From Symptomless to Sudden Cardiac Arrest
Dennis Murphy, 55, thought his heart would warn him. Fifteen years ago, a routine physical exam revealed that he’d been born with an abnormal cardiac valve, and he’d been getting regular echocardiograms ever since. His cardiologist, Scott Shapiro, MD, at Abington Hospital – Jeﬀerson Health, had urged him to immediately report any symptoms – shortness of breath, fainting, or chest pain – as these could be signs that the valve would need to be replaced.
But Dennis never felt anything less than healthy. As a Cheltenham Township foreman, he was frequently on the move at work, and he exercised vigorously several times a week. On a cold January evening in 2016, he and his wife, Katie, a nurse, went to the Hatboro YMCA for one of his favorite workouts, a BodySTEP class that incorporates high-intensity cardio and resistance training. “I felt great that night,” he recalls. “Then, a few minutes into class, I bent over to pick up a weight, and suddenly I got extremely dizzy.” And then he felt nothing at all.
A Textbook Rescue
Aaryn Drinkwater, his BodySTEP instructor, who also happens to be a certiﬁed registered nurse practitioner at Abington Pulmonary and Critical Care Associates at Abington Hospital, saw him collapse. “He didn’t fall – he just lowered himself to the ﬂoor in slow motion,” she recalls. Aaryn and Katie rushed to his side and immediately realized that he had no pulse.
What followed was a textbook case of how to revive someone in sudden cardiac arrest. Aaryn and Katie immediately began cardiopulmonary resuscitation (CPR), compressing Dennis’s chest and breathing air into his lungs to keep oxygenated blood ﬂowing throughout his body. Other class members called 911, alerted the YMCA’s aquatics director, who had the most knowledge of rescue techniques, and brought the facility’s automated external deﬁbrillator (AED). Aaryn then used the AED to apply two shocks. The ﬁrst one had no eﬀect, but after the second, Dennis’s heart started beating on its own. By the time paramedics arrived, within 15 minutes of his collapse, he was conscious and responsive.
“I had no idea what had just happened,” Dennis recalls. In the ambulance on his way to Abington Hospital, he was shocked to discover that his heart had stopped with no warning at all.
The Cause of the Collapse
The problem lay in Dennis’s abnormal aortic heart valve, located between the left ventricle (the heart’s main pumping chamber) and the aorta (the largest artery in the body). The aortic valve normally has three ﬂaps, or leaﬂets, that open and close to regulate blood ﬂow, but Dennis was born with a bicuspid aortic valve with only two leaﬂets, a condition estimated to occur in 0.5% to 2% of the U.S. population. Over time, normal blood ﬂow through the heart can cause these leaﬂets to stiﬀen and the valve to narrow. This can cause symptoms, such as chest pain or fatigue, but in Dennis’s case, the valve failed suddenly, temporarily cutting oﬀ blood ﬂow and causing his heart to stop beating.
“Dennis’s good health may have actually worked against him, because he compensated well and had no symptoms even though his valve was very narrow,” says Abington Cardiothoracic Surgeon Mauricio Garrido, MD, who took charge of Dennis’s care and immediately made him feel at ease.
“I knew I’d have to have this surgery someday, and I’d been scared to face it,” Dennis says. “But Dr. Garrido was very calm and reassuring. And the entire staﬀ at Abington was so caring and answered every question I had.
”Dr. Garrido gave Dennis the choice of receiving a mechanical artiﬁcial valve or an animal tissue valve. Each has its advantages and disadvantages: Mechanical valves may last a lifetime, but recipients must take blood thinners to protect against clots that may form on the surface of the valve. Tissue valves don’t require the use of medication but aren’t as durable and may need to be replaced in 20 years or less. Dennis chose a tissue valve because he wanted to avoid taking medication. Also, according to Dr. Garrido, operative techniques currently in development may make a replacement procedure less invasive than it is today.
Dr. Garrido replaced the valve during a nearly three-hour procedure that involved making an incision through the breastbone and placing Dennis on a heart-lung machine while he cut away the old valve and replaced it with the new one. After a four-day hospital stay Dennis went home and continued his slow but steady recovery.
Better Than Before
February was a rough month, but by the second week of March, I was feeling better,” he says. A home care nurse came by to check on him, and when he had a question, Dr. Garrido’s staﬀ was a phone call away. He slowly started exercising again, easing into walking on the treadmill. In early April, he went back to work, and later that month, he was back in Aaryn’s class at the YMCA.
Today, he’s made a full recovery and then some. “I never realized how much my heart had been slowing me down,” Dennis says. “Today my stamina is actually better than it’s ever been. Sometimes I used to hang back in BodySTEP — now I’m at the front of the class, going as hard as I can.