Dennis Kilnac / Tuesday, February 7, 2023 / Categories: Heart, Patient Story Minimally Invasive Heart Surgery Helps Tom Return to the Basketball Court Tom Caspari thought he was too healthy to have a heart attack. At age 79, Caspari, a business owner and retired banker, still played weekly in a competitive over-40 basketball league, worked out regularly with a trainer and enjoyed an active lifestyle with his wife, Dede, their children and grandchildren. His cholesterol levels were a little high, but otherwise, he was fine. Or so he thought. High Blood Pressure Diagnosis In mid-November, Tom went to Missouri Baptist Medical Center’s emergency department for a nosebleed that wouldn’t stop and learned that his blood pressure was much higher than normal. After treating his nosebleed, doctors sent him home with a prescription for medicine to help lower his blood pressure to a healthy range. Over the next week, Tom noticed he felt tired, with intermittent pain in his left arm that only went away with rest. He also couldn’t complete his workouts with his trainer and saw that his blood pressure remained high. “I took it easy, thinking that my body was adjusting to my new blood pressure medication.” Then, one Sunday morning in mid-December, Tom woke up feeling something was wrong. “I felt a heaviness in my chest that worried me,” he says. After he and Dede arrived at MoBap, the emergency department team monitored Tom’s vital signs and performed an electrocardiogram (EKG) to check his heart’s electrical activity and rhythm. While his blood pressure was high, the EKG results showed his heart muscle was performing at normal levels. Tom also had blood drawn for a test to measure for the cardiac protein troponin. Troponin is sent into the bloodstream when the heart muscle has been damaged, as in a heart attack. “As someone who is used to being active and not sitting around, I was ready to leave the emergency room before the test results were back. Thankfully, my daughter, Susan, and the doctors convinced me to stay,” Tom says. “When the bloodwork results came back, it showed the presence of troponin, which indicated heart damage.” Tom was admitted to MoBap’s advanced cardiac care unit for more testing. As a heart patient, he was assigned a team of physicians and nurses who provide specialized care for patients with heart and chest problems. Diagnostic Procedure Shows Blockages The next morning, Tom met with Stuart Higano, MD, BJC Medical Group interventional cardiologist on staff at MoBap. He is also a part of MoBap’s heart team. Dr. Higano talked to Tom about diagnostic cardiac catheterization (cardiac cath). This non-surgical procedure gives doctors more information about the heart and blood vessels. “I wanted to have the procedure to find out what was happening to my heart so we could fix it,” Tom says. Before the procedure in the cardiac cath lab, Tom was given medicine to relax. Then, Dr. Higano passed a thin, flexible tube (catheter) through a blood vessel in Tom’s groin up into his heart. Next, a dye was injected through the catheter to provide a clear view of blood vessels. After the procedure, Dr. Higano told Tom, Dede and Susan that Tom’s blood test confirmed he had suffered a heart attack. The cardiac cath showed that the vessels at the front of Tom’s heart were 90 percent blocked and the vessels at the back of the heart were 70 percent blocked. “Both my mom and I were surprised when we heard the news. This was a curveball we didn’t see coming,” Susan says. “Although I knew my overall cholesterol had been elevated for the past year, I didn’t realize it had risen well above 200,” Tom adds. “And I never imagined it would lead to a heart attack.” Choosing the Best Procedure Dr. Higano consulted with other members of MoBap’s heart team about Tom’s cardiac cath results and treatment options. This multi-disciplinary approach allows patients to receive care from a specialized team of cardiologists, cardiac and cardiothoracic surgeons along with cardiac nurses with in-depth knowledge of heart diseases and treatments. They meet weekly to discuss patient cases and treatment options and review results. “To improve blood flow to my heart, they recommended placing stents or performing a bypass procedure,” Tom recalls. “I appreciated that Dr. Higano talked to me about the different treatment options and took the time to answer questions. I felt a part of the decision-making process, which was important to me.” Because of his age and health history, Tom decided on stent placement. “I liked that the procedure was minimally invasive with lower risk and quicker recovery time. I also felt I was in good hands with Dr. Higano and the heart team,” he says. To place the stents — small mesh tubes that prop blood vessels open — Dr. Higano performed a balloon angioplasty, a minimally invasive cardiac cath procedure for opening narrowed and blocked arteries. During the procedure, a catheter with a small balloon is used to insert the stent near the blocked area of the artery. When the balloon is inflated, the stent, which is mounted on the balloon, is pushed against the plaque in the artery wall, opening up the artery for blood flow. As with the diagnostic cardiac cath, Dr. Higano passed a small catheter, or flexible tube, through a blood vessel in Tom’s leg up into his heart and placed five stents to open the blocked arteries. After a short stay in the recovery room, Tom returned to the advanced cardiac care unit. “I felt some soreness where they accessed the vessels in my leg and overwhelming relief that my heart issues had been addressed and fixed,” he says. The following afternoon, Tom was discharged to home with instructions to limit strenuous activity, watch for bruising or bleeding and take the medications he had been prescribed. On the Road to Recovery Since returning home, Tom hasn’t had any further chest discomfort, he’s not as tired and every day he feels better. Tom had his first follow-up visit with Dr. Higano Jan. 4. “My heart is continuing to recover, and I’m looking forward to starting cardiac rehabilitation later this month to further strengthen my heart muscle,” he says. “I’m finding that the hardest part of this journey is slowing down to give my body time to heal.” He says this experience has taught him not to ignore warning signs, no matter how small. He also stressed the importance of getting to know your doctors and asking questions. He adds that he is thankful for Dr. Higano and the entire team at MoBap. “The phenomenal care I received has put me on the road to recovery and back on the basketball court.” Common Warning Signs of a Heart Attack Some heart attacks can start slowly with mild discomfort or pain, while others may be sudden and intense. With a heart attack, minutes matter to help prevent heart muscle damage. If you notice the following symptoms of a heart attack in yourself or someone else, call 9-1-1 rather than drive to the emergency department, which can cause delays and increase risk during the pre-hospital time. Chest pain or discomfort Lightheadedness, nausea or vomiting Jaw, neck or back pain Discomfort or pain in arm or shoulder Shortness of breath Heart attack symptoms can vary between men and women. Visit missouribaptist.org/womenshearthealth to learn more about heart attack warning signs for women. 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