As many of us know, life can literally change in a heartbeat – one minute all is well, the next moment illness cruelly strikes.
Every day, 54 families across our country lose a loved one to a sudden heart attack – that’s a mother, father, brother or sister, every 27 minutes. It has become an epidemic affecting around 1.4 million Australians.
Already the nation’s single leading cause of death, the continuing rise of cardiac risk factors like smoking, obesity and inactivity suggest it will become far worse unless research can deliver better treatment approaches.
Graham Vimpani, a paediatrician from Newcastle, shudders to think how close he came to suffering a potentially fatal heart attack last December. He was supposed to fly to Melbourne that morning but decided to cancel because of severe back pain.
“I was incredibly lucky,” Graham reflects. “If I’d gone to Melbourne I honestly believe I wouldn’t be here now – my heart attack would’ve happened on the plane.”
Graham had devoted his career to the important field of child health and protection. During a stint in Adelaide he joined a medical research team investigating lead exposure and his ground-breaking findings saw the adoption of unleaded petrol in Australia.
Even as a medical professional, however, he was caught unaware by the early symptoms of his heart attack. “The previous February I’d been to see my GP about chest discomfort but the cardiac tests showed nothing – it was gastric reflux, and I thought it was happening again,” he says.
“After a fairly sleepless night I felt a sudden onset of severe mid-back pain that was different to anything else I’d experienced, so I decided to call an ambulance. They took an ECG and sent it to the doctors own smartphone at John Hunter Hospital and I ended up being whisked straight into surgery.
This meant Graham’s cardiac team were ready, reducing preparation time and increasing the likelihood of Graham’s survival and full recovery.
“I was in the right place at the right time. The doctors think there had been some degeneration of plaque that was causing the back pain overnight and the clot just blew.
“It was descending what they call the ‘widow-maker’s artery’” [the left anterior descending coronary artery]
Heart specialist Dr Suku Thambar met Graham at John Hunter Hospital to perform the emergency surgery. As an HMRI affiliated researcher, Dr Thambar also offered Graham the chance to join an exciting stem cell clinical trial aiming to limit heart damage and help with healing.
“Stem cell research has really taken off in the past decade as stem cells have the potential to form new blood cells which would improve heart muscle function after a heart attack,” Dr Thambar explains.
“There is strong laboratory data supporting this and over time it has become evident that stems cells secrete a bunch of growth factors. This also results in a rebuilding and recovery of the left ventricle after a heart attack, which is a very important clinical outcome for the patient.”
Graham was shaping up to have a relatively large heart attack, Dr Thambar adds, and therefore was considered eligible for this trial. First his artery was opened to restore blood flow then he was directly infused with either donor stem cells or a placebo – the selection being randomised under trial conditions.
“We take patients like Graham who are having what we call an anterior myocardial infarction, where a large amount of heart muscle is at risk of dying,” Dr Thambar says.
“The study’s endpoint is to look at the amount of dead tissue and determine the impact of this stem cell therapy. Early results from the clinical trial are indicating that administering stem cells soon after a heart attack does result in less heart muscle damage. Otherwise, patients are at risk of having long-lasting heart damage.”
Graham, happily retired with a wife, two sons and six beloved grandchildren, says he took little convincing to join the trial. “The long term effects are still unknown because it is too early and the trial is ongoing, but I received very thorough follow-up and today I’m feeling fine. I’m back doing walks, cycling and playing with my children.”
Of course, Graham’s survival story began the moment an ambulance arrived at his door. Under new protocols being tested and researched at HMRI, his ECG diagnostic test was transmitted from the scene to a smartphone being carried by a John Hunter Hospital cardiologist.
Then came his prompt delivery to the cardiac theatre, bypassing Emergency, where his cardiac team was waiting and ready for him, having been able to make an early diagnosis and triage.
All of that is the result of fantastic work by another clinician aligned to HMRI, Professor Andrew Boyle, and his laboratory team … a prime example of research and clinical practice working in harmony to improve patient outcomes in hospital.
“Our saying is ‘time equals muscle’,” Professor Boyle says. “The quicker you get the artery open, the better it is to salvage the heart muscle that is dying by the minute, so we have been researching the clinical effectiveness of new time-saving measures.
“We have two approaches to remedying a blockage – one is to open the artery mechanically with a balloon and stent, which we can do at John Hunter Hospital. If you’re further afield, the best treatment is a clot-dissolving drug [Tenecteplase] administered in transport by the ambulance drivers, prior to reaching a hospital.
“We find in about two-thirds of the latter cases [for those who received the clot-busting drug] that the arteries are already open by the time the patient reaches hospital.”
Like Graham, 82-year-old James Stokes is another “poster child” for swiftly opening the artery. According to Professor Boyle, James’s heart attack had the potential to cause considerable damage, but recent scans have shown remarkable results.
James had the fitness levels of an extreme athlete. Seven years ago he competed in his first ever Australian Championships for indoor rowing and won two events – then came international titles.
He has attended a local gymnasium almost every day for the past 20 years, doing an intense workout regime involving weights, bike training and rowing for thousands of metres.
“The day of my heart attack I was one of the first at the gym and spent 90 minutes training. Afterwards I felt a severe pain starting in my chest, right over the sternum, then I began perspiring and I immediately said to my wife, ‘Janette, get the ambulance’.”
Dr Boyle inserted two stents, including one in the main artery, and within just a few hours James was in the coronary care ward, still in his gym clothes and on the way to a full recovery.
“I was originally on about 60% of my exercise capacity and chafing at the bit, but after my last scan Professor Boyle said I can do anything I like. My heart’s in good nick and he said ‘go for it’.”
The 12-month survival rate for heart attacks in the Hunter New England region is now 93% for those who come through the new research-inspired ambulance protocol, Professor Boyle says. That’s a remarkable improvement over years gone by.
“If an artery is blocked for more than six hours then most of the damage is already done. In our region, patients are often at least six hours away, so delivering the clot-dissolving drug up front within 10 minutes of diagnosis means that more are surviving and doing better afterwards,” Professor Boyle adds.
“Also, with the ECG being transmitted from the ambulance to the cardiologist’s smartphone, the entire cardiac team can be activated ahead of the patient’s arrival.”
