My Mom had two heart attacks within 6 months and is now in Intensive Care! She’s in an induced coma, what’s next for her?

Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM, where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!

This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from our readers and the question last week was

My 40 year old brother has been in ICU for 4 weeks after bowel obstruction and Sepsis! He’s still ventilated with tracheostomy and I don’t want him to die, help!

You can check out the answer to last week’s question by clicking on the link here.

In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer another question from one of our readers and the question this week is

My Mom had two heart attacks within 6 months and is now in Intensive Care! She’s in an induced coma, what’s next for her?

This question from Vasillica formed part of an email counselling/consulting session with me.

Vasillica writes

Hi Patrik,

my mom had a heart attack two days ago…. Unfortunately she’s unconscious, in an induced coma and on the ventilator with a breathing tube in Intensive Care… My question is… Is it necessary to keep her asleep all the time? My Mom is 75 and had a previous heart attack in December last year.

Any insights into this would be much appreciated!

Thanks

Vasillica

Hi Vasillica,

Thank you for signing up for my email counselling/ consulting with me.

I’m very sorry to hear that your Mum had two heart attacks within such short time periods.

If you’re Mom had a heart attack last year in December and is now suffering from a second heart attack, she’s probably too sick to be awake and she needs mechanical ventilation and the induced coma to be kept alive.

Related article/video:

WHAT IS AN INDUCED COMA AND WHY IS MY CRITICALLY ILL LOVED ONE IN AN INDUCED COMA?

A second heart attack within 6-7 months can have devastating consequences to the life of your Mom. Therefore mechanical ventilation and induced coma are generally speaking the right things to do to let her heal, recover and rest.

As long as she needs mechanical ventilation, she will need to be in an induced coma so that she can tolerate the ventilator and the tube in her mouth, otherwise she wouldn’t be able to cope.

It’s very uncomfortable to have the breathing tube and the ventilator attached to your Mom, therefore she needs to be kept asleep for now until she is more stable and can be woken up.

On the other hand, your Mom may be so sick and unstable that she may be asleep without too many medications on board.

You have to ask the doctors and the nurses whether they keep your Mom asleep with drugs/ medications or whether she is asleep naturally because of her illness.

Chances are that your Mom is in an induced coma, but you’ll only know and find out if you ask.

Here is also a link to an article that will empower you to ask questions when you’re in Intensive Care(click on the link)

3 QUICK STEPS ON HOW TO POSITION AND PREPARE YOURSELF WELL MENTALLY, WHILST YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!

There is a very high chance that your mother’s heart has de-compensated after the second heart attack within less than six months. Therefore your mother’s heart muscle is most likely so weak that it’ll be difficult for the weak heart to maintain a good blood pressure.

There is a high likelihood that your mother’s heart is currently not strong enough to maintain other vital organ functions such pumping enough oxygenated blood to other vital organs such as to the liver or the kidneys.

Therefore the oxygenated blood that’s coming from the lungs can’t be circulated around the body and sufficiently perfuse kidneys and lungs.

In order to ascertain how much damage there has been caused to the heart, the Intensive Care team as well as the Cardiologists should have done the following tests and diagnostics

An Angiogram(=an X-ray photograph of blood or lymph vessels, made by angiography) to find out where the heart attack originated, I.e. blockage in major coronary arteries supplying the heart with oxygenated blood(this could have only been done if your Mom wasn’t too unstable)

ECG (=Echoecardiography) to determine and interpret any damage done to the heart

Ultrasounds of the heart as well as a transoesophageal echocardiogram, again determine the size of the damage as well as to determine Ejection Fraction (EF is an important measurement in determining how well your heart is pumping out blood and in diagnosing and tracking heart failure). Normal EF is between 50-75%, anything below 50% may indicate heart failure

Your Mom will most likely need time to recover and she’s also most likely on inotropic support. Inotropes are intravenous drugs given for low blood pressure and a weak heart.

Inotropes are also drugs that can only be given in an Intensive Care environment, they need constant monitoring and experienced staff to manage it.

Therefore, stabilizing your Mom is priority, let her take a rest in the induced coma and give her heart as well as her body recover and heal.

Your Mom will also be at risk of going into pulmonary oedema (=fluids on the lungs) after a heart attack, as the lungs may experience fluid congestion from the inability of the weak heart to pump blood and therefore fluids around. Therefore all vital organs will need close monitoring and management until she is more stable.

The same applies to the kidneys. As long as the heart is weak, there is a risk that the kidneys are not getting enough perfusion and kidney or renal failure may occur.

Again the kidneys will need close monitoring and management in order to sustain functionality.

I am also including two links here for you so that you can find more information about heart attack in Intensive Care and Induced coma in Intensive Care! (click on the links to get more information)

Heart attack

HOW LONG CAN YOU KEEP A CRITICALLY ILL PATIENT IN INTENSIVE CARE IN AN INDUCED COMA?

You should also check out this email counselling/ consulting question here from one of our readers in a similar situation

My husband suffered a heart attack, has been in an induced coma for over three weeks now and is not waking up! What do I do? Help!

Be patient Vasilla. Being in Intensive care after a heart attack can take time, especially since it’s been your mother’s second heart attack within six months.

It’s often two steps forward and one step back.

If all therapy and treatment fails and the heart muscle remains weak, there is a possibility that your mother might need cardiac surgery for bypass grafts.

You can find out more information here

CABG(=open heart surgery)

However this can only be done if

Your Mom is more stable
An Angiogram has been done, determining the location and the severity of the blockage in the coronary arteries

Blockage in the coronary arteries means that the arteries supplying the heart with oxygenated blood have been blocked causing the heart attack.

Ventilation and an induced coma isn’t going to stop your Mom from going to have cardiac surgery.

Recommended:

1:1 phone/ Skype counselling/ consulting with Patrik

Get your questions answered in email counselling/consulting

On the other hand if the damage to the heart is too significant it may increase the risk for cardiac surgery and bypass grafts(CABG), therefore the Intensive Care team as well as a Cardiologist may suggest conservative management for now, looking into surgery down the line when your mother is more stable.

Another option may be to go on ECMO if the heart is really weak, however the Intensive Care team and the Cardiologist may think that at the age of 75 ECMO might not be appropriate as the age cut off for ECMO is usually around 65-70.

Check out information about ECMO here.

ECMO

ECMO is generally speaking a machine bypassing the heart and taking over the function of the heart to give it time to rest and heal. It can also be used for bridging to a VAD or to a heart transplant.

I hope that helps Vasillia, please let me know if there’s anything I can help you with.

Wishing you and your family all the best.

Your friend

Patrik

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