Every minute is precious in the event of a heart attack

The earlier a heart attack is treated, the higher the chance of survival and the less permanent damage there is. This requires quick action and smoothly functioning emergency care. However, a heart attack always requires a portion of luck, as the example of Marcel Waespi shows.

Patient report with interventional cardiologist PD Dr. med. Christophe Wyss

Five years ago, there was little to suggest that Marcel Waespi would suffer a heart attack. The then 59-year-old was neither a smoker nor overweight and also played football regularly, even at club level in the past. Above all, however, he did not exhibit the typical symptoms of coronary heart disease, i.e. a circulatory disorder of the heart that precedes most heart attacks. These include feelings of tightness and pain in the chest, which occur during exertion and are known as angina pectoris. Waespi’s only known risk factors were his diabetes and high blood pressure – both of which were well controlled thanks to medication. Added to this was a high level of stress to which the executive had been exposed for years, first at Swissair and then at SR Technics, despite his great professional fulfillment. But there was little reason to suspect that this stress was not good for his heart, given that he was free of complaints.

With this in mind, it is not surprising that Waespi did not immediately think of a heart attack when he was struck by diffuse abdominal pain and a strange feeling of discomfort in the night of May 1 to 2, 2014. At 5.30 in the morning, it was clear to him that he needed to see a doctor immediately. And so, after a quick call to his family doctor, he and his wife drove to the emergency ward of the Hirslanden Clinic in Zurich, where he introduced himself with the sentence: “One full service, please!” After describing his symptoms, an ECG and a blood test, it was clear that Waespi had suffered a heart attack. He was immediately taken to the cardiac catheterization laboratory, where he was treated by interventional cardiologist PD Dr. Christophe Wyss.

Rapid reopening of the vessel

Coronary angiography, an X-ray examination of the coronary arteries using a catheter, showed one completely blocked and two severely narrowed coronary arteries. In order to reopen the blocked vessel as quickly as possible, Dr. Wyss pierced the blocked blood clot with a wire advanced through the catheter tube and then widened the vessel with a balloon. To prevent the vessel from closing again, Dr. Wyss could have inserted a stent, as is usually done after a heart attack. The two other narrowed coronary arteries could also have been treated with a balloon and a stent. However, as Marcel Waespi already had a severely reduced cardiac output due to the circulatory disorder, Dr. Wyss and the heart surgeon who had been called in recommended a different procedure, namely an immediate bypass operation. Marcel Waespi gave his consent and added: “I came in here alive and I want to leave here alive.” He was then taken directly from the cardiac catheterization laboratory to the operating theatre.

To bridge the narrowed coronary arteries, four bypasses were created from Waespi’s own arteries and veins in a heart surgery operation lasting several hours. This restored blood flow to the heart muscle. After the operation, Marcel Waespi was admitted to the intensive care unit for three nights for monitoring, after which he spent one and a half weeks in the nursing ward. This was immediately followed by three weeks of rehabilitation at Lake Constance, where Marcel Waespi gradually regained his strength. After a further seven weeks, he began working again, initially 50% and then 100% just one month later. Three years ago, Marcel Waespi took early retirement. Today he enjoys an active retirement, which includes excursions as well as regular sport. The fact that his wife not only cooks well for him, but also in a varied way, is an ideal complement to this. Only the daily intake of his heart and diabetes medication and the annual check-ups with Dr. med. Wyss remind him that his health also depends on the blessings of modern medicine.

Heart attack without warning

According to Dr. Wyss, who shares a cordial doctor-patient relationship with Marcel Waespi, his case is not atypical: “Every second heart attack patient does not know beforehand that they have coronary heart disease and are therefore at risk.” However, even completely unexpected heart attacks rarely occur without any warning signs. Heart pain and shortness of breath often occur in the hours or days beforehand and then subside. This was also the case for Marcel Waespi, who had to stop twice a week before his heart attack due to such symptoms, once while gardening and once while walking uphill.

Marcel Waespi was very lucky, as Dr. Wyss emphasizes: “Half of the heart attacks that seem to occur out of the blue end fatally.” The cause is cardiac arrhythmia caused by the heart attack, which leads to sudden cardiac arrest. Because they can occur at any time after a heart attack and the time window for resuscitation in the event of a sudden cardiac arrest is only ten minutes, Dr. Wyss advises calling an ambulance immediately if a heart attack is suspected. However, there is another reason why it is important to react quickly: once the heart muscle tissue has died, it does not regenerate but becomes scarred. The result is cardiac insufficiency (see page 12). Against this background, Dr. Wyss believes that the fact that a heart attack is often accompanied by a strong feeling of anxiety is a useful phenomenon: it motivates people to seek help immediately, and the rapid action of the person affected sets in motion a well-established emergency care chain that can extend from the outpatient clinic to the 24-hour emergency ward and the cardiac catheterization laboratory, which is always ready, to the operating theatre and intensive care unit – as in the case of Marcel Waespi. Medical progress and close cooperation between the emergency services, emergency physicians, cardiologists, nurses and other specialists as required have led to the mortality rate following a heart attack being more than halved throughout Switzerland in the last twenty years.

Source: Herz-Beilage-Tagesanzeiger 2020, Bernhard Widmer (Text)