Thursday, January 26, 2006

Widow Maker


I wrote this piece for the chronicles on my first rotation of my second year of residency. This patient eventually left the hospital, although, her quality of life was never the same again.

There is a young fifty eight year old mother of two currently walking the tightrope between life and death in my Coronary Intensive Care Unit (CICU). She had a massive heart attack earlier and was rushed to the angiography lab where one of the critical arteries supplying blood to the heart failed to appear on the monitor- it was completely blocked.

The “Widow Maker” was the affectionate name we give to a stenosis of this vessel. It’s all in the name, they say. Most commonly, this fatal stenosis usually affects fifty something year old men, fatally. But diseases never read textbooks and Ms. R had no idea of this horrible monster forming in her arteries. Now it threatens to end her life.

I told her family that the situation is grim, they cried, I had nothing to say to comfort them at all. She has a very slim chance of survival and they better be prepared.

At the moment she’s nearly maxed out on all the possible medication we could give her to raise her blood pressure and the only thing standing between her and the other Unit in Sky is the love of god and a resident with 14 months of experience.

I am scared.

Back to work!

For more information on the Left Anterior Descending arterys' nickname go here. Coronary artery disease is among this nations top killers. It is silent and deadly. If you experience symptoms of angina please go to you doctor to report them and have the appropriate work up.

18 Comments:

Blogger Kim said...

Oh man....

Another thing that filled me with dread when I was in Coronary Care: a patient with an anterior MI who started having issues with second degree heart block.
Not only did you have to deal with pump failure, but conduction disturbances at
the same time.

Now this is in the old days, before angiography/angioplasty and calcium channel blockers were experimental and John Travolta was just a kid on a sitcom but as coronary care nurses we knew:

Hypotension, elephant on chest, tachycardia, diaphoresis and SOB = anterior

Epigastric/sternal pain like indigestion, bradycardia, vomiting and first or second degree heart block (third degree for the unlucky) = inferior

If I'm ever going to have an MI, make it an inferior one.

11:10 PM  
Anonymous Joe said...

Doc,

Yikes...been there, done that.

http://attaboy.tommydoc.net/?p=1170

My block wasn't (I believe) in the wideo maker, as it was on the right (my left) side. They did need to defib me at the house three times, then once again at the second hospital. I don't recall any of that. That was all a year ago, and I'm doing a lot better. I have a great cardiolgist. And far more admiration and respect for folks like you and for the amazing ways you keep people like me alive.

5:52 AM  
Anonymous Anonymous said...

I'm a walking dead man. I'm totally asymptomatic but I encourage you to read on. At 50 I had what one would call an "executive" physical. Part of that was a nuclear stress test (rather than a typical stress test) since there had been an occaisonal irregularity on my EKG's since I was about 20, and there is some CAD in my family history. The test revealed what appeared to be blockage, the next step was a cardiac cath which revealed a 100% blockage in my LAD, yep the REAL widowmaker and this was/is completely blocked. I have a medical background and while the cath was being performed I watched and spoke with the MD who was performing the procedure. After the initial shock to both of us, he attempted to get a wire through the blockage and was unable to make any headway, the calcification was solid, and apparently had been that way for years. Today at 53 I'm still ticking away, still asymptomatic, and now I go to my cardiologist regularly, I do all of the "right" things and take loads of expensive meds, but hey I'm here and that's a good thing. There are no other vessle abnormalities whatsoever. OK so there you have it, there is life after the Widowmaker comes to visit. I'm living proof.

10:47 PM  
Anonymous Anonymous said...

Wow, I was shocked when the Dr told me this morning that my 53 year old husband suffered a massive heart attack and referred to it as the widow maker... I googled it just to see if anything came up and was shocked... (glad I didn't know this before I knew he was ok) luckily it didn't do any damage to his hear that it won't repair on it's own, and his other arteries look fine...
too odd...

10:11 PM  
Anonymous Anonymous said...

I have left coronary artery failure 100% blockage
RFA- 6ER Jl4 JR4
Right function is barely getting by with 80% and 40% blockage at two seperate sites
Most of of my heart is getting by on collateral flow.
I have preserved systolic function thanks to 20 years of mountain climbing and a high level of fitness. I found out about this when I could not climb a hill one day, I finished the climb and walked home.
I will climb again after triple bypass.

4:08 PM  
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2:06 PM  
Anonymous michelle said...

my husband just experienced the widowmaker, and thank God he's alive. It was 100% blocked and is now stented. He's only 38, so we know age is not a safety net. He was on Lipitor, but obviously not enough and also had family history that played a strong role. Don't ignore any symptoms.

11:38 PM  
Blogger Nancy said...

My husband survived the widow maker about a month ago. Thank God for stents and for Dr. Cohen and the amazing team in our local ER.

Nancy, not a widow, near Philadelphia

5:39 AM  
Blogger Adam said...

My Dad miraculously survived this heart attack earlier this month. Not only did he survive it, but he is now ready to go golfing on friday(about 3 1/2 weeks after nearly losing his life. He coded in the ER and that is the only reason he survived. He has no damage to his heart or brain and is back to being himself(albeit with a little more respect for the fragility of life.

Amazing.

1:15 PM  
Anonymous Anonymous said...

Doctor,

Your understanding of heart attacks due to blocking of the "widow maker," or LAD, reads like bad scare literature. You were a resident, and maybe when you become a bit more experienced you'll realize that there can be much hope after an attack due to a clogged-up LAD. While treating your patient was no doubt an eye-opening experience back then, you should be glad that she made it out, and realize that she can have a very fulfilling and active life once she leaves your capable hands, as is the case of the father of poster Adam above.

Your hands are less capable in the blogosphere, and I suggest you revise your tone so that the thousands of Americans who hear the words "widow maker," google it, and then arrive at this site do not feel like they're reading about an intense opening scene from /ER/.

I wish you the best of luck in improving your tone not only in your writing on the internet, but also when speaking about coronary defects with the families of patients in the future.

7:32 PM  
Anonymous Anonymous said...

October 13 2007 @ 10pm I forgot to take out the trash for the morning pick up.I got up from bed walked to the garage opened the door took two cans of trash out walked back to the door and started sweating somehting terrible and felt very sick to my stomach my jaw started aching and then started throwing up as i walked back to the bedroom my wife asked whats wrong i said i didnt know ireally didnt know i figured at this point i may need to go to the hospital which is minutes away so we loaded up the kids and drove to the emergency room she stoped at the door i got out of the car and walked in the lady behind the desk ask whats wrong i said i didnt know she sat me down in a wheel chair and began to take my blood pressure and looked at my wife an said he has no pulse or pressure he is having a heart attack iwoke up two days later in intensive care not knowing what had happened and was told i had the widow maker heart attack i had one blockage at 100% and one at 99% she said if i hadnt forgot to take out the trash i wouldnt have woke up the next morning because i was lucky to just survive the massive heart attack i would consider myself the luckiest person in the world i suffered the most signifigant damage to the lower part of my heart but there is hope it may with drugs and hard work i will live past my 39th birthday stephenabumgarner@yahoo.com

11:24 AM  
Anonymous Anonymous said...

I am a registered nurse and on Nov. 15, 2008 I developed chest pressure that I could barely tolerate. I spent several days in the MICU..my LAD was 100% occluded, RCA 90% and circ 80%.I was only 5 blocks from the ER.... I am very fortunate to be alive and am thankful for each day that I have.
wolflover804@aol.com

1:00 PM  
Blogger aajn4 said...

My Dad has his widow maker blocked and can only be helped by a triple bypass. He has one schedule for the end of January but went to the hospital with bad chest pains(my dad does not say when he has chest pain. His cardiologist said to wait to hear from the surgeon because he would probably need the surgery done sooner which they wanted to do but my dad insisted on waiting. The surgeon could not make it so the cardiologist let him go home for now. Now keep in mind the surgeon called and told him he would be up there to see my dad but now can't make it.
Is that ethical to send my Dad home even though he really wanted to? How can they release him knowing his condition?

7:59 PM  
Blogger bruic said...

This is 17 February, 2009. Last Saturday, Valentines Day, I started by climbing a 30 ft. ladder to work on my roof. I own a contracting company, and went to work later in the morning. I have felt chest "twinges" for years, and periodically complained to a few doctors. Despite being a heavy smoker, I passed several stress tests easily. I went to dinner for the occasion with my wife, and then laid down back at home because I did not feel well. Within an hour, I awoke with a very heavy, steady pain localized in the center of my chest. I got hold of my wife, (an RN) to take my blood pressure, but before she could even get her cuff, things went downhill so swiftly, that I could not even dial 911. My son took over on the phone and my wife rode with me in the Rocky River squad wagon to the hospital. At 10:55 PM I was in my kitchen, at 1:00 AM I was in my room at St. John Westshore with my new stint, no pain, and a new lease. Monday morning, I was released to go home, contact my doctor, and get my new rules.
This particular hospital has established a special team of CC nursed and doctors who are on call, who drop everything to show up for any kind of heart attack or stroke. Between a well equipped squad, who hooked me up to a machine that goes direct to the hospital, and the doctor and nurses who attended me--I owe them everything. Amazing though, Saturday night I had 100% blockage of the so-called, (with good reason), "widow maker", and Tuesday morning I was in my office. Here's to St. John West Shore Hospital, Westlake Ohio, with the fastest door to balloon time in Ohio.
Sincerely
Brian Ruic

12:31 PM  
Anonymous Anonymous said...

Feb 12, 2009 4:33 pm, I got a call at work, My husband was at the cardiologist, he was having a heart attack and being taken by ambulance to the hospital. By 6:20pm he was out of the cardiac cath lab with cleared occlusion and stenting of his lad. He is a very lucky man. 40% blockages in other arteries, not sure why they couldnt get it all, but we love our life saving physician.

My husband had crushing pressure for 3-4 days prior, we thought it was due to a new medication, Flagyl, tried to see the doc, not unitl Tuesday they said, told of the chest pressure (not pain he says), they said go to ER.

Of coarse we didnt go. My husband showed up at the doc office, they walked him to the cardiologist, and lo and behold, we should have gone to the ER a few days prior.

Please, anyone else out there, do not make the mistake and wait. I am planning on making my appt with PCP to get to the cardiologist myself.

5:33 PM  
Blogger Richard said...

On may 9th after 4 days of chest pain with no other pains I went to the er. I was put into the hospital and had angiography/angioplasty on may 11th One stint lad with 95% blockage. I feel lucky to be alive. I hope to live a lot of years to come. This is not the end of your life just the begining of your second chance.

10:57 PM  
Anonymous Anonymous said...

I had a widow maker attack in September of 1999. They lost me 5 times and barely revided me the last time. They stablized me long enough to place the stent.
I have been prblem free since that time. Friday, 19 June 2009, I am having a heart cath performed to check my stent. No problems really, just kind of a ten year check up.

2:19 PM  
Anonymous Anonymous said...

One of my best friends just died. He was the picture of health and only 41 years old. He was slender and he always ate right. Doctor said it was what they call a widow maker. He complained of chest pain and played it off. He went to sleep and didn't wake up. He left his wife and 8 year old daughter behind. Please keep his family in your prayers,,,

12:08 PM  

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