Advanced Cardiac Care Helps Patient Overcome Heart Failure
Patient in his early 30s receives life-saving treatment at Scripps
Patient in his early 30s receives life-saving treatment at Scripps
Eric Roberts doesn’t remember much of August 2022. He spent most of the month at Prebys Cardiovascular Institute on the campus of Scripps Memorial Hospital La Jolla recovering from acute heart failure.
It all started when the 34-year-old and his fiancée, Jen, contracted COVID-19. They both had fevers and felt weak, dizzy and out of breath for several days.
“It seemed fairly mild, so we didn’t think it was anything too serious,” Roberts recalls.
Once he thought he was through with COVID, Roberts went back to working long hours at his job in small business finance. But his fatigue and shortness of breath only got worse during the ensuing weeks.
He was unsure if it was another wave of COVID or if it was just a cold or respiratory issue, so one day after work, he drove himself to an urgent care location to get checked out.
“They were taking my vitals, and they looked at me funny and asked if I was feeling OK. I said, ‘No, I’m not feeling great, but, you know, I got myself here,’” Roberts says.
The urgent care physician told him he was suffering from atrial fibrillation (AFib) — an irregular, rapid heart rate that happens when the heart’s upper and lower chambers beat out of sync. He was initially transferred to Scripps Memorial Hospital Encinitas and later to Scripps Memorial Hospital La Jolla for more advanced cardiac care.
“After the short ambulance ride, all I remember is being brought to the emergency room,” Roberts says. “From there, I was actually unconscious for the next three-and-a-half weeks.”
From AFib to heart failure
Rola Khedraki, MD, a cardiologist at Scripps Clinic Encinitas and Scripps Clinic Anderson Medical Pavilion in La Jolla, will never forget the call from the physician to provide her with the latest information on Roberts’ health.
In a short time, the patient’s abnormal heart rhythm had “avalanched into full-blown cardiogenic shock,” she says. Roberts’ heart suddenly couldn’t pump enough blood and oxygen to his brain and other vital organs. An echocardiogram revealed heart failure and fluid in his lungs.
“It was astounding how fast he had deteriorated from having walked into the urgent care for shortness of breath,” says Dr. Khedraki. “I quickly accepted the transfer because I knew that we had to be aggressive and that we had very little time. I remember I couldn’t wait for him to arrive at our hospital because I was just so afraid that he was going to decompensate on the way over and not make it.”
Roberts was given high-dose intravenous medications, put on a ventilator and fitted with a catheter to monitor his heart activity, but Dr. Khedraki knew those were stopgap measures and more intensive treatment would soon be needed.
“Just looking at the numbers, I knew that we weren’t going to be able to achieve what we wanted just with medications. He wasn’t getting enough oxygen, even on 100 percent oxygen on the ventilator, because his lungs were so bogged down with fluid,” says Dr. Khedraki. “This is something that can happen when the heart is so weak, it can’t pump the blood forward.”
ECMO machine for support
The next step in Roberts’ care would need to be extracorporeal membrane oxygenation (ECMO). An ECMO machine pumps and oxygenates a patient’s blood outside the body, ideally giving the heart and lungs time to heal, but it can be extremely taxing on the body.
Dr. Khedraki was concerned that a traditional ECMO treatment could do Roberts more harm than good. If the fluid in his lungs worsened while he was on the ECMO machine, a secondary machine would be needed.
“I was really worried about all this manipulation causing increased risk of infection,” Dr. Khedraki says. “Additionally, his heart anatomy was such that I worried that it might not accommodate a second device very well. I needed an all-in-one device that was going to aggressively unload the heart and remove the fluid from the lungs to help his oxygenation.”
Advanced cardiac care
Roberts was in good hands. Scripps’ nationally ranked and comprehensive cardiology program is known for leading-edge treatments, advanced techniques and state-of-the-art facilities. Its network of highly trained physicians also collaborates to ensure the best possible care.
In Roberts’ case, a different type of ECMO treatment could help him. The complicated procedure, LAVA ECMO — short for left atrial venoarterial cannulation during extracorporeal membrane oxygenation — is performed by only a handful of centers and physicians in the United States, so Dr. Khedraki called on her colleague, Matthew Price, MD, an interventional cardiologist at Scripps Clinic Anderson Medical Pavilion in La Jolla.
LAVA ECMO, the right choice
Dr. Price has developed a specialization in LAVA ECMO because of his experience with transseptal puncture procedures, which can offer an alternative to open heart surgery.
In a transseptal puncture procedure, surgeons create small passages in the heart via needle or a special wire that uses radiofrequency energy, which is guided by specialized imaging and an ultrasound catheter.
“The key part of LAVA is the ability to safely perform the transseptal puncture procedure, particularly in very sick patients,” says Dr. Price.
LAVA ECMO was a better choice for Roberts, given how quickly his heart was failing.
“Eric’s heart had become very weak, and his lungs were backed up with fluid because the major pumping chamber of the heart, the left ventricle, could not pump the blood forward. Because of this, the oxygen that he was breathing could not get into his bloodstream,” Dr. Price recalls.
“LAVA, by directly pulling blood from the left atrium, puts less stress on the heart and can eliminate certain additional procedures required with traditional ECMO. It can also be used in situations where the heart is weak, but there is sufficient oxygen being absorbed from the lungs.”
Dr. Price implanted Roberts with an external pump that pulled blood from his left atrium, ran it through an oxygenator, then returned the blood to his aorta. Roberts’ heart got stronger, the fluid in his lungs cleared and he was eventually taken off the ventilator.
Dr. Khedraki feels fortunate to have partnered with Dr. Price to bring Roberts back to health.
“It’s an enormous privilege,” she says. “It literally involves deploying everything in your toolbox — the technical side, the emotional, the psychological — every aspect of medicine is involved, and every skillset you’ve picked up along the way.”
Understanding heart failure
Understanding heart failure
“The team, along with my family, did a great job of calming me down and giving me a better understanding of what actually happened and what the steps forward would be.”Eric Roberts
Dr. Khedraki keeps a photo of Roberts’ family and a thank-you note from his mother on her desk. She developed a special bond with his family while he was hospitalized, as Roberts couldn’t speak for himself.
“I communicated with his family regularly to get his history from them. I was just trying to understand who Eric was prior to this and what led up to this,” Dr. Khedraki says. “I was trying to gather all of this data. You have to be in detective mode. For Eric, he was someone who hadn’t put a lot of focus on his health prior to this incident, and the COVID infection weeks prior likely made things worse.”
Roberts remembers regaining consciousness slowly, drifting in and out of a dreamlike state. At one point he panicked and tried to remove his IVs, medical sensors and oxygen mask. It was a while before he understood just how serious his heart failure had been.
“It was definitely shocking, but I feel like the medical team did a very good job of explaining things,” Roberts says. “The team, along with my family, did a great job of calming me down and giving me a better understanding of what actually happened and what the steps forward would be.”
COVID and vital organs
Before his first and only bout of COVID, Roberts had been in good health. His blood pressure was normal, he had no history of heart problems, and he was rarely sick with more than a cold. As a busy young professional, he admits he didn’t get regular checkups. He was vaccinated against COVID but not boosted.
COVID infection can trigger extreme inflammatory responses in some people, an immune overreaction that can damage vital organs. Throughout the pandemic, Scripps has seen numerous COVID patients requiring various forms of ECMO.
“We still see patients with COVID coming to the hospital with weak hearts or with sudden heart attacks. We still need to be vigilant, get vaccinated and boosted — particularly our high-risk patients,” Dr. Price says.
Getting back to normal
Roberts says his recovery has been slow, but steady. His ejection fraction, which is a measure of how well the heart is pumping, is in the normal range. He still takes medication, is eating healthier and is getting regular exercise.
“I wouldn’t say I’m 100 percent back to normal, but I feel like I’m on the right path,” he says. “The team at Scripps is amazing. It’s hard to express how grateful I am to them, and obviously, the support of my fiancée and my whole family has just been incredible.”
He recently played a round of golf at Torrey Pines Municipal Golf Course and has resumed planning his wedding. He and his fiancée hope to be married before the end of the year.
“The future is bright and I’m going to take it day by day,” he says.
Roberts says he now recognizes the importance of regular doctor visits to maintain heart health, even at a young age.
“I can understand how you might maybe ignore those things when you’re young, but I’m certainly proof that it’s a good idea to monitor that early and often,” he says.
This content appeared in San Diego Health, a publication in partnership between Scripps and San Diego Magazine that celebrates the healthy spirit of San Diego.
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