The Challenge: Blocked Coronary Arteries and Shock
When 56-year-old Jeff Kratzenberg felt short of breath one day in April 2017, he thought he was having a heart attack. He was right.
Jeff and his wife called 911, and paramedics rushed him to the emergency room at his local hospital.
The ER staff took Jeff to the cath lab right away, where he had a heart catheterization. The doctor made a small puncture in Jeff’s leg and used the main artery to access his heart and look for blockages.
A few years before, Jeff had a blocked artery in his heart that doctors successfully treated with angioplasty and a stent.
Jeff’s team now found that his previously treated left coronary artery had become blocked again. They quickly restored blood flow through angioplasty and stenting.
But when they tried to view his right artery, they found something unexpected. Jeff's right coronary artery was abnormal, coming out of his aorta in an irregular way.
Despite many attempts, doctors couldn't see Jeff's right coronary artery during the procedure.
The Path to the Heart and Vascular Institute at UPMC Shadyside
As Jeff’s condition got worse, his team felt it was best to transfer him to UPMC Shadyside for a heart surgery evaluation. Once there, Jeff had more tests to see if heart surgery was the best course of action given his condition.
Krishna Tummalapalli, MD, director of interventional cardiology at UPMC Shadyside, performed a transesophageal echocardiogram to assess Jeff’s heart function.
Dr. Tummalapalli said:
“When we decide on a patient’s treatment, we always want to choose one with the best possible outcome and lowest risk. Jeff’s case was quite challenging because of his coronary anatomy and his right heart failure with cardiac shock. These factors made the risk of open heart surgery very high.”
The Solution: Transradial Cardiac Catheterization and Stenting
Rather than open heart surgery, Dr. Tummalapalli suggested a transradial cardiac cath to help restore proper blood flow to Jeff’s heart.
Unlike a standard heart cath that accesses the coronary arteries through the leg, Dr. Tummalapalli used the radial artery in Jeff’s wrist. He found that Jeff's right coronary artery was indeed 95 percent blocked.
Once Dr. Tummalapalli opened the blockage, he placed a stent to help hold the artery open and allow for healthy blood flow. A few days later, an echocardiogram showed improvement in Jeff’s heart function.
Jeff spent a few more weeks in the hospital, followed by time in inpatient cardiac rehab at UPMC Mercy, before going home. He remembers very little of his time at UPMC Shadyside but is grateful for the care he received.
Today, Jeff has regular follow-up visits with Dr. Tummalapalli. He also takes medicines to help control his blood pressure and cholesterol in the hope of preventing future blockages.
Jeff's treatment and results may not be representative of similar cases.
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