Brought Back from the Brink: CPR Gave Mark a Second Chance

Mark and Diana Kmiec rarely exercised together. On weekends Mark usually woke up earlier than Diana and worked out then. But that Sunday morning Diana asked him to wait for her and they’d work out together, so Mark went outside to work in the yard of their Hardwick home, then joined Diana inside.

They were running in place and then resting when Diana went into the kitchen to stir something on the stove. She heard Mark cry out her name. By the time she reached him, he was on the floor, his face purple.

That’s when Diana’s training kicked in. A registered nurse for more than three decades, she sprang into action, calling 911 and beginning to administer CPR in less than 30 seconds.

Mark had no pulse. “I remember just thinking over and over, ‘you’re not going to die on me, you are not going to die on me,’” Diana recalls. She continued CPR, having no concept of time as she willed her husband to live. The police arrived, and while not every police car in their central Massachusetts town had an AED (automated external defibrillator), “we were lucky this one did,” Diana says. Mark had to be shocked twice to jumpstart his heart rhythm. When the ambulance arrived, paramedics shocked him again.

Somehow, miraculously Mark had come back to them and was awake, alert, and talking by the time the ambulance left to take him to Baystate Medical Center. But his medical situation was dire.

Emergency Surgery Crucial to Survival

Mark was quickly taken from Baystate’s Emergency Department to the Cardiac Catheterization Lab, where he was diagnosed with critical left main disease, which is when the left main coronary artery (LMCA), the biggest supplier of oxygenated blood to the heart’s lower left pumping chamber, becomes blocked. “It is associated with a poor prognosis and has a detrimental effect on the heart,” says Dr. Kelly Wanamaker, a cardiac surgeon at Baystate Medical Center. “Mark’s left main coronary artery was nearly 99 percent blocked. He needed immediate treatment for any chance of survival.”

The first step was for Mark to have an emergency procedure to place an IABP (intraaortic balloon pump) into his aorta to increase blood flow to his heart. This was a successful but temporary solution; Mark needed bypass surgery, and he needed it immediately.

When he arrived at the hospital, Mark received large amounts of blood thinner in the emergency room to quickly improve his blood flow. Unfortunately, that meant he had an increased risk of bleeding complications during surgery. Dr. Wanamaker saw the severity of his blockage and knew these issues were secondary to saving his life. “There were a lot of risks going into that operating room. I knew we could not wait given how critical his disease was,” Dr. Wanamaker says. “I introduced myself to Mark and Diana in the ICU, explained the situation, and they agreed to the surgery.”

Back from the Brink

Coronary artery bypass graft (CABG) surgery is a major operation to restore blood flow to the heart by grafting a healthy vein or artery from another part of the body onto the coronary artery.

“Going into a situation like this in the OR, it’s all about preparing and planning. I run through the possibilities in my mind, possible challenges and how to attack them,” says Dr. Wanamaker. “Surgery is a team sport, and the surgeon needs to rally the room as a leader: conveying the plan, concerns, potential needs for the patient, and considering input from everyone.”

The team set into action repairing Mark’s heart, working from Sunday night until 3 a.m. on Monday morning. From the time he was wheeled out of the operating room, Mark’s amazing recovery began.

Mark woke up and had no memory of anything that had happened to him from the moment he collapsed. Enveloped by the support of his family and Baystate caregivers, he was able to be discharged from the hospital after just four days. From there he recuperated at home and went through four weeks of Baystate’s outpatient cardiac rehabilitation. After just two months, he returned to his job in construction. Dr. Wanamaker says the good physical shape Mark was in before his collapse played a role in his quick recovery.

“And Mark’s story is one where everything had to fall into place. The timing in his situation was critical,” she says. “He received immediate CPR. Paramedics with an AED arrived quickly. The speed in which he reached the Cardiac Cath Lab was vital. Mark’s survival is thanks to excellent timing and efficiency of care.”

Healthy, but a heart attack?

How did Mark, who was in relatively good health - ate a balanced diet, exercised regularly, never smoked, and showed no signs of heart disease - have a near-fatal heart attack? Dr. Wanamaker says the culprit was coronary plaque (made up of fat, calcium, and other substances) that built up in Mark’s arteries. Like a clogged pipe, over time the plaque can build. Many people show symptoms such as fatigue, shortness of breath, or chest discomfort, and people who are overweight, have high blood pressure or diabetes are at a higher risk. But sometimes this plaque build-up occurs without an outward warning.

For those who appear healthy but may have a family history of heart disease or high cholesterol, Dr. Wanamaker says there is an option to help detect the health of your arteries called cardiac calcium scoring.

“This is performed via a CT scan of the heart that measures the amount of calcified plaque in the coronary arteries,” says Dr. Wanamaker. From that result a doctor can calculate a person’s risk of developing coronary artery disease. If you have concerns, talk to your primary care doctor about the possibility of having a cardiac calcium scoring test performed. This relatively new screening test is not part of standard guidelines for heart screenings and may not be covered by insurance.

A New Outlook

Mark plans on retiring later this year. He and Diana look forward to spending the summer watching the grandkids play in their pool. Diana thinks back to this past Easter, when they invited all of their children and grandchildren over for dinner. As she looked around, she felt her emotions rise as she reflected on how different the day would have been if Mark was not there.

“I think of all the milestones he would have missed. He’s irreplaceable,” says Diana, adding, “Knowing CPR changed our lives. You never know when you’re going to have to step in and do something like that. I encourage everyone to take a class; it’s not that difficult. If Mark’s story can help just one person and save a life, it was worth it.”

“I’m thankful for Dr. Wanamaker – Baystate was fabulous; for the Hardwick Police and Fire Department; and for my wife,” says Mark. “She is my hero.”

“Life is very fragile. It can be gone in a heartbeat,” he continues. “There’s a calmness about me now. I look around and just smile. Life is a gift.”