Heart health warning: Man scheduled for hip replacement winds up with quadruple bypass surgery

A Manhattan man’s dialogue together with his orthopedic surgeon days earlier than his whole hip alternative surgical procedure resulted in a surprising discovery about his coronary heart. 

David Holland, 57, stated his orthopedic surgeon, Dr. Vladimir Schur, PhD and chief of trauma service within the Division of Orthopedics at Mount Sinai-Beth Israel in New York Metropolis, determined to delay Holland’s surgical procedure after discovering that Holland had a coronary heart murmur. 

Regardless of Holland’s assurance that he had his murmur since childhood and had no signs of coronary heart illness, the orthopedic physician insisted he get it checked out earlier than going for surgical procedure.

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Holland informed Fox Information Digital that he was lively previous to his hip concern — he performed hockey and tennis all through his 30s. 

Ache in his hip, not a coronary heart concern, was limiting his exercise stage, he stated. 

“I took statins for prime ldl cholesterol, however apart from that I had no concept something was improper,” he stated.

“It’s so surreal,” he stated. 

He added, “I’m comfortable to be alive.”

Holland stated that Dr. Schur, FAAOS (Fellow of the American Academy of Orthopaedic Surgeons) was not snug doing the surgical procedure and not using a heart specialist’s workup — particularly on condition that Holland had a number of members of the family with histories of coronary heart assaults and a historical past of excessive ldl cholesterol.  

“The affected person needs to be checked out medically.”

“I believed overkill — simply by no means had any points,” stated Holland. “I believed he was being overcautious.”

Schur informed Fox Information Digital that as an orthopedic trauma specialist and joint alternative surgeon, he believes it is very important be thorough. 

“I’m not simply placing metallic right into a affected person,” stated. 

“The affected person needs to be checked out medically,” he stated — noting that it’s “crucial to make sure the affected person is match for surgical procedure earlier than it’s too late.”

David Holland thought he can be having a hip changed. As a substitute, he wound up having quadruple bypass surgical procedure. He credit his medical doctors for his or her “seamless” teamwork on his surgical procedure and for probably saving his life.  (David Holland and Melanie Seymour/iStock)

Schur despatched Holland to Dr. Maurice Rachko, a heart specialist at Mount Sinai Beth Israel Hospital who carried out a easy non-invasive take a look at known as a calcium rating screening coronary heart take a look at.  

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A traditional calcium rating take a look at is lower than 10 milligrams (mg) of calcium per deciliter of blood (dL). Holland’s rating was 2,060.

An angiogram revealed that Holland had 4 blocked coronary arteries of his coronary heart. 

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That end result led Holland to Dr. John Fox, an interventional heart specialist at Mount Sinai Beth Israel Hospital. 

He performed an angiogram that exposed Holland had 4 blocked coronary arteries of his coronary heart. Holland shared that Dr. Fox informed him that the coronary arteries have been so blocked the medical doctors couldn’t use stents.

Dr. Fox shortly consulted with Dr. John Puskas, chair of cardiovascular surgical procedure at Mount Sinai Morningside Hospital in New York Metropolis’s Higher West Facet, the place Holland had the surgical procedure inside days of the angiogram. 

“I went in for a hip — and as an alternative bought coronary heart surgical procedure,” stated David Holland of New York Metropolis to Fox Information Digital.  (iStock)

“I went in for a hip — and as an alternative bought coronary heart surgical procedure,” Holland stated.

He added, “The teamwork was seamless between the medical doctors.” 

Non-invasive process

The take a look at that raised the pink flag known as a calcium rating screening coronary heart take a look at. 

It’s a non-invasive process that entails inserting an IV within the arm and a fast go by a CT scan that measures calcium deposits within the coronary arteries of the guts, cardiac specialists informed Fox Information Digital. 

Calcium rating testing is a “large breakthrough” when it comes to screening for coronary heart illness. 

A better coronary calcium rating suggests the individual has the next threat of narrowing within the coronary arteries and an elevated likelihood of a future coronary heart assault, in line with coronary heart specialists.

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Puskas stated in an interview that calcium rating testing is a “large breakthrough” when it comes to screening for coronary heart illness. 

“The most recent CT scanners are comparatively low radiation, so it is actually a really benign, non-invasive take a look at. It has a really robust predictive worth in figuring out a affected person who has vital blockages of the coronary arteries even earlier than they turn into symptomatic.”

Dr. Puskas stated sufferers usually assume they’re asymptomatic as a result of they don’t acknowledge the signs — and in some instances they even mistake coronary heart ache as heartburn associated to gastroesophageal reflux illness (GERD).

Dr. John Puskas (on left) and affected person David Holland. “The [cardiac] calcium rating is a really goal method of figuring out these sufferers and getting them on the pathway towards remedy earlier than they’ve a giant coronary heart assault,” stated Dr. Puskas.  (Mount Sinai Morningside)

“The GERD is definitely angina. It is coronary heart ache, not heartburn. It’s not coming from the abdomen. It is coming from the guts, but it surely’s been handled with Tums or antacids or no matter,” he stated. 

Puskas added, “The [cardiac] calcium rating is a really goal method of figuring out these sufferers and getting them on the pathway towards remedy earlier than they’ve a giant coronary heart assault. It’s one factor to have a coronary heart assault after which a coronary bypass operation. It’s significantly better to have the coronary bypass as an alternative of a coronary heart assault to stop that coronary heart assault.” 

“It is type of the most recent and best method of doing coronary bypass surgical procedure.”

He concluded, “That basically is the elemental good thing about coronary surgical procedure. It is to stop a coronary heart assault.” 

Puskas stated that CT scanners have gotten extra subtle. 

“We now have CT scanners that can inform us not simply how a lot calcium is within the coronary arteries, however how tight the blockages are within the coronary arteries.” 

Puskas additionally stated Holland underwent a novel sort of open-heart surgical procedure not often carried out in the US. 

Dr. John Puskas (left) and affected person David Holland, who underwent a novel sort of quadruple bypass surgical procedure in November 2022.  (Mount Sinai Morningside)

Holland underwent an “all arterial, no aortic contact, off–pump, quadruple bypass surgical procedure,” he stated. It is a surgical procedure carried out in lower than 1% of sufferers in the US, in line with the cardiovascular specialist.  

The center will not be stopped in the course of the surgical procedure, he stated. There isn’t a use of a heart-lung machine, and the aorta (a giant artery within the chest close to the guts) will not be clamped in the course of the process. 

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By avoiding clamping the aorta throughout surgical procedure, the danger of stroke is lowered, the surgeon defined to Fox Information Digital. 

Such a surgical procedure rewires arteries from the affected person’s chest and one from the arm to assist present blood move to the guts, as an alternative of utilizing veins stripped from the legs. 

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Puskas additionally stated this sort of surgical procedure really rewires arteries from the affected person’s chest and one from the arm to assist present blood move to the guts, as an alternative of utilizing veins stripped from the legs. 

“It is type of the most recent and best method of doing coronary bypass surgical procedure. Fairly completely different from a surgical procedure that was designed within the ’70s and which continues to be the commonest method of doing it,” he stated.

The center surgeon defined the advantages of utilizing artery vs. vein grafts to do a coronary bypass, particularly in a youthful affected person.

Dr. John Puskas (left) and coronary heart affected person David Holland of New York Metropolis. Holland stated is recovering nicely since his surgical procedure this previous November.  (Mount Sinai Morningside)

“We all know the arteries will last more than the veins. Arteries are designed for a high-pressure setting. Veins are designed for a low-pressure setting. After we take veins from the legs and connect [them] to the guts, they’re now in a excessive stress scenario — they usually do not final so long as arteries.” 

The vein grafts have a tendency to wear down in a decade, stated Puskas.  

“Half of veins could have closed in 10 years. That is OK in case you’re 77. However [this patient is] 57. So we wish to give him an operation that is going to final a long time.”

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Holland stated he’s recovering nicely since his surgical procedure this previous November. “I went in on Monday and [was] dwelling Thursday,” he stated. 

Inside per week, he was “capable of stroll a mile and a half with out stopping,” he proudly stated. 

He credit Dr. Shur with probably saving his life, because of his thoroughness. 

“The protection of our sufferers is our first precedence.”

Shur, the orthopedic surgeon, stated that surgical procedure locations stress on the physique and “so something, murmur or shortness of breath — I take it critically.”

He added, “The protection of our sufferers is our first precedence.”

Schur credit his eager sense and thoroughness to his coaching with trauma sufferers on the College of Maryland in Baltimore’s Shock Trauma Heart.

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As for Holland, he hopes his story will increase consciousness for others that it is vital to get checked for coronary heart illness, even when folks do not assume they’ve any indicators or signs. (He has not but had hip alternative surgical procedure.)

Coronary artery illness is the no. 1 killer of people, stated Dr. Puskas. He advised that those that have traditional threat components for coronary artery illness — together with a household historical past of coronary heart illness, diabetes and excessive ldl cholesterol (being chubby and being a smoker are additionally threat components) — to ask a doctor in regards to the calcium rating take a look at. 

Food plan and train are vital in stopping coronary heart illness, he additionally famous. 

“Food plan and train — there’s no substitute. No capsule will substitute that,” he stated.