This is another episode of “YOUR QUESTIONS ANSWERED" and in last week’s episode I answered another question from our readers and the question last week was

How to wean off ECMO?

You can check out the answer to last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED”  I want to answer another question from one of our readers and the question this week is

My father had a massive heart attack and is now in ICU ventilated and in an induced coma. He developed Pneumonia and is in kidney failure! What are his chances of recovery?

This question from Laura has been part of a 1:1 phone counselling and consulting session with me.

Here is an excerpt of the counselling and consulting session.

Laura writes

Hi Patrik,

so my 73 year old father had a massive heart attack two weeks ago, after going to the nurse two days before and she sent him home saying nothing was wrong with him, even though his blood test came back as abnormal.

He had a stent fitted immediately after he represented back to hospital a few days later, and went to hospital as an in-patient. He ended up in intensive care and only had 2 hours to live, but the oxygen helped him and he started to recover, although the tests showed that the whole right side of his heart is completely dead, and in the past two weeks it has not healed slightly.

He was recovering well until 2 days ago he became really ill and it turns out he has Pneumonia and another infection on top of that, that they don't know what it is yet.

He was rushed into intensive care again, delirious and he has fluids on his lungs that are hard to get rid of, and this morning he was put into an induced coma as his body was too weak by itself and he had not slept for two weeks so he was hallucinating and delirious, it also turns out he has a blood clot in his heart, his lung collapsed and his kidneys are starting to fail.

Of course he's really close to dying but is there any chance that his certain position at the moment he could live? Will his kidneys and lungs be able to repair themselves if they got rid of the Pneumonia and how easy is Pneumonia to treat?

If so how many days would it take before they could wake him from the coma and he could start to breathe better and start recovering?

Many thanks

Laura

Here is my answer

Hi Laura,

thanks for sending  through your questions and thank you for using my 1:1 counselling and consulting service.

I am very sorry to hear what you and your Dad are currently going through! Know that there is help at hand and that I can help you take control of this situation so that you are in a position to make informed decisions, get peace of mind, control, power and influence!

It’s very sad to hear that the nurse misdiagnosed your Dad when he first saw her a few weeks back. It looks like the nurse didn’t pick up on rather obvious symptoms and despite the abnormality in the blood results an ECG of the heart should have been done as well as it would have most likely shown changes pointing towards the heart attack.

It’s not overly surprising to me that your Dad ended up in Intensive Care after the heart attack with the right side of the heart being severely weakened.

Usually after a severe heart attack, the heart muscle is irreversibly damaged and therefore a recovery can take a fairly long time.

Let’s look at what’s happened to your Dad in detail.

With the heart attack and the right side of the heart being severely damaged, it is only natural that your Dad ended up with fluids on the lungs(=Pulmonary oedema) and the Pneumonia.

If the right side of the heart isn’t working properly because of the sever heart attack, the heart can’t pump blood around the body and therefore it’s natural that excess fluids end up in the lungs causing shortness of breath and Pneumonia.

With the right side of the heart being de-compensated the lungs are usually the first organ to suffer the consequences of a right-side heart attack usually with fluid overload.

This also explains why your Dad would have had a blood clot in his heart, again with the heart muscle being so weakened from the heart attack, the heart is not strong enough to pump blood around, therefore making blood flow more static and causing the blood to clot.

Depending on which side of the heart the blood clot was formed your Dad maybe at high risk of a stroke, however the blood clot was more likely to have formed on the right side of the heart, making it less likely to cause a stroke.

The heart attack would have also caused severe hypotension(=low blood pressure) and therefore your Dad’s kidneys most likely took a hit because they didn’t receive adequate blood perfusion due to the low blood pressure.

Again this is what often happens after such significant events like a heart attack.

Therefore it doesn’t surprise me that your Dad went back into ICU for a second time, this time with ventilation and induced coma.

Related article/video:

• What is an induced coma and why is my critically ill loved one in an induced comaced coma?

When your Dad had the PTCA(Stent to open up clogged arteries to the heart) it might have been too late for damage control, given the delay in diagnosing him properly in the beginning when the nurse sent him home after he already had sustained a heart attack.

When Patients suffer a heart attack, timing is of essence and caregivers usually only have few hours after a heart attack to take the steps that are necessary to control or minimise the damage.

You have mentioned that your Dad’s heart has not healed slightly in the last couple of weeks and it’s unlikely that it will.

A heart attack usually irreversibly damages the heart muscle and therefore a healing is unlikely to occur.

Hence with all of these issues leading up to your Dad’s second ICU admission the writing was almost on the wall that he would need mechanical ventilation, a breathing tube(endotracheal tube) and the induced coma.

Again, the heart was getting de-compensated after the heart attack and therefore breathing for your Dad was getting more and more difficult due to the fluid accumulation in the lungs and the Pneumonia.

On his first ICU admission your Dad’s condition was not as bad as on his second ICU admission, therefore oxygen might have helped to stabilise him.

On his second ICU admission, his lungs had collapsed, his kidneys had failed and therefore with the kidneys failing, he would have even had more fluids on the lungs(=Pulmonary oedema) due to the inability of the kidneys to excrete urine and offload fluids from the lungs.

Again, it’s only logical that your Dad needed ventilation, the breathing tube and is now in an induced coma.

It’s also no surprise to me that your Dad now has another source of infection. Hopefully they can locate and categorise the infection and then treat it accordingly with antibiotics.

What’s next for your Dad is to give him time to rest and heal, especially since you have mentioned that your Dad hadn’t been sleeping for two weeks and was hallucinating and delirious.

Check out my 1:1 counselling/consulting options:

• ONE on ONE phone counselling with Patrik!

• 1:1 email counselling/ consulting with Patrik

The induced coma and the ventilation will give your Dad time to rest and heal.

Other  things that need to happen in the induced coma are

• Give Diuretics(=medications such as Friusemide/Lasix to increase urine output) and offload fluids on the lungs

• Treat the Pneumonia with antibiotics if it’s a bacterial Pneumonia

• If Diuretics such as Frusemide don’t work, start your Dad on kidney dialysis as a substitute for physiological kidney function

• Maintain good vital signs such as a good blood pressure to re-perfuse the kidneys with blood. This can be achieved with Inotropes such as Noradrenaline, Adrenaline, Milrinone or Dobutamine

• Keep ventilating your Dad at least for a few days to give his lungs a rest and also pressure to open up the collapsed parts of his lungs with the added on extra pressure(=PEEP)

• The combination of mechanical ventilation, kidney dialysis, the diuretics, the inotropes and the antibiotics should give your Dad the best possible option to recover

Related article/video:

• Why your critically ill loved one might need Dialysis(Kidney machine) or Haemofiltration for Kidney Failure(Renal Failure) and is having a Dialysis machine attached to them

Please keep in mind that the heart muscles are irreversibly damaged after the heart attack making a recovery challenging but not impossible. It will take time and your Dad might need cardiac rehabilitation after he will get out of Intensive Care and the ward.

Normally Pneumonia in Intensive Care can take a few days or a bit longer when critically ill Patients are induced into a coma.

Here is also a link to an article/ video that will get you started(click on the link)

• HOW LONG IS MY LOVED ONE GOING TO STAY IN INTENSIVE CARE WITH PNEUMONIA?

Furthermore, an induced coma can take some time and here are some articles and videos that will help you understand what to expect in an induced coma.(click on the links)

• How Long Does It Take To Wake Up After An Induced Coma?

• HOW LONG CAN YOU KEEP A CRITICALLY ILL PATIENT IN INTENSIVE CARE IN AN INDUCED COMA?

At this stage my advice is to be patient.

This is easier said than done, however Intensive Care is often two steps forward and one step back and usually nothing happens fast after a severe heart attack, Pneumonia, pulmonary oedema and kidney failure.

Being patient, asking the right questions, asking for professional help- which is what you are doing- not giving up, staying positive and believing that your Dad will recover are your biggest assets in this “once in a lifetime” challenge!

I hope that helps Laura!

Take care!

Wishing you and your family all the best!

Your friend

Patrik Hutzel

PS: I only have one slot left for counselling/consulting left for this weekend, as I'm fully booked otherwise. Let me know if you want the one slot left by hitting reply to this email or by calling me on one of the numbers below!