Life had just returned to a new kind of normal for the Cardillo family.
Dominic, 36, finished his recovery from a lengthy course of treatments following surgery for brain cancer and returned to work full time.
Having learned how unpredictable life can be, he and his wife, Lisa, also 36, started taking overnight getaways from time to time—just the two of them, without their kids, ages 5, 8 and 11.
In June, for their 15th wedding anniversary, the couple from Macomb, Michigan, planned a mini-vacation to the west side of the state. They booked a bed and breakfast, got tickets to see the Red Hot Chili Peppers at Van Andel Arena, mapped out a brewery tour and planned to take in some Lake Michigan sunsets.
They checked into their Grandville room and had just popped open a bottle of red wine when everything went wrong.
Lisa felt a burning sensation in her chest, and hot pain seared through to her back. Immediately she felt sick and told her husband, “This is a sign of a heart attack.”
That’s the last thing she recalls. Her memory picks up four days later.
Heart attack to cardiac arrest
What happened next Lisa knows only secondhand: They jumped into the car and Dominic drove toward downtown Grand Rapids. Spectrum Health Butterworth Hospital popped up in a Google search on her phone, and they made it to the emergency department in 12 minutes.
As Lisa’s been told, she climbed out of the car, waved off the offered wheelchair and walked into the emergency department on her own. Then, as she approached the triage desk, she collapsed to the floor, hitting her head on the counter on her way down.
Staff rushed to help her and quickly realized she was in cardiac arrest—her heart had stopped beating. It took CPR and two defibrillator shocks to get her heart pumping again. As the medical team worked, Dominic walked in and realized Lisa lay at the center of the commotion.
The emergency department team performed an EKG and called in Ryan Madder, MD, the on-call interventional cardiologist, to evaluate her heart. They also performed a CT scan to rule out a significant head injury.
“I hit my head, the whole left side of my body was bruised from head to toe, I chipped a tooth, I hurt my left ear … (but) I managed to not break anything,” she said. Nor were there signs of internal bleeding.
“Her EKG showed she was having a heart attack—an acute myocardial infarction,” Dr. Madder said. “We tend to be pretty aggressive about taking patients to the cath lab, particularly when they’re young, after a cardiac arrest. But when they have findings of heart attack on their EKG, we’re even more aggressive.”
Using an invasive coronary angiogram, Dr. Madder pinpointed the cause of Lisa’s heart attack as a tear in the lining of an artery that supplies the heart—an event known as spontaneous coronary artery dissection.
The spontaneous tear causes bleeding within the arterial wall, and the accumulating blood collapses the vessel, blocking blood flow to part of the heart.
It’s a rare occurrence that accounts for less that 5 percent of all heart attacks, Dr. Madder said—though recent estimates say spontaneous coronary dissections may account for up to one-third of heart attacks in women under age 50.
The reasons why a tear like this happens aren’t well understood. But because of the size of the heart program at Spectrum Health, Dr. Madder and his colleagues see several of these cases a year, so he could quickly identify it.
“As soon as I took the pictures of her heart, I recognized immediately that that’s what it was,” he said.
Fortunately, by the time Lisa made it to the cath lab, the blood flow in her coronary artery had resumed on its own.
So Dr. Madder followed the standard of care for this situation and did not intervene.
“In the vast majority of cases, the artery is going to heal on its own,” he said. “By marching in and trying to fix it with a stent, you can actually make this problem worse.”
Putting Lisa’s cardiac arrest into context, Dr. Madder explained that her heart attack at the bed and breakfast triggered an abnormal heart rhythm called ventricular fibrillation, which then caused her heart to stop.
“One of the most common causes of cardiac arrest is that the patient is having a heart attack,” he said. “It’s actually the heart attack that’s the primary problem. The cardiac arrest is a secondary phenomenon that is triggered by the heart attack.”
Worst fears realized
Lisa stayed the night at the ICU in a medically induced coma so her body could rest.
Her mother soon arrived from the Detroit area with an aunt and uncle to support Dominic, who had no friends or family in Grand Rapids.
But Lisa’s crisis wasn’t over.
During the next 12 hours she developed cardiogenic shock. The heart attack had weakened her heart so much that it wasn’t pumping enough to sustain life.
Milena Jani, MD, the advanced heart failure specialist who followed Lisa’s situation, called Dr. Madder for a consultation. He recommended inserting an Impella heart pump to keep her heart working temporarily while giving it a chance to regain strength.
Back in the cath lab, he used a catheter to place the device in Lisa’s left ventricle.
“When we put this pump in, it can circulate enough blood to keep all the vital organs alive and well,” Dr. Madder said. “We place the pump with the hope that the heart function recovers over the course of the next several days.”
In Lisa’s case, that’s exactly what happened, and after two days, Dr. Madder removed the device.
Four days after Lisa walked into the ER, the doctors brought her out of sedation and, with her family, explained what had happened.
“When I woke up from the coma … I kind of realized that I was living my worst nightmare,” she said. “When you have a spouse that already has a cancer diagnosis and you have young kids, I mean, your worst fear is that something might happen to you, too—and in my case that came true.”
Nothing felt the same. She was too weak to walk or even hold a phone. She felt as if she’d aged 40 years overnight.
“I had gone from being this young, active homeschooling mom” to someone needing help with everything, she said. “In the blink of an eye my whole life changed.”
Lisa was discharged after nine days in the hospital and returned home to a summer of restrictions—no driving, no housework, no playing with her kids. But in August she began cardiac rehabilitation, and that gave Lisa her life back.
“I did 36 sessions of cardiac rehab, which was really the turning point for me. I was a different person on the day that I walked out of my last session,” she said. “I don’t have too many limitations now, and I really worked hard to regain my strength.”
Lisa’s heart was still vulnerable, however. Statistics show up to a 20 percent chance of a coronary artery tear recurring in women her age, so the team at Spectrum Health had wanted to surgically implant a defibrillator before she left the hospital.
Instead, she chose to start out with a wearable defibrillator vest. But when she finished cardiac rehab, she felt ready for the surgery.
Living near Detroit, Lisa could find cardiac care closer to home, but, she said, “I just could not stop thinking about how much I liked the staff at Spectrum and just how much they cared about me.”
So she contacted them.
“When I said, ‘Hey, would you think I was crazy if I came to West Michigan for my care?’ they said they’d be happy to have me.”
That’s when she decided to stay with Spectrum Health for follow-up cardiac care.
In November, Alfred Albano, MD, an electrophysiologist with Spectrum Health Medical Group, implanted a defibrillator in Lisa’s side. The Spectrum Health Cardiac Device Clinic monitors her device remotely, and she returns to the clinic quarterly for checkups.
Less than a year after her heart attack, Lisa has made a full physical recovery and her heart function has normalized, “which is incredibly gratifying,” Dr. Madder said.
Her emotional healing still needs time.
“I live with a good amount of fear that this will happen again,” Lisa said. “Anxiety and PTSD are things that I deal with … but, for my kids, I try really, really hard to have as normal of a life as we can.”
Dominic’s cancer diagnosis three years ago already taught the family about how fragile life can be and the importance of making memories with loved ones. Her heart attack reinforced that lesson.
“It’s really important to make the most of your time—and I know that sounds cliché. But just being able to hear my kids read to me, to watch them do new things and grow, it’s really a privilege,” she said. “And I came really close to missing out on that.”
Today, with two major health crises behind them, the family is focused on regaining a sense of normalcy.
“Life goes on after bad things happen,” Lisa said. “That’s kind of our mantra now.”