When Doctors Enter The Battle

It is often said that doctors are soldiers on the health front. Every prescribed dose and decision contributes to a patient’s wellbeing and survival. A recent severe, complex, near-death case of heart disease at FV Hospital was a particularly nerve-racking battle, where Head of Cardiology Dr Huynh Ngoc Long acted as the general taking charge of the “troops”, establishing tactics and strategies and coordinating with many combat units at the hospital to fight for the patient’s life.

Mrs Le Thi Het (from District 7, HCMC) is 67 years old. She has a history of diseases such as hypertension, diabetes, dyslipidemia and a myocardial contractility which was half that of the average person. However, she still felt very confident in her general health so didn’t worry too much about caring for herself or taking preventative action or medicine.

Suddenly, on the night of July 20, 2018, she suffered hypotension and felt “too fatigued to breathe”. After a few hours struggling, at 11.30 pm, Mrs Thi Het was taken to FV Hospital with dyspnea (laboured breathing). Her daughter was in tears, preparing to call friends and relatives to announce bad news.

FV doctors immediately reassured Mrs Thi Het’s family members and helped stabilise her vitals. Early diagnosis showed that Mrs Thi Het had a non-ST segment elevation myocardial infarction, with signs of severe heart failure due to her weak myocardial contractility. Her coronary artery was damaged and narrowed in all three major branches. Most worryingly, the largest branch was narrowed from beginning to end, rendering it extremely fragile with such a slow bloodstream that it was about to become completely blocked. The other two branches had narrowed along 90 per cent of their lengths. Mrs Thi Het’s life was on the line.

FV’s Head of Cardiology Dr Huynh Ngoc Long, who has successfully performed 10 thousand cardiovascular interventions, was in charge of this emergency case. Dr Long quickly assessed Mrs Thi Het’s condition, which was akin to a complex chess board. All three coronary arteries were damaged and each branch was very narrow – a bit like being surrounded by enemies on three sides.

Having noticed that the largest branch was about to be completely blocked, Dr Long considered that this may have been the main culprit. He observed that lesions were diffused throughout Mrs Thi Het’s body, making the blood vessels too fragile to be treated. A coronary artery bypass surgery or cardiac dilation surgery was impossible due to the extreme danger to the patient’s life. Dr Long had a quick discussion with the team of doctors, setting a very delicate strategy to “break the siege”.

The patient was given two intravenous infusion routes with resuscitation to increase her blood pressure, and a coronary intervention to clear the two less damaged branches first to ensure more oxygen reached her heart. After nearly one hour of intense intervention, there were times when Mrs Thi Het’s blood pressure dropped to a dangerous level but was successfully raised again by the team. Finally, the two severely narrowed branches were clear and two stents inserted to prevent them collapsing again. Mrs Thi Het’s blood pressure gradually increased and regained stability so that her condition was no longer life-threatening, but she was still very weak and needed rest before having a second intervention on the largest, most narrowed artery.

A week later, Mrs Thi Het’s health had improved significantly compared to her first day at the hospital and she was fully conscious when taken to the Cath Lab. Dr Huynh Ngoc Long and his partners again devised their strategy to win the unfinished battle.

They only had one artery to clear, however it was the largest and narrowest branch and so very fragile and weak that it was about to become completely blocked. A highly experienced “captain”, Dr Long calmly developed a plan with his team and explained things carefully for every member to understand each task and its intended result. As the whole branch was very narrow, intervening and placing the stent might lead to future risks for the patient, such as thrombosis or a higher re-narrowing rate.

The most dangerous complication was that the stent would be covered from the beginning to the end, causing many lateral branches to become blocked and resulting in more severe heart failure. Therefore, the doctors decided to use a balloon to dilate the middle to the far end of the artery and only place a large stent in its nearer portion. The medical balloon’s anti-proliferative feature made it a good option to keep blood vessels from receding and to help them expand without blocking the lateral branches.

The whole team commenced “battle”, having mastered their weapons.

At one time, the monitor showed that the narrowed artery was a tiny and fragile as a strand of hair, with many narrow, disrupted parts, making tool insertion much more challenging. The equipment continued to make progress up the artery, little by little. Finally, the balloon was inflated and allowed to press against the blood vessels to allow the drug to absorb.

During that minute, there was a possibility of hypotension, myocardial infarction and cardiac arrest. Mrs Thi Het’s blood pressure continued to drop, and everyone was nervous. However, Dr. Long had already planned for this eventuality, clearing her other two arteries during the first surgery to reduce the pressure on the third.
As time passed, gradually the bloodstream through this largest artery and its many lateral branches was completely restored.

The surgery was a success! Two days later, Mrs Thi Het was completely recovered and able to walk so was discharged, much to the joy of her family.

Mrs Le Thi Het’s case is one of many complicated cases that FV Hospital doctors have received. The positive outcome resulted from many factors, including rhythmic coordination, strong teamwork from doctors and technicians, an accurate strategy and time-saving, cost-effective procedures which delivered the highest degree of efficiency.

Last but not least, the hospital’s latest generation equipment was undeniably a powerful “weapon” for the fight.
Each patient’s illness resembles a complex, unpredictable battle, but FV’s doctors have scored many victories over death, enabling their patients to return to a normal life.

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