Why did they continue to just resuscitate and not operate?

Hi everyone

Some of you know that my dad suffered from a sudden, fatal ruptured MI last september.  I am now wondering why, when he was brought into the hospital, the team just continued resuscitation attempts and after about 10 minutes the docotr told me they had stopped the resusciation as it was not working.  That bit i can understand because the ambulance personnel had been resuscitating for 45 minutes at our home and then all the way to hospital as well.....

What i can't understand is my dad had a ruptured heart.  No resuscitation was going to work.  Although i don't expect the ambulance personnel to know that, the doctor surely should know that this is a complication of a heart attack and that....as my dad presented with sudden collapse and cardiac arrest, rupture could have occured?

As i understand it when rupture occurs, although it's almost always fatal, an operation can occasionally save the patient.

In the middle of being told my father had died i vaguely remember someone saying something like 'we could open him up and see what has caused this but he is too weak to take that, he would never survive.'  This being said to me after i was told they'd stopped resuscitation and he had therefore died.

Maybe it is the case that they only attempt an operation on someone who is still showing signs of life.....?

but then the doctor said we would need a postmortem (autopsy) to see why he had died so suddenly.  

This leads me to wonder whether the doctor was even aware of myocardial rupture?

and while thinking about it, the ambulance people really wasted a lot of time with resuscitation considering it was never going to work.  I am not blaming them, there may have been really good reasons why they spent 45 minutes resuscitating at the house.....but if a rupture has occured, that wouldn't help.  Obviously they know more than me, but i just need to check things.  I would have thought the best place for someone requiring resuscitation is the hospital, as quickly as possible?  (and then a doctor at the hospital who is prepared to attempt a repair on a rupture).

Does anyone have any knowledge in this?  I was thinking of asking for the doctor's report from the hospital.  What do you think?  Or should i let it go now?

Thanks for listening

[erijon]

Hey again, nice to hear from you. First off, from what I've read there is no procedure that can repair a rupture of necrotic heart tissue as was your father's case. In addition, the patient needs to be as stable as possible to undergo any type of surgery. If your father had no vitals, there was really nothing to offer by way or an emergent surgical procedure that would have made any difference.

Since your first post, I have read many articles on MI Ruptures and the one thing that they all say is that these are rarely survivable, if at all.

I know this doesn't make the questions go away, but I hope it helps.

Jon

[ireneo]

I don't think emergency personnel like ambulance folks are allowed to stop resuscitation efforts. I think by law they have to keep it going until there's a doctor present to make the call. An experienced doctor can probably guess what may have happened in the heart but only an autopsy can tell them for sure. Just like an experienced oncologist can guess whether tissue looks malignant but only a pathology test will say for sure.

Considering the long time involved in resuscitation attempts, the doctor was probably pretty confident that the window of opportunity to fix things had passed. So they stopped.

The only question I have is why the ambulance folks spent 45 mins. at the house. Maybe it took that long just to get everything going. Time flies in situations like that.

[Rosemary349]

thanks for your replies.  Out of interest what are the vital signs that a doctor looks for in an unconcious patient?

The border between life and death is now of fascination to me.  How does a doctor know when to stop?

I generally believe that they all did a great job with my dad, but i have to question it to be sure.

[Flycaster305]

The doctor doesn't know the border between life and death in many cases.  I'm a volunteer in a Cardiac ICU unit and have seen doctors and nurses work extremely hard to save people who come in clinically dead who's health directives aren't known. It's important that our health directives be on file at the local hospital,

I had what was called a spontaneous dissection of the RCA artery, but it was just a leak, not a rupture or I'd be on the other side of life.

  

[grendslori]

Rosemary, My father died the same way; from a ruptured heart. There wasn't even an attempt to revive him; there was no point. This is not something you can fix. They know a rupture of the heart happens when the skin turns all blue. Usually people who die like this have a history of high blood pressure or a dilated cardiomyopathy where the heart wall is so thin it gives out. Having worked as an EKG supervisor and technician, I have been called to many statarrests where people have had to be worked on. Usually most doctors will work hard to bring a person back for about 45 minutes; after that, the chances of bringing anyone back is basically nil. Surgery would have been out of the question with your father, as it would have been for mine, because the blood loss is too great when a rupture takes place. Take care

[ed34]

I am wondering how an ambulance crew, or Cardiologist for that matter would know if a rupture had occurred by looking at the patient? Would there be lots of swelling from internal bleeding? If the ambulance crew perform cpr, would it really pump blood out of the heart? or would it just squeeze through the rupture? I always thought a rupture occurred about 24 hours or longer after a heart attack, maybe this is wrong.

[grendslori]

The way they can tell if it is a rupture is because the body is blue. (As i stated in my answer above) There wouldn't be any swelling because the heart wouldn't be pumping any longer. If the rupture is small and the paramedics used CPR then the blood probably would go through to the body as well as through the rupture. If the rupture is a really bad one; death is immediate and the person dies.

[Rosemary349]

I've been told by a cardiologist that ruptures are relatively rare and less likely in anyone with existing heart disease.  They tend to occur in hearts that have not experienced angina and so haven't thickened in response to a previous lack of oxygen.....but even then they are rare, but it is a complication of an MI.

Ed34....you are right they tend to occur later following an MI, i think my dad must have had a heart attack in the preceding two days.  Unfotunately no one has ever taught me or anyone else i know that indigestion felt in the stomach can be the only symptom of a heart attack....my poor dad was looking out for chest pain and not getting it, so he was putting up and shutting up with the stomach discomfort.

Grendslori - i'm so sorry to hear about your dad too.  I have been told that an operation is sometimes considered but with a very low chance of success, virtually nil.  My guess is if the person suffers the rupture in the hospital and they can identify what it is quickly.....i really don't know.

Ed34, i don't think the doctor's would know if a rupture had taken place by looking but I would expect them to guess...as i understand it the two main reason why someone won't recover from a cardiac arrest following an MI is either ventricular fibrillation (which they know what to do about) or rupture..... (or of course too long a delay before resuscitation is attempted and/or large areas of heart muscle damaged).

I know i'm splitting hairs, but i can only let something rest when i've gone through it wit a fine tooth comb.  It's just the way i am.  I can't have blind faith in doctors, they are not infallible.  Although i know you too don't blindly trust them.  I'm not saying they don't do a brilliant job, most of them do and all credit to them....but many people are intelligent enough to do their own research.

I've now got my cholesterol figures, had bp and stress test.....all because i pushed for it...and i had to push.  People should be invited along for cardiovascular risk assessments and they are not.  Most people don't even know how important it is.  Everything i know now i've had to fight to find out.  No one has freely given me information (apart from you guys here)....but they will freely invite me along for cervical screening and tell me all about that and yet it's not the biggest killer.  It doesn't make sense and i cannot trust that system.

[ed34]

I know Doctors are not infallible but I think the problem is them gaining experience. It's probably very different in practice to being taught verbally. It's a bit like being told how to drive a car in a class room, then being shoved in a car and told to drive it. The basic knowledge is there, but the experience has to be gained. In ER there are many Doctors who know the basics about all parts of the body, but they don't generalise in a particular area. When my Mother was checked into ER finding it hard to breathe, six different doctors went over her with a fine tooth comb. They all came to the same diagnosis, a chest infection. A Cardiologist was not called in, I think the consultants are only called if they really feel they cannot determine a cause. My Mothers heart stopped in the night and they couldn't restart it. A post mortem discovered atheroscerosis of the coronary arteries as the cause of death. I believe if a Cardiologist was called, he may have recognised the symptoms. Her Troponin was due to be taken 12 hours after the problem started (which is standard) but she didn't last that long. Her ECG looked perfect.
I see it that six Doctors now have gained experience, as painful as it is to me, and hopefully they can use that gained knowledge to save others with the same symptoms. Another good thing which has come of this is that through knowledge of her disease, mine was immediately quickly diagnosed when I had MI. If I had the knowledge then, that I have now, I would have insisted they do an angiogram. We are all learning in our lives but unfortunately we sometimes get some important knowledge when its too late.
I have put what I know to good use and a friend of mine was getting more short of breath than I was. She was also getting strange discomforts in her chest. Her GP diagnosed reflux and asthma, but I convinced her to go to ER and have some tests. Withing 48 hours they discovered a single blockage in her coronary arteries, stented it and now she can run up hills. So really, the knowledge from my Mothers death has helped both me and my friend, its causing a chain reaction.
I know we feel anger at Doctors sometimes, we all have, but they have feelings too, well the majority. When my wife was put onto life support, her consultant could hardly talk and had tears in his eyes. He said they are not supposed to get emotionally attached, but sometimes nature is hard to ignore. He said he just doesn't normally show his feelings but in this case he couldn't hold them back. She wasn't supposed to survive the first night and he stayed with her until 7am continually watching all the monitors. She pulled through. That's what I call a Doctor :)   Not only did he save my Wifes life, he saved mine also because life without her would be empty. I dont know how often that kind of dedication occurs, probably not much, but I'm sure glad he was her doctor.

When I was in CCU, there was a man brought in opposite me. He had a heart condition where it would just jump out of rhythm for no reason. This was explained to him and he was told that he needed a special pacemaker. He was also told that he could die at any time. As soon as the consultant walked away, all his alarms went off. His heart suddenly stopped. Nurses were running everywhere shouting "CRASH" and the consultant ran back over. He spent 30 minutes on this man and got him back. He was shipped off in an ambulance to have a pacemaker fitted immediately. I was astonished at the way that cardiologist did his job and never gave up.