Synchronizing Heart Care Offers Patient a New Lease on Life

Nathaniel (Nate) Rentz has very few memories of what he went through to care for his failing heart in January 2017, but the O'Fallon, Missouri, retiree said he might not be here today if it were not for the doctors, nurses and therapists who cared for him along the way.

Thanks to the coordination of care between the medical teams at Progress West Hospital and the advanced cardiac care team at Missouri Baptist Medical Center, Nate is alive today.

"They are all very special people, and I appreciate everyone who took care of me," said the 63-year-old. "I wouldn't be here without them, my family and friends. I'm blessed to be here."

Nate had no idea that he had a weakened heart when he first went to a local urgent care to find out why he was having difficulty breathing. After several urgent care visits and a visit to the emergency department at Progress West Hospital, Nate was diagnosed with bronchitis and given prescriptions for medications, inhalers and steroids. A smoker at the time, he was also diagnosed with chronic obstructive pulmonary disease (COPD), but his symptoms were not getting any better.

"By the Sunday of the same week, I'd gone out to dinner and my breathing became more difficult," he recalled. "Progress West Hospital was right by the restaurant, so I drove myself to the ER."

First Steps at Progress West

After being admitted and evaluated by the medical team at Progress West, Dr. Christine Craig, an internist at the hospital, recommended an echocardiogram. The echo showed that he had an ejection fraction of 12 percent, which is the percentage of blood leaving the heart each time it contracts. (A normal ejection fraction is 55 percent or higher.) In addition, he had severe mitral valve leakage, moderate pulmonary leakage and moderate pulmonary hypertension, which meant that his heart wasn’t pumping blood effectively.

Suddenly, Nate became a complicated heart patient who required immediate intervention. Dr. Michael Missler, an interventional cardiologist at Progress West, performed a heart catheterization, where it was determined he had ischemic cardiomyopathy (a severe narrowing of the blood vessels), and a balloon pump was inserted to help the heart pump blood.

"The next thing I knew, I was being transferred by ambulance to Missouri Baptist. I asked the driver what was going on, and he said I was in good hands and not to worry," Nate recalled. "I don't remember anything after that until I woke up days later."

Advanced Heart Care at Missouri Baptist

Nate became a patient of the Missouri Baptist heart team, which includes Dr. Joshua Baker, a cardiothoracic surgeon, and Dr. K. Bryan Trimmer, an interventional cardiologist.

After being reviewed by the heart team, it was determined that Nate would not be able to tolerate heart surgery, and next steps were then decided.

"The discussion became how do we support Mr. Rentz through the necessary intervention," Dr. Trimmer said. "The decision was that Dr. Baker would put him on ECMO (extracorporeal membrane oxygenation – a life-saving heart and lung machine that is used with patients who require a temporary support system for their heart and lungs), and I would do the intervention while he was on ECMO."

On January 20, 2018, Nate underwent successful percutaneous coronary intervention, a non-surgical catheter-based treatment of the arteries. He remained on ECMO under sedation for more than a week in the cardiovascular recovery unit (CVR), and an updated echocardiogram, showed that his injection fraction had improved to 35 percent.

"When I woke up, Dr. Baker told me I was a miracle," Nate recalled. "I came through the procedure because of all the doctors and nurses in the CVR."

Nate continued his care with cardiac rehab at Missouri Baptist and later completed 36 weeks of outpatient cardiac rehab at Barnes-Jewish St. Peters Hospital.

Continued Cardiac Care

"Although his ejection fraction went from 12 percent to 35 percent, Nate still had a weak heart," Dr. Trimmer said. "After his discharge, I saw him in the office and we optimized his medication to help his heart, while he was on a LifeVest® for three months."

A LifeVest is an external, wearable defibrillator that continuously monitors a patient’s heart rhythm and delivers a treatment shock to help should a life-threatening rhythm be detected.

"I was fortunate that I was never shocked with my LifeVest, and three months later, I was able to get an implantable defibrillator at Missouri Baptist," Nate said.

Now, more than a year later, Nate is back to doing the activities he loves, including, bowling, working in his yard, being a Praise Dancer at his church and singing in the choir.

"Although I don’t remember much, everybody told me my family and friends were always with me in the hospital. I had two brothers and nieces from Florida visit, my partner, Robert Goedecke, was at the hospital every day and my friend, Carol Russell, who is like a sister to me would spend the night," he said. "I appreciate that someone was always present. I’d never been a patient at Missouri Baptist before, but if I had to go anywhere, that's where I want to be."

Dr. Trimmer said Nate has a good prognosis now that he has quit smoking, has a dual chamber ICD (pacemaker/defibrillator) and is taking care of himself.

"Thanks to the coordinated care from the heart teams at both hospitals, Nate's got his life back," said Dr. Trimmer.

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