Heart Rehabilitation for Diane Davis Andrew    last updated Apr 29, 2008

Current Status Diane was in cardio rehab three times per week; back at her Admin. Asst. job at church Monday, Tuesdays & Thursdays, and takes part in prayer group and church on the weekend. Now she has a Schwinn recumbent exercise bike and upper-body tabletop machine to do rehab at home. See hyperlinked narrative and chronology below describing her heart attack and treatment plan. Houston Chronicle front-page on hospitals bypassing ER, trials on medicine in ambulance. Heart Attack & Treatment Diane experienced an acute myocardial infarction - 70% blockage of right coronary artery - from a blood clot formed from eruption of lipids after a vulnerable plaque rupture (see video). The duration of heart muscle oxygen deficiency was reduced by >30 minutes, by receiving 1/2 the FDA dose of clot-busting Retavase in ambulance vs. hospital, part of a UT clinical trial. This artery had experienced an uncommon separation (dissection) of the interior flow area from the artery wall, that caused blood to flow down a newly created "false plenum" which had the effect of partially collapsing the "true plenum". This artery now has only 10% stenosis after being fully reinforced with SEVEN(!) expanding mesh titanium stents. These Liberté-brand stents by Boston Scientific were positioned to allow all the smaller arterioles to still feed oxygenated blood to the right ventricle. (Note the two other coronary arteries displayed no problems) Dates below chronicle the heart attack, treatment, monitoring & cardiac rehabilitation plans. Friday Jan 11 The afternoon of Jan 11, 2008 Diane was at Church of the Redeemer with Dick Bird, getting music ready for a new Friday night service. Suddenly she felt sharp pain spread to her jaw and  left arm so Dick called "911". Our Rector Rev. Nan Doerr was already on her way over to church and saw two ambulances go by, and got there in time to help EMS gain access into the building. The Emergency Room's were full at St. Joseph's, St. Luke's and Methodist hospitals. Fortunately Memorial Hermann  has a new process that gets patients directly to Cardiac Catheterization Lab, bypassing their ER procedures. EMS crew immediately began treatment while Diane was being transported. They did not wait for any of the required health insurance forms to be filled out - support staff arranged for all the forms for on patient "Yankee1229" (her hospital code name for the first 24 hours) to be bought to Bob when he arrived! UT Med School interventional cardiologists over several hours used minimally invasive procedures that started out with a coronary angiogram - live Xray images captured on digital video that shows arteries using radio-opaque contrast injected - followed by a catheter inserted through a groin incision in the femoral artery. This first catheter procedure used a live video camera which is how Dr. Ali Denktas discovered the extent of the problems in the right coronary artery. The team did the stent placements guided by the live imagery. Early evening she was transferred upstairs to the CCU of their Heart & Vascular Institute. Bob stayed in the CCU for several hours filling out detailed medical history required, then slept in the waiting room. Saturday Jan 12 In the early morning hours a Resident removed the heart catheter which had been preventively left in as a precaution after the procedure. Later that morning a full echocardiogram was done of her heart -from four angles - to look if any areas of heart muscle were not fully responsive to the electrical rhythm of the heart. She will get an initial opinion on Sunday, but the doctor warned it might be six months before they fully know if the MI caused any permanent damage, comparing the enzymes and heart function. Diane has EKGs performed several times per day. If all is still well Sunday, she will transfer to an intermediate cardiac care  room. The doctor advised she can resume her job within a week, which doesn't involve lifting more than 5 lbs. While in hospital she is on Aspirin, Beta-blockers, Lipitor, Plavix and Protonix Sunday Jan 13 Her doctor reported no problems with any of the diagnostics they had performed, and only made adjustments to some of her intravenous medication. He used the phrase "perfect" and teased why wasn't she in her chair (because it was too low compared to the bed). The "markers" in her blood that occur after an MI were coming down as expected, so he arranged for her transfer to Rehab, which will start Monday Jan 14. She was moved to Room 352 of Cullen Pavilion. Monday Jan 14 Diane begin doing in-hospital rehab walking exercises, but was not able to do closed cardiac MRI - and there is no open MRI for hearts.  Diane was referred for out-patient Phase II cardiac rehab near our home, at Memorial Hermann South-East. She was given full details of the Retavase trial agreed to on Friday, with phone call follow-up to occur monthly for a year. Tuesday Jan 15 She was discharged after lunch, received a written report of the cath. lab procedure, prescription for medicines with literature on each, and written advice about diet and lifestyle. Bob signed her up for Clear Lake Community Ass'n low-impact aquatic exercise classes Tues/Thurs 8-9 am for her knee health and weight loss, and got map directions to her trice-weekly cardiac rehab. Saturday Jan 19 Diane has stayed home this week, getting up each day, and doing small things around the house (making tea, feeding dogs, washing dishes) and looking forward to being driven to church Sunday. Sunday Jan 20 She sat in the congregation, joining in the hymns and prayers, staying afterward for the annual parish meeting and lunch before going  home for a nap. She and Bob have decided to switch to evening aquatic exercise on Tues and Thurs so they both can do it, once she is cleared to do exercise other than supervised cardio. Friday Jan 25 Diane's sister Joanne drove her to cardio rehab where she worked out on the recumbent bike. Her next appointment with her cardiologist is January 29, to get cleared for driving. Thursday Jan 31 Had a follow-up appointment with her catheterization doctor, who has cleared her to drive and go back to work. She's working two days/week from 10 am to 2 pm i.e. half as many days as before.