Mom had a heart attack

In My Humble Opinion
1

She was just sitting there on the computer. Got chest pains, sweats, dizziness… so like any good idiot, she took a Tums and went to lie down, waiting 45 minutes before calling 911.

It happened Sunday, at her home in Montreal. She had “a scan” today and was told she needs a quad bypass because stuff is blocked pretty bad. She said some were 30% and some were 60% blocked, but she doesn’t know enough about medical stuff to tell me exactly what the doctors are saying and what they mean. She’s flipping out, she wants to go home and get things in order before the surgery but I told her that’s insane, since the doc said that since this happened with no exertion, the risk of a fatal heart attack in the next couple weeks is like 1 in 15. I’m sorry if I’m not making sense. I’m not even sure if I’m getting the right info right now.

She’s depending on me to ask the right questions and help her make the right decisions. I’m hundreds of miles away and I don’t even know where to start. I’m sure dozens here have been through this - what’s important for me to know about her condition? What do I need to ask the cardiologist about her results, her prospects, her care?

I’m going to get there ASAP, but until then, please help me think of the right questions to ask. I’ll email them to my aunt who will bring them to the cardiologist. Christ I’m scared. She’s not even 60.

2

Start with deep breathing, to calm yourself.
Get a list of all her doctors–Family, Cardiologist, surgeon, anesthesiologist.

Ask them to start explaining.

3

Sorry to hear that Antigen. I’m not knowledgable enough to be able to provide you with good questions but best wishes and hopefully she’ll pull through okay. However doctors can be pretty good at explaining things, so listen and if necessary take notes because there might be a lot to take in.

4

Get the doctor’s number. Ask him/her to tell you, in layman’s terms what is happening. 60% occlusion is significant.
Make sure she goes into surgery ASAP, since women are more likely to die from coronary artery disease.

5

I’m so sorry to hear this. I have no suggestions for you, but wish you the best.

StG

6

My thoughts are with you. My father had a heart attack at 52, and it shook my world. The cardiologist was great at explaining everything afterwards, but some doctors definitely have more “bedside manners” than others. Hopefully you get the answers you’re looking for.

7

The only advice I’ve gotten from distant relatives who are doctors that applies to all surgeries is:

  1. You need to get a surgeon who does that exact procedure all the time. Practice matters.

  2. His numbers need to be good, for that kind of surgery. The minimum basic is asking her family doctor which surgeon would be best. Even a hundred miles away, it might not be a bad idea to ask your family doctor, too. Beyond that, I know that facilities and associations keep statistics, but don’t know how to ask for them.

  3. Have it done at a facility where it’s done all the time. If the assistants and nurses all have lots of practice, that’s a good thing. So is having all of the equipment and a streamlined procedure.

Antigen, we’re all hoping that things go smoothly. You might want to ask your Mom and others what you can get into order before she comes home after the surgery. Because you may as well plan for the best as well as for the worst.

She may have to sign a release to allow the doctor to explain things to you and answer your questions. Also, your mother may be asked to fill out a medical directive and assign someone a medical power of attorney. Don’t be freaked by that. At our local hospital it’s a standard requirement to any surgery, even minor surgery.

Tell your Mom we’re rooting for her.

8

Stay calm yourself. Don’t drive too fast getting to your Mom. Sleep and eat regularly, don’t try to stay up all night with her.

Get all the doctor’s names and numbers. As others have said get them to explain in layman’s terms what it going on. Before you go, if there’s a hospital nearby, ask them for those informational pamphlets most places have, they can help.

Is your mom religious? If she is, has she informed her clergy? Maybe a visit from a priest/minister/rabbi/imam could help calm your mother.

9

I’m sorry for you and your family Antigen, my thoughts are with you. If you need anything I’m im Montreal.

As the others have said, try to remain calm.

10

The problem with some of this is that in Montreal you don’t get to surgeon-shop like you can in the US. She’s in the critical care unit in a hospital near home and there are cardiology surgeons there who will do the procedure. They do it often there… I don’t know how to find out the stats and all that and I don’t think I can just call the doctors up. Complicating things is they all speak very little English and when I’m panicked my French gets shaky. I would personally prefer her to be at a different (English-language) hospital but I don’t know how I would do that, since she’s not exactly in shape to take a cab over.

From the info I got tonight, it looks like she’s accepting that the surgery needs to happen, and it will likely be next week. She desperately wants to go home for the weekend to get her things in order pre-surgery. I doubt the doctors will allow it, but if they do, she’s planning on doing her will and advance directives at her kitchen table. I feel like that’s probably something the hospital can help with somehow but again, I’m not sure who to ask. I need to start looking up the French words for all the important things. I’ll be up this weekend.

The doc said her heart is strong, which is why she’s a good candidate for the bypass. So there’s that, at least.

11

Most U.S. hospitals have someone who’ll help patients and their families with things like advance directives and medical powers of attorney. I’ll bet Canadian hospitals have people to do the same. You might try contacting the hospital to find out what interpretation services they have available. You can’t be the first person who’s needed things explained in English rather than French. If they do have interpreters available, they’re likely to be with the same hospital department as the people who do the advance directives and such.

My dad had a quadruple bypass after a heart attack many, many years ago, and he lived a very long time after that. While a bypass is still a major operation and it’s really scary to think about, most major hospitals have surgeons who are well-versed in them. While heart disease is never good, at least now your mom knows about the blockage and her doctors can take action to prevent a future heart attack.

I hope things go well. Regardless of the language they speak, the hospital is definitely the best place for your mom right now.

12

Sorry you’re going through this, Antigen. Seems like you’re getting some good advice, both on the medical end and the practical end – so I’ll move this to IMHO (from MPSIMS) so you can continue gathering more.

13

Last August, I had heart surgery (Aortic valve replacement plus quadruple bypass) at the Cleveland Clinic. I had known for a few years that I’d eventually need a new valve, but I didn’t know I needed bypass until about a month before surgery, when I had a heart catheterization test. Ask her doctor whether she’ll be getting a cath test, because it can show problems that can’t be shown any other way. It may show that she also needs a valve replacement, so they need to do that at the same time. The one thing you DON’T want is for her to be opened up in a year or two.

If her hospital is anything like the one I was in, they’ll give her (and you) a ton of reading material, explaining EVERYTHING you need to know. I don’t think there was anything not covered.

Also ask about the veins harvested for the bypasses. Those will be the last areas to stop hurting. Mine still hurt a little, 5 months later.

The good thing is that your mother is still young, which will shorten recovery time.

14

Don’t worry too much (I know, easy to say). Yes, a heart attack is a life changing event, for the one who has it and their direct family, but at your mother’s age, her prospects are fine. I had a heart attack November 2010 at age 53, and aside from the common anxiety the first two years (everything you feel in that region becomes an alarm), I have been in tip-top shape since I left the hospital. As the cardiologist told me, with the medication I am taking now and the regular check-ups, my chances of having another heart attack are lower than for the average person my age. Wish your mother the best, and keep strong in this difficult time.

15

That’s how she knows it’s going to be a bypass. Initially we were hoping a stent would cut it, but the doctor is saying that a stent would feed too much blood to small blocked areas and might cause a clot to break off and make it worse. I think? It’s so hard getting the information second- and third-hand.

Here are the questions I’m sending my aunts and brother so they can ask:
Questions to ask the doctors

Why are we doing a bypass and not a stent?
Can someone send me a copy of her results? Or at least tell me WHICH arteries are blocked HOW MUCH? some are 30% and some are 60% but I need to know which ones.

Who will do the surgery? (I want his name, to look him up)
How many times has he done the procedure?
What are the most common complications they see with this procedure at this hospital? How often do they happen (to how many people)?
What is the risk of having another heart attack after a bypass operation?
Does a heart attack after a bypass feel the same as one before? Will she know she’s having one?
What is the risk of stroke during/after a bypass operation?

What sort of pre-op procedures need to be done? Have them explain very clearly so Mom can be ready for what is coming. Will they give her anxiety medication? Antibiotics? Will they need to shave anything? Will she have to fast for a day?

Can she have PJs and slippers from home? Books?

How long is the actual operation?
Who can be there in the waiting room while it’s happening? How many of us? For how long? Will we get news during the procedure or will we need to wait until it’s all over?
Can her kids stay with her (in a waiting room) overnight the night before or the night after for support?
Can we ask the hospital to NOT admit certain visitors who might stress her out?

Will they be cutting open her leg to get veins or can they do it laparoscopically (make small holes, put in instruments and a camera)?

Is there somebody in the hospital who can help Mom write her medical wishes down so that we can respect them? Like does she want to be resuscitated, does she want a feeding tube, etc, in case things go bad. If not, and we do it ourselves, will the hospital respect it if her children agree? If so, would we need to get (sister, in Vancouver) in to sign something as well or can she consent by phone?
Is there someone in the hospital who can act as a notary if Mom needs to write a will before the surgery?
If Mom wants to, can she speak to a priest before the surgery? She may not have thought about it, ask her if she wants this.
Does the hospital have English interpreters 24/7 in case we can’t find our words in French?

How long is the recovery period? How long does she stay in the hospital? Which hospital will the recovery period happen in? Does she go home after or to a special care facility?
If she goes to a care facility, do we get to choose? Can it be near (brother) so he can visit more?

How will her life change after?
What does she need to watch for after she’s sent home? Where can she expect pain? Bleeding? What subtle things should she (and we) be looking for as a sign she needs to go back to the hospital?
She doesn’t have a family doctor - who will keep track of her health and medications?
What sort of exercise and diet?
When can she go back to work?
Will there be follow-up appointments in the weeks and months after surgery? How often? Which hospital?
Will she need to be on medications (like coumadin) for life? If so, how will she get her levels checked if she has no car and CLSC (clinic) is far?
Did i miss anything?

16

When my mother would be in for heart-related issues, she needed to wear their PJs because they have a special pocket built in for a monitor she’ll need to wear.

After heart surgery they recommended she sleep in a recliner for the first week or two. It’s easier on her body and easier to get in and out of. We went shopping before surgery for the most comfortable one we could find.

Be prepared to sneak real butter and salt into her hospital room - the cardiac floor has the worse “heart-healthy” meals.

That’s all I can think of for the moment.

StG

17

hugs It’s really scary but these surgeries are second nature to those who do them every day; I’m sure she’s in great hands. I hope she recovers as quickly as possible. In the meantime don’t forget to take care of yourself!

18

There are plenty of English/Spanish medical bi-lingual dictionaries available in U.S. bookstores. A Canadian bookstore might have a French/English one.

19

This is a US story. When my Aunt was in the hospital, we used a local lawyer to write up her financial power of attorney and medical power of attorney, then called a mobile Notary Public in to certify her signature on that and on the filled in advance directive that the hospital had provided. Canada may have different procedures, but I’m pretty sure that if your mother wants to make out a will before surgery, there’s some way to do that from the hospital.

20

Of course you want to hear this from her doctor but I thought I would put in my two cents.

Write down your questions. When the doctors make rounds they may only spend 5-10 minutes in the room and if you forget your questions you may have a long delay until you have another opportunity to ask again. If you have a lot of questions (like you do) try to arrainge a face-to-face sit down meeting with either the surgeon, cardiologist, their NPs (nurse practitioners), or PA’s (Physican’s Assistants).

Bribe the nurses with sweets. Nurses will go the extra mile for patients and families we like.

As a cardiac ICU nurse I can answer some pre-op, intra-op and post-op questions you have here but this from my experience in an American hospital so some things may not be the same.

The general rule of thumb for bypass vs. stent is 2 or less arteries = stent, 3 or more = bypass.
The hospital should have a social worker and chaplain available for patients and their families. If she does not fill out paperwork saying who her surrogate decision maker is the rule here is 1. spouse 2. adult children 3. adult siblings 4. extended family 5. friends who have a reasonable concern. Our social worker goes down the list.
The pre-op procedure is not eat or drink anything starting at midnight before surgery and to have a special bacteria reducing bath twice the night before. And to have the chest and legs clipped. (Not shaved, that results in little cuts that bacteria can enter through.)
She will be able to sign her own surgical and anesthesia consents but the surrogate decision maker should be in the hospital during and immediately after surgery in case of rare complications.
These surgeries generally take 3-5 hours in the operating rooms with only 1-1.5 hours being the actual surgery.
She will come out of surgery with lots of wires and tubes, including a breathing tube and 2-4 large drainage tubes coming out of her chest. For our hospital as soon as vital signs are stable and the patient is awake the breathing tube is removed the same day. The chest tubes come out in 2-4 days depending on the patient. The goal is to have her out of bed in a chair the day of surgery and up and walking the next. One of the most important things to control after surgery is pain, you want her pain controlled enough that she can cough and take deep breaths.
Once the chest tubes are out and she can get up and around on her own (get out of bed and go to the bathroom by herself is our litmus test) she is ready to go home.
Rules on family visiting are specific to the hospital.

These are great questions, good luck!