.”
It turned out that the heartburn was actually a heart attack caused by a clot in his left coronary artery. The heart attack had resulted in damage to his heart muscle, which caused his heart to beat ineﬀectively. This caused blood to pool in his heart, forming a second clot that had traveled to his brain and caused the stroke.
On October 31, Craig underwent another procedure, performed by interventional cardiologist Bruce Klugherz, MD, to remove the clot in his heart and place a stent in the artery to ensure proper blood ﬂow.
On November 1, Craig left the hospital and went home to his wife and three kids. He no longer takes his health for granted, especially because it’s still something of a mystery as to why he developed a clot in the ﬁrst place. But he’s committed to taking steps to prevent it from ever happening again.
“I saw a lot of Abington doctors for follow-up, and the one recommendation they all made was to exercise,” he says. “So in addition to taking a cholesterol-lowering medication and aspirin, I’m trying to get out and walk more every day. I still can’t believe this happened to me, but I know I was very fortunate to have come through it the way I did.”