From Breathless to Bypass: Treatment for Blocked Arteries

How One Man's Subtle Cardiac Symptoms Were A Warning 

Michael Everett was enjoying a beautiful winter day of deer hunting on his Eastern Shore property with his grandson when he felt like the wind got knocked out of him. He had walked just three-quarters of a mile from his truck to the tree where he usually hunts when suddenly he couldn’t catch his breath.

“That had never happened to me before,” said the former Marine, who had always found the walk easy.

As soon as Everett returned from his hunting trip to his home in the eastern suburbs of Baltimore, he promised his wife he would see his longtime family doctor, Daniel Collector, MD, with the University of Maryland St. Joseph Medical Center.

Fast-thinking Thorough Physicians

Dr. Collector knew Everett’s history.

“He had hypertension [high blood pressure], diabetes, hyperlipidemia [high cholesterol] and a family history of heart disease. Prior to this, his stress test ten years ago was fine. So when he presented to me with shortness of breath, I knew this was a warning sign,” said Dr. Collector, who immediately referred Everett to a cardiologist with an office in the same medical building in Rosedale.

“Once you have shortness of breath, chest tightness or unexplained fatigue, you need to seek medical attention,” Dr. Collector said.

“Dr. Collector let me know right away about Michael, noting that it was very important for me to see him quickly,” said board-certified cardiologist Shannon Winakur, MD, with UM St. Joseph Medical Group – Cardiovascular Care in Rosedale.

When Subtle Symptoms Hide a Serious Condition

“Michael’s symptoms were pretty subtle. He walks a lot for work, but only had symptoms when he walked in the woods,” said Dr. Winakur, who sprang into action with diagnostic tests, including an EKG and a stress test.

“Dr. Winakur is very detail-oriented,” Everett said. However, the stress test “wasn’t adding up with his symptoms” in Dr. Winakur’s opinion, so she ordered a cardiac catheterization at the Sandra R. Berman Heart Institute at UM St. Joseph.

A cardiac catheterization is a procedure done under X-ray guidance to help determine how well someone’s heart is working. A catheter, which is a thin hollow tube, is inserted into a large blood vessel that leads to the heart. The catheterization procedure can reveal blocked arteries. In Everett’s case, it showed that an artery on the left was 100% blocked, while his right-side artery was 70% blocked.

With this amount of blockage and other risk factors, Everett was not a candidate for stent placement—a minimally invasive procedure to place small devices to open the blockages. The next step was to bring in a cardiac surgeon to discuss heart bypass surgery. In this case, Everett’s surgeon was Stewart Finney, Jr., MD, cardiac surgeon at University of Maryland St. Joseph Medical Center and clinical associate professor of surgery at the University of Maryland School of Medicine.

Feeling Fantastic Thanks to Enhanced Recovery

Everett recalled how shocked he was when Dr. Finney said, “You were being set up for a very bad heart attack,” but quickly felt relieved when Dr. Finney added, “We can help you.”

“Fantastic” is the word Everett now uses to describe the result of his bypass operation. “I felt fantastic just an hour after surgery. I could take deep breaths and walk in the hospital,” he said.

The type of enhanced recovery Everett experienced is the result of an approach developed by Rawn Salenger, MD, cardiothoracic surgeon and chief of Cardiac Surgery at UM St. Joseph Medical Center, called Enhanced Recovery After Surgery (ERAS).

“Dr. Salenger and our team created a program to optimize the patient experience,” Dr. Finney said. “The use of narcotic pain medicines was markedly reduced, and we now use an advanced combination of non-narcotic medication for pain control. Two hours before surgery, we give the patient a high-carb drink that keeps their bowels functioning following surgery. We get the patient up in a chair that evening after surgery and get them walking the next day. During their hospital stay, which averages about four days, patients walk the halls three to four times daily with supervision. Our goal is to get them back to everyday life more quickly.”

The Evolution and Revolution of Bypass Surgery

Another advancement that Everett marveled about was how much heart surgery had evolved since his father had a heart bypass operation in 1997. The bypass is still sometimes created from a vein harvested from the patient’s leg, but today’s process is far less invasive.

“My dad’s leg was cut from his ankle to his groin,” Everett said. “I just have a two-inch incision where they removed the vein through minimally invasive surgery.”

This approach, which doctors have been using for the past 15 years, is called “endoscopic harvesting and is performed by our physician assistants, who are quite skilled at removing the vein,” Dr. Finney said. “They also harvest an artery from the forearm endoscopically, by threading a long, thin tube through a tiny incision. Another artery is taken off the patient’s chest wall and, in this case, was used to bypass the 100% blocked artery. The vein from the leg is divided in sections, then sewn onto the aorta and blocked arteries, creating other bypasses.”

Dr. Finney compares a heart with clogged arteries to an engine that is still good but has clogged fuel lines. Everett required four bypasses.

A Dream Team with Heart

Cardiac bypass surgery takes approximately four to five hours. The cardiac surgery operating room team has seven members in addition to cardiac surgeon: the anesthesiologist, critical care technician, scrub nurse, circulating nurse, two physician assistants and a perfusionist who runs the heart-lung machine, an artificial blood pump that is necessary for about two hours during the operation.

Every year, the highly experienced cardiac team at the Sandra R. Berman Heart Institute performs approximately 520 open heart surgeries and more than 150 hybrid interventional heart surgeries, procedures which combine minimally invasive and conventional surgical approaches. Upon leaving the hospital, Everett qualified for physical therapy at home. Just five weeks following heart surgery, he returned to his job as a facilities manager for a few hours a day and then went back to work full time a month later.

“I’m extremely proud to be part of the cardiac care team here at UM St. Joseph Medical Center,” Dr. Winakur said. “Patients can get excellent, comprehensive care, including cardiac catheterization, pacemakers and cardiac surgery. We have a wonderful group of cardiac surgeons who I can call and text right away with any patient concerns. Patients say they had a great experience getting their cardiac catheterization, stress test, cardiac rehab and other services.”

Everett agrees.

“The St. Joseph heart team saved my life. I cannot say enough good things about St. Joe’s. Top to bottom, they were aces. I always put in a plug for the nurses, in addition to the rest of the team,” said Everett, who has 13 grandchildren, including the one he hunts with. “Now I can hunt and keep up with my 22-year-old grandson, and he wants me around for a long time.”