After finishing a 12-hour workday, Dr. Naresh Mistry felt worn down when he got home and tried napping. But sleep evaded him. As he walked downstairs, he began experiencing intense shortness of breath and shoulder pain. The cardiologist knew exactly what was happening.
“This looked like heart attack symptoms to me,” Mistry, an interventional cardiologist at Covenant Health in Knoxville, Tennessee told, TODAY. “We said, ‘OK, let’s go to the ER.’ I try to get in the car and as we come out of the driveway, the symptoms get worse. Then I said, ‘I think this is not a good idea.’”
Instead, he and his wife called for an ambulance. As the EMTs arrived, he shared his symptoms.
“I laid down on the gurney. (Up) until then I was able to talk and communicate,” he said. “I passed out. I do not remember after.”
Heart attack and resuscitation
When the shortness of breath and shoulder pain began, Mistry also called his partner in his cardiology practice who urged him to go to the emergency department. But his health quickly worsened, and he thought it would be safer in an ambulance. Although he called 911, his wife needed to talk to them. Even though he doesn’t remember being in the ambulance, he did pepper them with his health history and symptoms.
“I was giving them my history, which I don’t recall,” he said. Upon arriving at Parkwest Medical Center, doctors confirmed he was experiencing acute cardiac event and they rushed him to the cardiac catherization lab.
“They found a multi-vessel blockage,” Mistry explained. “The surgeon was called and then the decision ultimately was made to intervene on one vessel called the left anterior descending arteries and the stent was put in.”
After the stent was placed, Mistry was going to be moved 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 did not put me in a bed. I was on the cath table,” he said. “The next thing they knew I was coding — meaning I was having cardiac arrest.”
Mistry’s colleague, Dr. Gregory Brewer, was in the catherization lab when Mistry began coding. In the back of his mind, Brewer thought of how Mistry’s father died of a heart attack at 65. He didn’t want history to repeat itself.
“Dr. Mistry proceeded to go into life-threatening rhythm. We ended up doing a code blue for about two hours with chest compressions and shocking the heart,” Brewer, an interventional cardiologist at Parkwest Medical Center, told TODAY. “We ended up putting in what’s called an Impella, which is a specialized device, a ventricular assist device, that can sustain a patient even if their heart’s not beating.”
Brewer said that normally someone who hasn’t been resuscitated within 40 minutes is at risk of permanent brain injury. But they had a doctor managing Mistry’s airway while he received compressions that helped Mistry stay oxygenated.
“It was touch and go there,” Brewer said. “Even after we do all these efforts — the recovery period — we always have to worry about the loss of brain function from such a prolonged exercise.”
Throughout the two hours of CPR, Brewer worried he would soon need to deliver bad news to Mistry’s family.
“You don’t know how many times I thought I was going to have to go outside the cath lab and discuss with his wife that Naresh wasn’t going to make it,” Brewer said. “I’ve been personal friends with Dr. Mistry for many years and it’s difficult. You’ve just got to stay focused, identify the problem solve the problem … you’re not guaranteed anything in this world.”
After the Impella was placed, Mistry went to the cardiac intensive care unit and was cooled, what’s called a hypothermia protocol, and intubated. As he stabilized, they removed the Impella and took him off the ventilator. It soon became clear he did not have a brain injury due to the sustained CPR.
“I recovered after a few days,” Mistry said.
Helping a close colleague and friend felt “very meaningful” to Brewer.
“The whole meaning of life for me is looking forward to time with friends and people I love,” he said. “That has been given to Dr. Mistry.”
Follow up with a mentor
Testing had revealed other blockages in his arteries and Mistry wanted to see what his mentor, Dr. Samin Sharma, director of interventional cardiology for the Mount Sinai System, recommended.
“He advised that we should repeat the heart catherization and go from there,” Mistry said. “Once he did the heart catheterization, he felt I was not the best candidate for … a stent. One of the reasons was there was a new blockage that came out of the same artery that had a stent put in, which was a newer finding.”
Sharma suspected a stent wouldn’t protect Mistry from future heart problems.
“When he came to see me with the angiogram, I said, ‘You still have some more blockages, which you need to take care of,’” Sharma told TODAY. “I felt that it’s better that he go for a complete long term solution because even if I put in a stent, chances are it will block again.”
Sharma said the stent likely collapsed because it was never fully opened and the calcium in the blockage weighed it down. While it had opened enough to prevent a heart attack and help Mistry have an almost normal ejection fraction, the percentage of blood pumped through the left ventricle wasn’t strong enough to keep the artery open.
“It was very unstable,” Sharma said.
Mistry had hoped Sharma could help him without a quadruple bypass surgery. But his blockages were too severe.
“Not only had the stent blocked up a little bit, which was about 70%, but also the main artery, which there was no stent for that, was also blocked 50%,” Sharma said. “I found that (stents) will not be enough for him on a long-term basis.”
Sharma recommended that Mistry see one of his colleagues for an off-pump coronary artery bypass surgery or beating heart surgery. Mistry met with Dr. John Puskas, chair of cardiovascular surgery at Mount Sinai Morningside, about his options.
“The blockages in the artery that had the stent had progressed and worsened and he also had significant blockages in three other vessels,” Puskas told TODAY. “He really was referred for a coronary bypass surgery.”
Puskas performs a type of bypass surgery that is used “infrequently” at other hospitals. He does not stop the heart from pumping during the procedure and he uses arteries from the chest, instead of veins from the legs, to replace the blocked arteries.
“We use a beating heart approach. We don’t manipulate the aorta. We don’t put cannulas in the heart or clamps on the aorta because that can cause stroke and can knock off calcium and cholesterol inside the organ that can embolize downstream to the brain or elsewhere,” Puskas explained. “We don’t use vein grafts. We use arteries only because the arteries, although they are smaller and a little more tricky to work with initially, they mature and grow over time and they are designed, of course for high blood pressure.”
Veins handle low blood pressure so that when they are replaced in the heart, they can become stressed and wear out easier. Puskas finds that this off pump procedure that uses arteries means patients are less likely to need a future bypass surgery. Considering Mistry had already been through so much, they didn’t want a surgery to contribute to future complications.
“He’s had a tough time already this year,” Puskas said. “We wanted to minimize the risk or stroke and we wanted to maximize the durability of his bypass graft.”
Life after bypass surgery
After a handful of days in the hospital to recovery, Mistry stayed in New Jersey for a few weeks to regain strength for the trip back to Tennessee. He hasn’t been seeing patients quite yet, but he’s gradually improving.
“I still am slow. Some days are good. Some days are really not good with weakness and fatigue,” he said. “I’m recuperating as well as could be expected.”
He feels grateful of the care he received from Brewer, Puskas and Sharm, who Mistry considers “a guru” in interventional cardiology, who gave him “an enlightenment and teaching about the profession.” His experience has changed how he thinks about his role as a doctor.
“It makes you humble about the disease process … It’s makes you humble about how you want to handle not just the patient, but it also makes you aware of how you to take care of the family members, too,” he said. “God was with us. He had directed me to take all the steps in the most expedient way to avoid delay and to get the care where I needed it most.”
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