Dad is in ICU deep sedation for 16 days after heart attack

[assyriangirl]

My dad had a massive heart attack 16 days ago, I had to force him to go to the hospital cuz he didn't want to go and we came in on time, he was coughing a lot but there was no pain and the coughing was from fluid building up around his lungs. His right ventricle was closed and his left ventricle too. Doctors put a balloon with 3 stents in his left ventricle. They said they had to stabilize him before fixing the right ventricle which needs a bypass and also the right one had been closed for a while according to doctors (maybe years). The procedure was successful given the circumstances and it was a miracle according to doctors (they said 90% of people in his situation die when coming to the hospital). They had him sedated on diprivan because he had a breathing tube in his mouth and also he had the balloon going through his leg to his heart. Every 12 hours they were waking him up, telling him to squeeze their hand or our hand and then they would put him back to sleep. I would ask him if he has pain and he would shake his head and we would ask him other question so we know he was mentally normal. On day 5 they removed the balloon. Then we found out he developed pneumonia so his lungs we started dealing with that issue. On around day 7 when we would try to wake him up his heart rate would go up and he would open his eyes wide and get very scared and fight to breathe. Throughout the days they would change his oxygen intake from 50% to 40% and even 70% or 100%. On day 13 they did a tracheostomy so he can be more comfortable and breathe easily and they also put a g tube. They also switched the diprivan to versed. He has a weak heart and it works 20-25% (normal person is 60%). Now we're on day 16 and every time we try to wake him up his heart rate goes up to 140 and now it's taking longer for him to wake up cuz it's been so many days that they've kept him asleep. His heart rate is 80 when he is sedated and his blood pressure is around 92/58 which is low. When they take him off the sedation his BP goes up. I keep asking the doctors what the plan is and they just keep saying "it's gonna take time we have to just wait and keep trying to wake him up until he can tolerate being off sedation". I mean I'm not a doctor but that doesn't sound like a good plan. We've been trying for over a week and we keep getting the same results. It's like they're waiting for him to die. I guess my question is does anyone know how we can take him off sedation without having his heart rate go up and his blood pressure dropping?

[ed34]

No but I know someone who has been through it more than once

[assyriangirl]

The nurse said they're not using beta blockers cuz it's not a heart problem anymore and it might lower his heart rate too much. They're saying he's just getting anxious and agitated and that's why his heart rate shoots up. He's probably uncomfortable because he also developed pneumonia while at the hospital. And he has fluid around his lungs from the heart attack/congestive heart failure. They sedated him so much after the incident that his blood pressure dropped to 74/45. And now they brought it back up to 90/60. Any normal person would be agitated after being sedated for 18 days in that condition >_<  their plan is to keep lowering the dosage slowly and apparently they accidentally did it a little too fast in the morning which is why it failed so now they're going to try all over again very very very slowly. They want to make it so that at first his eyes open, then maybe many hours later his eyes start moving around the room, then slowly he moves his toes a little etc.  
I also told the doctor about the beta blockers and he said he will use it next time. He said before today when they would take him off sedation his blood pressure would drop but today when they took him off sedation his blood pressure was 160/90 and they need to do another echo to see if his heart is working better. It was working only 10-15% when he had the heart attack. Then last week it was 20-25%. And now they are hoping it is higher. And they might possibly move him to a rehab facility.  

Sorry for typing so much thank you for all the information you have given me. You seem to know a lot about this subject are you a doctor?

[ed34]

You are very welcome. Hospitals have a whole array of medications at their disposal, some increase blood pressure, some reduce it. They can speed the heart up, or slow it down. I think the Doctor is spending too much time trying to get your Father awake and have a normal heart rate and blood pressure on his own.

[assyriangirl]

Thank you for helping ed34 you are very helpful >_<  It is very stressful when were not being given any answers or progressing.  

[assyriangirl]

He finally woke up today when they turned off the morphine. He was breathing hard (30-36 breathes per minute) and his heart rate went up to 150-160 and at one point it went up to 202 for a second. He was also having v-tach and his oxygen was on 100%. Oxygen saturation dropped to 82-85.  They put the morphine back on. And they added Versed sedation again. Feels like we're going backwards again. And the nurse also gave something to lower his heart rate I asked if it was a beta blocker and she said yes. Then I asked why the doctor isn't lowering his heart rate when he wakes up using beta blockers and she said "I told him that and he he's gonna do it later, he had a reason for why he's not doing it now but I don't remember what it was".  The only good news is that in the midst of him trying to breathe I was asking him questions and he was responding by forcefully blinking so it's good to know he's mentally intact.

[ed34]

He only needs small doses of beta blockers which won't affect his blood pressure. They could try 2.5mg of Bisoprolol or something similar.

[assyriangirl]

I will ask the doctor tomorrow if I see him, I think they said they cant do that because his blood pressure will drop. When his heart rate goes up too high he starts getting atrial fibrillation and his blood pressure drops and his oxygen level goes down because he starts breathing heavily. They say it's due to a number of things. It could be anxiety, or the pneumonia, or just the heart. He has congestive heart failure so he has a weak heart. His doctors are not giving us answers, they just keep saying we have to wait. They also said if he was a 90 year old they would have pulled the plug on him but since he's only 61 they are trying their best. He's still on morphine 3mg/h but not on a sedation and he opens his eyes but he has this blank stare like he's still dreaming or something. Now I'm worried about his mental state. The neurologist will be taking an MRI tomorrow.  

[ed34]

There are drugs to calm the heart down, such as beta blockers. Why dont they try one of those? It will stop his heart racing.

[assyriangirl]

They've been slowly decreasing it. The new drug they are are using is called Versed. He was on 20 mg/h then they changed it to 10 mg/h. Right now as I'm typing this they have taken him off sedation and it takes about 4 hours for him to start opening his eyes. It's been off for 5 hours and he's opening his eyes and closing it but he's not responding cuz the drug is obviously still in his system. Doctor said it could even take days for him to wake up after being sedated for that long.  They thing is, it doesn't matter how many mg of sedation he is on, the fact of the matter is when he is fully trying to wake up, his heart rate starts going up too. For example he's not on sedation right now but he's also not awake for his heart rate to go up to 140 so how can we call that progression?

[ed34]

no but can't they slowly take him off the sedation instead of suddenly? Maybe a more gradual decline of sedation will have the desired effect?

[assyriangirl]

Also, my dad is 61 years old so he's not really old.  :(