Quickly diagnosing a failing heart

On a warm summer day in 2020, Israel Contreras went for a run in Chollas Park. The 33-year-old father of two had made it a goal to start running again. The first step toward his goal was to time how long it would take to run 1 mile.

“My mile was slow, so I wanted to push myself,” Israel recalls.

He fainted at the end of that mile. Fortunately, a woman who happened to be a nurse was behind him on the trail. She found Israel’s cellphone and the phone number for his mother. She dialed it. Israel’s mother then phoned his wife, who was also at the park that day. Israel’s wife quickly went to where Israel had fainted and paramedics were called.

A week later, Israel woke up in the intensive care unit at Sharp Grossmont Hospital. He had been placed in an induced coma so that doctors could perform a life-saving procedure.

Leading the way
Israel’s heart had stopped functioning effectively. He was in cardiogenic shock.

Cardiogenic shock is a rare and extreme form of heart failure. When it occurs, the heart suddenly fails to pump enough blood throughout the body. The condition is most often caused by a heart attack, cardiac arrest or other serious cardiovascular event. If not recognized and treated immediately, it can result in death or serious complications.

To help his weakened heart pump oxygen-rich blood, doctors had to act quickly before his other organs could fail. When Israel arrived at the ER, doctors immediately started on a cardiogenic shock algorithm — a flowchart for clinicians to follow when a patient arrives at the hospital with possible cardiogenic shock. The algorithm focuses on being able to quickly diagnose cardiogenic shock and, if appropriate, treat it using specialized heart pumps to restore cardiovascular functioning.

Nationwide, a person treated for cardiogenic shock typically has a 50% chance of survival. The low survival rate may be due to not recognizing the signs and symptoms quickly enough to treat it, as well as clinicians relying on previous experience in treating the condition, rather than standardized guidelines.

“When we looked at our hospital data to assess survival rates, we found that we were consistent with what was happening across the nation,” says Dr. Jad Omran, a complex and high-risk coronary interventional cardiologist affiliated with Sharp Grossmont Hospital. “Knowing this, our team worked tirelessly to implement a standardized process to improve patient outcomes.”

Dr. Omran and his team at Sharp Grossmont’s Burr Heart & Vascular Center developed a cardiogenic shock algorithm that mirrors the National Cardiogenic Shock Initiative protocol. Sharp Grossmont is the first hospital in San Diego County to implement the approach to improve survival outcomes.

“The most important aspect of the algorithm is early identification of a patient who may be in cardiogenic shock,” says Dr. Omran. “It is common in hospitals nationwide for patients to arrive in the emergency department and sit there for hours without knowing that they may be experiencing cardiogenic shock.”

How it works
The algorithm provides specific, timed, step-by-step guidelines to rapidly identify patients with cardiogenic shock and transfer them from the ER to surgery in 90 minutes or less.

To swiftly recognize cardiogenic shock, doctors take various assessments in the ER to confirm diagnosis. This includes viewing ultrasound images of the heart and measuring pressure in its blood vessels. Doctors also measure lactate, a substance made by cells in the body that — at high levels — can indicate organ failure.

Once the diagnosis is made, the patient is promptly transported to the cardiac catheterization lab, where the cardiovascular team inserts a special state-of-the-art pump into the lower chambers of the heart to help pump blood. According to Dr. Omran, this particular pump is used in 99% of patients who meet the requirements for treatment with a mechanical device to restore heart function.

“By applying the algorithm and using this specific heart pump, several centers documented that patient survival rates increased to 70% or 75%, as opposed to the national survival rate of 50%,” says Dr. Omran. “If you take into account the grave seriousness of this type of condition, these numbers are outstanding.”

Moving forward
Israel is grateful to be one of the survivors. Doctors had quickly assessed him and inserted the device to help his heart until it was deemed well enough to pump on its own. Israel was in the hospital for approximately 2 weeks, where he was on dialysis, physical therapy and other supportive measures to help his body heal.

It has been nearly 6 months since that fateful day in the park. Israel is working again as a delivery driver and says he is feeling better, but plans to pace himself before running and exercising again.

“My job involves a lot of walking, but I feel the difference between now and before that day,” says Israel. “With the help of my cardiologist, I will continue to focus on rebuilding my strength.”