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Local mom shares cautionary story of rare pregnancy complication

1/14/2016

Reported by HonorHealth

Cooper was only a month old on Sept. 8, 2015, when his mother’s right coronary artery began to fray in earnest.  A rare pregnancy complication, it happens once in 64,000 women, with a mortality rate of 30 to 60 percent.

For weeks, Ashley Wachtmann, 32, of New River, had been experiencing pain around her shoulder blades.

“I’d been having the back pain even before Cooper was born, but I had similar shoulder pain with the birth of my daughter, too,” said the mother of three. Doctors at two different emergency rooms had told her it was just her body adjusting after childbirth. “So I didn’t even tell my OB about the pain this time around.”

On Sept. 8, after dropping off her 3-year-old daughter, Kristy, at the school bus stop, she grabbed the baby’s car seat and went inside her home. Bending down to pick up her crying son, she stopped cold. Her shoulders locked from an intense burst of pain.

Leaving the baby in the car seat, she propped up his bottle to feed him. While warming up the heating pad to treat her pain, it moved to her chest. “I began to feel nauseous, and it felt like 500 pounds on my chest with stabbing pain there and in my shoulder blades,” she said. “The pain was so bad I couldn’t talk. I texted my husband to call the paramedics. I thought I was having a heart attack.”

Trying to Breathe

It got worse. Five minutes before the paramedics arrived, cold sweats and vomiting accompanied the pain. Ashley lay on the floor with a fan blowing on her as she tried to breathe. She called her husband again. “Where are they?” she begged. As he tried to calm her, the crew arrived.

The paramedic chief fed Cooper as his team started an IV and gave Ashley chewable aspirin. “They said they weren’t sure I was having a heart attack,” Ashley said, “and asked if I still wanted to go to the hospital. I felt like I wasn’t breathing very well, so I said I did.”   
Halfway to HonorHealth Sonoran Health and Emergency Center off Interstate 17, the paramedics were unable to get Ashley’s blood pressure. The cardiologist on the phone agreed that it sounded like a heart attack and advised the crew to head straight for HonorHealth Deer Valley Medical Center, which has a Cath lab.

“I told the paramedics that with the pain I was in, I didn’t think I’d make it,” Ashley remembered. Morphine lessened her pain, and the ambulance soon pulled up to the hospital. A room full of doctors and nurses greeted her, ready to save her life.

Not Your Typical Heart Attack

Christian Lopez, MD, a cardiologist making patient rounds at Deer Valley that day, received a page from the emergency room: A patient with a possible severe heart attack was on the way. He headed downstairs.

“The initial EKG revealed evidence of a heart attack,” he said. “But Ashley’s case was atypical. She was 32; she was not diabetic or a smoker. The next EKG showed improvement after nitroglycerin and morphine for the pain. That fluctuation in the EKGs was atypical, too. At that point, I said to myself, ‘Hold the presses! Let’s wait to go to the Cath Lab for an angiogram. Let me figure this out.’”

Because Ashley was one month postpartum, Dr. Lopez suspected spontaneous coronary artery dissection – the tearing apart of the three layers of a coronary artery. With a dissection, one of the inner layers tears away from the others. A dissection can be caused by a genetic predisposition – a weakness in the artery walls – and the influence of pregnancy hormones.

“It’s quite unusual, but I had seen a case like this during my fellowship,” Lopez said. He ordered:

  • An echocardiogram that revealed a heart wall defect consistent with the EKG.
  • A troponin blood test, which confirmed a heart attack. The test measures the levels of troponin T or troponin I proteins in the blood. They’re released when the heart muscle has been damaged, as it is with a heart attack.
  • A chest CT scan. “At that point, I didn’t know if it was a coronary artery dissection or an aortic dissection,” Lopez said. The scan ruled out an aortic dissection.

 

Stents vs. Surgery

With the test results in hand, Lopez called in Mayurkumar Bhakta, MD, an interventional cardiologist who performed the next step, an angiogram. The X-ray procedure uses a narrow tube (catheter) threaded through the arm to the coronary arteries. After injecting dye through the tube, Bhakta could evaluate blood flow through the arteries.   

The angiogram revealed that her left anterior descending artery was scarred.

“It looked like the remnants of a previous heart attack due to dissection, most likely in her second pregnancy,” Bhakta said. The right coronary artery was indeed dissecting.

Cardiovascular surgeon Ken Ashton, MD, also was in the Cath Lab, standing by to perform open heart surgery, if needed. He knew that the vast majority of patients like this go to the O.R., but he hoped that stents would prop open the artery instead. During surgery he often finds that the dissecting artery is friable – crumbly – and won’t hold sutures, he told his colleagues.
With Ashley anesthetized, Bhakta started the angioplasty. During this procedure, a balloon catheter placed over a guide wire inserts the stent, a small metal mesh tube, into the narrowed coronary artery. Once in place, the doctor inflates the balloon tip, and the stent expands to the size of the artery, holding it open. 

“I could tell the first wire was in the space where the layers of the artery were falling apart,” Bhakta said. “I left it there and used a second to probe for the true lumen (opening) in the artery.” He found it and placed three of the longest stents manufactured, 38 millimeters each, into Ashley’s right coronary artery.

“It was very tense,” Lopez said. “But the stents held.”

‘A Walking Miracle’

“Ashley was extremely lucky,” Bhakta said. “Cases like this usually end up in surgery.”
After two-and-a-half days at Deer Valley Medical Center, Ashley headed home to her husband and three children to recuperate.

Next came 36 cardiac rehab sessions on the Deer Valley campus to strengthen her heart, plus medication to relieve the narrowing in the left anterior descending artery. A checkup weeks later with Lopez showed the treatment plan was working.

“I feel very lucky,” Ashley said. “The doctors and nurses who took care of me saved my life. In fact, my nurses called me a walking miracle. Several doctors and nurses stopped by while I was in the hospital to see how I was – I know I was an unusual case!”