World Heart Day: How Pakistani expat in UAE survived rare heart rupture

Dubai: A 53-year-old Pakistani expat in the UAE has made an extraordinary recovery after surviving a catastrophic heart rupture, thanks to the swift intervention of surgeons at a Dubai hospital.

Shah Nawaz, who runs a business in Dubai, was rushed to Aster Hospital, Qusais with severe chest pain that had persisted for four days, radiating to his jaw and accompanied by fever.

Medical evaluation quickly confirmed he had suffered a massive anterior wall heart attack, one of the most severe and deadly forms of cardiac emergency.

But the worst was yet to be discovered. Further tests revealed additional life-threatening complications.

Critical discovery

The patient's condition deteriorated rapidly and doctors found reduced movement of the heart muscle in the region supplied by the left anterior descending artery.

More alarmingly, they discovered a rupture in the partition between the heart's chambers, a condition known as Ventricular Septal Rupture (VSR).

This rare but catastrophic complication causes blood to flow abnormally into the lung circulation instead of being pumped to the rest of the body, leading to breathing difficulties, impaired lung function, reduced oxygen supply and, if left untreated, death, said Dr Sandeep Shrivastava, Consultant in Cardiovascular and Thoracic Surgery, who treated Nawaz.

VSR following a heart attack is among the most dangerous complications in cardiology, carrying an extremely high mortality risk without prompt intervention. The patient was haemodynamically unstable and required urgent, high-risk surgery, explained Dr Shrivastava.

Surgical challenge

"VSR after a heart attack is one of the most critical emergencies in cardiac surgery, with an extremely high mortality rate," said Dr Shrivastava.

"This case was especially challenging given the patient's recent heart attack, multiple co-morbidities, and fragile heart tissue. Thanks to timely diagnosis, rapid decision-making, and seamless teamwork, we were able to achieve a positive outcome."

The fragile state of the heart tissue following the infarction made this case particularly complex. A multidisciplinary team comprising cardiac surgeons, cardiologists, anaesthesiologists, and critical care specialists carefully planned and executed the life-saving procedure.

Nawaz underwent surgical closure of the ventricular septal rupture to restore structural integrity and normal blood flow, combined with Coronary Artery Bypass Grafting (CABG) to restore blood supply in the blocked arteries.

Quick recovery

The surgical outcome was remarkable, said Dr Shrivastava. Nawaz was taken off the ventilator on the same day as his surgery, required no blood transfusion during the operation, and was discharged just four days later with improved heart function and a stable recovery.

Understanding ruptures

Heart rupture refers to a tear in the wall of the heart muscle that occurs after a severe heart attack. It's a life-threatening complication where weakened or damaged heart tissue gives way, causing blood to leak into surrounding areas.

A severe heart attack damages the heart muscle, leaving the tissue fragile. If the damaged area can't withstand the pressure of blood pumping, it may tear.

Dr Shrivastava explained that ruptures can involve: the ventricular free wall (tear in the main pumping chamber), the septum (tear between the left and right ventricles), or the papillary muscles (which control the heart valves).

Warning signs

He said the symptoms usually appear suddenly and severely. These can include sudden, intense chest pain; shortness of breath or difficulty breathing; low blood pressure and fainting (shock); rapid or irregular heartbeat; and signs of heart failure such as sweating, bluish lips or skin, and confusion.

Many cases progress rapidly and can prove fatal without urgent treatment.

Prevention focus

Since rupture often occurs after a heart attack, prevention focuses on maintaining heart health.

Key preventive measures are: controlling blood pressure, diabetes, and cholesterol; quitting smoking; limiting alcohol intake; maintaining a heart-healthy diet; and exercising regularly.

It is also important to adhere to prescribed cardiac medications after a heart attack, and to attend regular follow-ups with tests like echocardiograms to detect complications early.

Patients must seek immediate medical care for chest pain or suspected heart attack, said Dr Shrivastava.

Treatment options

Heart rupture constitutes a surgical emergency, he pointed out.

He said the treatment options include emergency surgery such as Ventricular Septal Rupture Repair (sealing the tear in the septum), Ventricular Free Wall Repair (patching or suturing the heart wall tear), and Coronary Artery Bypass Grafting (CABG) to restore blood supply if coronary arteries are blocked.

Mechanical support through devices like an intra-aortic balloon pump (IABP) or ECMO may be used temporarily to stabilise patients before surgery.

Medications can provide supportive care by stabilising blood pressure, reducing strain on the heart, and managing arrhythmias, but they're not a cure, explained Dr Shrivastava.

"Without surgical intervention, mortality rates remain extremely high," he pointed out.