Cardiac Sonographer Spots Rare Heart Condition, Helping Save Patient’s Life

What started as chest and back pain for a northern New York man turned into life-saving open heart surgery just hours later thanks to the sharp eye of a Cardiac Sonographer at CVPH and her fast-acting cardiology colleagues across The University of Vermont Health Network.

When the patient first arrived at Alice Hyde Medical Center in Malone two days before Christmas, he underwent an EKG test that indicated he was suffering a heart attack. He was immediately given blood thinners and rushed to CVPH, part of the standard protocol in an emergency situation like this. As serious as the heart attack was, the Invasive Cardiology team at CVPH was about to discover an underlying cause that put the patient in even greater peril.

“When he got here, his symptoms were getting much worse,” Hanna Slim, MD, MPH noted. “His blood pressure was dropping and, clinically, he was getting worse despite the blood thinners that he had received.”

Dr. Slim said that’s when the Interventional Cardiologist on call, Eric Gauthier, MD began the first of several procedures that re-

Eric Gauthier, MD

established blood flow to the heart and stabilized the patient’s condition. While his blood pressure was improving, Dr. Gauthier still had some concerns and ordered an echocardiogram.

Cardiac Sonographer Stephanie Webb was just about to wrap up her shift late in the afternoon when she got the call. As she began her examination of the patient, something caught her eye.

“I immediately put the probe down and I could see this line in the aorta,” Stephanie recalled.

“This shadow that she saw was suspicious for what we call an aortic dissection,” Dr. Slim added.

An aortic dissection is essentially a tear in the inner layer of the aorta, or the body’s main artery. Blood rushes through that tear, causing the inner and middle layers of the aorta to split (dissect). Dr. Slim explained that aortic dissections can be very tricky to diagnose, because they can cause a variety of serious problems including a heart attack, stroke, and kidney failure and can also lead to loss of limbs or death.

While the echocardiogram raised suspicions about a dissection, the pictures were not clear enough to provide a definitive answer. Stephanie advocated for further testing, including a transesophageal echocardiogram (TEE), which made it easier for Dr. Slim and Dr. Gauthier to see what was happening with the aorta.

“We did the TEE and sure enough, the first picture we did, we found this dissection,” Dr. Slim stated.

Aortic dissection is rare and potentially catastrophic. According to the National Institutes of Health, there are an estimated 1,650 to 9,900 cases in the United States annually with a mortality rate of 50 percent in the first 48 hours if untreated. Stephanie, who estimated that she has done tens-of-thousands of echocardiograms in her 22-year career, said this was just the third dissection she has ever seen in her career. It was the first case Dr. Slim had seen in his six years at CVPH.

While the patient’s condition was stable at the time, Dr. Gauthier and his team knew that action on the dissection was needed immediately. He requested a transfer to the University of Vermont Medical Center in Burlington for open heart surgery, which was successfully performed that evening. After some time in the hospital, the patient was able to return home to celebrate a new year – and a new chance at life.

“I cannot speak enough of Stephanie’s professionalism and commitment to patient care,” Dr. Slim offered. “She basically saved this patient’s life. She spoke up about what she saw and stayed at the hospital hours after her shift to make sure the imaging was done. She went above and beyond her responsibilities and truly made a difference in this patient’s life.”

Dr. Slim and Stephanie also praised the teamwork and communication across the University of Vermont Health Network, ensuring the patient received the right care as close to home as possible. They both agreed this case is one they will not soon forget and will inspire them for years to come.

“It feels great. Especially knowing that he is on the road to recovery, and it could have been much worse. At the same time, that’s part of our job, to advocate for the patient, and if we don’t show the physician what we’re seeing, then they can’t see it. I’m glad I helped give the physicians all of the information they needed to make the best decision for the patient,” Stephanie added.

“Yes, ninety-nine percent of the patients we see may not be in such a life-threatening situation,” Dr. Slim continued. “But, every now and then, situations like this come up and it makes us realize why we do what we do. It’s cases like this that basically cause us to pause for a second and think about what we just did. And you know, it keeps us going.”

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