42-year-old female patient suffered sudden cardiac arrest; had history of multiple uterine fibroids
Cardiac Arrests are on a rise in covid recovered patients
Bengaluru, April, 2022: In what may be termed as a miracle, a 42-year old lady got a new lease of life at Fortis Hospital, Bannerghatta Road post suffering from sudden cardiac arrest. The lady had a history of Covid-19 related illness two months back and had undergone Covid treatment at home. She was presented with a history of multiple fibroids uterus, heavy bleeding, painful periods and severe anaemia. She was admitted at the hospital for removal of uterine fibroids and had no history of comorbidities i.e. Diabetes, Hypertension, respiratory illness etc.
The only significant past medical history of her was a mild episode of covid-19 infection (during the third wave) 8 – 10 weeks prior to surgery, despite taking 2 doses of vaccination.
As the patient was anaemic, a proper workup was done for over 10 days to correct her anaemia followed by a coagulation test to rule out any possibility of blood clotting. After a series of examination, doctors went ahead with the surgery for removal of uterine fibroids.
While the surgery was successful, the patient complained of giddiness and uneasiness on post-operative day 1, while she was walking and collapsed suddenly. She was later found to have a cardiac arrest. The team of doctors and nurses performed 15 cycles of CPR (cardiopulmonary resuscitation) and managed to revive her, post which she was shifted to medical ICU for further management.
She suffered from Acute Pulmonary Embolism (blockage in the pulmonary (lung)artery) along with Acute Kidney injury, a condition where kidneys stop functioning properly. The multi-disciplinary team of doctors who treated the patient comprised of Dr Manisha Singh – Senior Consultant, Gynaecology and Head of Reproductive Medicine; Dr Rajpal Singh – Director, Intervention Cardiology, Dr Padmakumar, Head- Critical Care Medicine, Dr Ashish Parekh, Consultant-Nephrology and Dr Sudha Menon –Director, Internal Medicine at Fortis Hospital, Bannerghatta Road.
Dr Manisha Singh – Senior Consultant-Gyanecology and Head of Reproductive Medicine, explains, “The patient came to me with a history of large uterus with fibroids and a desire to achieve a pregnancy. Post thorough examination, she was listed for myomectomy (a surgery to remove fibroids). The procedure was uneventful and 8 large fibroids were removed. Thirty hours’ post-surgery, as the patient was mobilising, she collapsed suddenly and was diagnosed to have had a cardiac arrest.
“Immediate CPR (Cardiopulmonary Resuscitation) was initiated and thrombolysis was administered to dissolve the clots in the lungs. The patient also suffered Acute Kidney Injury secondary to the clot and needed dialysis for 72 hours. She recovered completely in a week and was discharged on blood thinning tablets. The source of blood clot was not found despite thorough evaluation. The most likely cause is Covid infection that predisposes individuals to blood clots for a few months’ post infection” she further added.
Dr Rajpal Singh-Director-Interventional Cardiology, Fortis Hospital, Bannerghatta Road, said, “This lady had undergone a surgery and suffered an episode of cardiac arrest which was later diagnosed to be pulmonary embolism (acute clot in the lungs). This condition is not very commonly seen in people who undergoes surgery and generally they are put on blood thinners post-surgery. But what was significant to notice was that she had recently recovered from covid illness, and covid per say is pro thrombotic and increases the risk of clot formation which might have been the contributory factor. The most effective treatment option in such acute cases is thrombolysis that is thinning the blood or breaking the clots that are formed in the arteries. However, it was little risky to apply this line of treatment for this lady as she had recently undergone a surgery. Nonetheless, it was a very important decision for us to take as we had to save her life keeping aside the complications involved although we had put the blood products on standby. Fortunately, the treatment went on well and it was delightful to see her going back home. On her follow up visit to the hospital, she was completely fine and will continue to be on blood thinner for another 6months to a year.”
Dr Padmakumar, Head, Critical Care Medicine, “As soon as the patient was shifted to ICU, we immediately placed ECHO cardiogram to access her heart function. We found out that her heart chambers were dilated and her pulse was very very feeble, within seconds she suffered another cardiac arrest and we started the CPR process again. By that time, it was clear that she is experiencing Pulmonary Embolism, in this condition, there won’t be any blood circulation going from the heart to the lungs. Usually, in this situation, we consider Thrombolytic drugs which dissolves the clot, however in a post-operative patient like her it was a risk as she might bleed further. Therefore, we consulted a cardiologist, Dr Rajpal as it was a question of life and death and we decided to go ahead with Thrombolytic therapy.
Immediately, after using Thrombolytic therapy, we saw a remarkable improvement in her blood pressure and it remained stable for another couple of hours. As her risk of bleeding was very high, we were closely monitoring her condition and had kept blood supplements & blood products on standby if in case there is any bleeding. While, we also kept on monitoring other organ dysfunction in order to be on a safer side. Luckily, her condition improved over the days and we witnessed no damage to any other organ, even though she had suffered kidney injury, the dialysis improved her condition. In her past medical history, we found out that she had suffered from Covid-19 two months back and several incidents has shown that Covid-19 has the tendency to put a person at high risk for thrombotic complications up to 3 to 6months time. It was a remarkable achievement for the entire team to see this patient completely normal in a week’s time.”
About Fortis Healthcare Limited: Fortis Healthcare Limited – an IHH Healthcare Berhad Company – is a leading integrated healthcare services provider in India. It is one of the largest healthcare organizations in the country with 27 healthcare facilities (including projects under development), 4100 operational beds and over 419 diagnostics centres (including JVs). Fortis is present in India, United Arab Emirates (UAE) & Sri Lanka. The Company is listed on the BSE Ltd and National Stock Exchange (NSE) of India. It draws strength from its partnership with global major and parent company, IHH, to build upon its culture of world-class patient care and superlative clinical excellence. Fortis employs 23,000 people (including SRL) who share its vision of becoming the world’s most trusted healthcare network. Fortis offers a full spectrum of integrated healthcare services ranging from clinics to quaternary care facilities and a wide range of ancillary services.
