Rose Medical Center November 03, 2017

From Intermountain Jewish News

On Friday, April 11, 2012, Dr. Andrew Ziller was enjoying his day off. He did his morning workout at the gym, came home to his wife Kerry and relaxed before they went to lunch.

“I felt fine,” says Ziller, 59, medical director of Rose Medical Center’s emergency department for the past two years. “When Kerry came down after doing laundry, I was pacing back and forth with this incredible pain in the middle of my chest. I thought it might be my esophagus; I was playing doctor with myself.”

Ziller, who seemed to be in excellent health, never suspected a heart attack. His blood pressure and cholesterol were great. He didn’t have diabetes, was a non-smoker and physically active. Both of his grandfathers had fatal heart attacks, one at 75 and the other, a smoker, at 60.

“I was in denial,” Ziller admits. “It’s hard for me to say this, but I’ve known colleagues who have died or suffered more than I have due to denial. One of my mentors had heart pain. Instead of getting help, he went to bed. “He never woke up.”

In addition to the knife in his chest, Ziller also was sweating — another key symptom of a heart attack. Although he suggested that they have lunch anyway, Kerry insisted they go to the ER. Now.

“So we hopped in our Prius and Kerry drove us to Rose,” Ziller says. “Even then I told her that if the pain went away, we’d still go to lunch.” 

The drive from the Zillers’ home in the Bonnie Brae neighborhood to Rose typically takes 12 to 15 minutes in light traffic..

"Oh G-d, it took forever,” he says of the journey. “Of course we hit every stoplight. My wife says that if Trader Joe’s was open then, we wouldn’t have made it in time.”

Ziller had the presence of mind to call his friend and mentor Dr. Donald Lefkowits, who was working that day, to alert him of his impending arrival.

“I said it was probably just anxiety, don’t worry.”

Lefkowits later told Ziller, whom he’d known for 20 years, that he “heard an unusual tone in my voice that worried him. He knew something really serious was going on.”

When the Prius pulled up to Rose’s ER entrance, Ziller got out of the car and Kerry went to find a parking place. Dr. Lefkowits was waiting outside the door.

Ziller, a Denver native, was born at Rose Medical Center and joined the emergency staff in 1992.

“That day,” he says, “I nearly died at Rose.”

RMC’s ER team reserved a high acute room, where the sickest patients are treated, for Andy Ziller. They hooked him up to an EKG to determine if he was having a heart attack.

Ziller stole a look at the squiggly data on the read-out, which confirmed a heart attack in progress. “At that point, it was a combination of ‘wow’ and ‘this is real,’” he says.

He remembers someone saying, ‘Dr. Ziller, I’m going to start CPR.’ Then everything faded away. “I arrested,” he says, meaning his heart stopped. “It was almost like falling sleep.”

Starting from his arrival at the ER, it took only 42 minutes to do the EKG, inject the dye, locate the blockage, which was in the LAD artery (the “widowmaker”), introduce a wire through the plaque, pass a balloon over the wire, inflate a balloon and insert a stent to maintain the arterial opening.

But it didn’t end there. “Because I arrested, the doctors decided to put me in a medically-induced coma for 48 hours to lower my body temperature,” Ziller says.

“The theory is that if you’ve arrested, it’s possible your brain has been deprived of sufficient blood flow. You chill the brain for 48 hours and allow it to recover.”

Ziller, a member of Temple Micah, has no memory of the coma. “There were no bright lights,” he says.

Two days later, physicians gradually withdrew the coma-inducing medications and Ziller regained consciousness.

“I had an achiness in my chest,” he says. “I knew I’d had a heart attack, but I didn’t know whether they did a bypass or inserted a stent. The tube was still in my throat. I couldn’t talk.

“I motioned for some paper and wrote, ‘Stent?’ The nurse said, ‘Yes, one stent in the LAD.’”

Then he asked about his ejection fraction, which measures how effectively the heart is pumping. A reading of 55 or higher is normal.

“She tossed the question to a nurse at the desk: ‘He wants to know his EF!’ ‘It’s 35!’ the other nurse yelled. “I thought, 35 isn’t bad. When the heart suffers damage, it can’t pump as well.”

The third thing he wrote was, “Tell my wife I love her.” “I have proof of this,” he laughs, “because I still have the piece of paper.”

One of the nurses suddenly remembered that somebody needed to inform Dr. Lefkowits. “He made them promise to call when I woke up,” Ziller says. “I found out later that he sat with me during the coma. “Don was afraid I might be brain damaged; that I wouldn’t be
myself when I came to.”

One week later, Ziller was walking three miles a day.

CVDs (cardiovascular diseases) are the number one cause of death in the world according to the World Health Organization. They claim more lives than cancer, diabetes, Alzheimer’s and AIDS. 

In 2015, an estimated 17.7 million people died of CVDs, representing 31% of global deaths. Of that percentage, an estimated 7.4 million died from coronary heart disease and 6.7 million due to strokes.

Dr. Sameer Mehta, 43, a cardiologist with the Denver Heart practice at Rose Medical Center, is well versed in the lengthening shadow ofheart disease and measures that may curtail it.

Plaque buildup in the arteries, the primary contributor to cardiac disease, “is a long-term process,” he says. “Risk factors include high blood pressure, diabetes, high cholesterol, family history and smoking. Other modifiable risk factors are diet and physical inactivity.”

Depending on their attitudes, patients will either assiduously monitor their numbers or file them away in the back of their minds.

“Some patients pay attention, other’s don’t,” Mehta says. “I’d say over half are motivated to do something.”

A thick fibrous cap covers arterial plaque. If that cap ruptures, plaque is exposed to the bloodstream and forms a clot on the surface, which leads to a heart attack.

Everyone’s heard stories about the ostensibly healthy 55-year-old who sees the doctor for a check up, receives a clean bill of health and has a massive heart attack a few days later. What’s going on here? “The reason that many people may be totally fine beforehand is that the majority of heart attacks stem from minor plaques that don’t cause symptoms until when, and if, they rupture,”

Mehta says. “We think, ‘Oh, I just had a stress test, I’m fine.’ That doesn’t mean you’re fine.”

Because definitive proof of plaque reduction is fairly scarce in the scientific literature, Mehta and four other cardiologists at Denver Heart focus emphasize stabilizing plaque to minimize the chance of rupture. 

“For example, we know Type 1 diabetics are at risk for plaque. This is the cardinal reason that diabetics die of heart disease. If I see a diabetic in the examining room, I will assume he or she has plaque.”

The frightening prospect — “so why fight it?” — in no way negates the necessity of choosing healthier options to improve the outcome, Mehta says. Diet and medications can lower blood pressure and cholesterol. Quit smoking. Exercise. “The data shows that three hours of moderate intensity exercise a week is where we see a reduction in heart disease,” Mehta says. “Walking is a good example.”

Denver Heart, which offers the full spectrum of patient care, offers community seminars at Rose, educates physicians about cardiac disease throughout the city, and has a research component.

While Dr. Ziller’s detailed account of his heart attack leaves little to the imagination, it’s important to note that human beings don’t always exhibit identical symptoms — especially men and women.

“Typically, men and women have similar presentations: chest pain, shortness of breath, jaw pain, sweating, nausea,” Mehta says.

“But we know that at least 10% of the national population don’t have classic symptoms or any symptoms — and atypical symptoms are more common in women.”

He mentions a female patient whose complaint was fatigue, although blockages were subsequently detected. “This was a very uncommon way to present with heart disease. When we fixed her arteries, she felt much better.”

Mehta says the long-term prognosis for women who’ve suffered heart attacks pales in comparison to their male counterparts

“And their risk of a recurrent cardiovascular event, whether a heart attack or a stroke, is higher.”

The medical reason for this discrepancy is as yet undetermined. What is the best course of action for those who lack classic symptoms but are concerned about heart involvement?

“Good question,” Mehta says. “First, you must have an inkling that something is wrong to call an ambulance. “If you’re just experiencing fatigue, make sure you see your doctor and explain what’s going on. He or she will probably do more tests. “But let’s says your stomach feels uneasy and it’s not going away; your chest kind of aches and it’s not going away; your arm hurts, or your jaw, and it’s not going away.

“Whenever something doesn’t feel right, and you think it might be your heart, don’t have someone drive you to the ER. Call 911. “If your heart arrests in the car, there’s nothing you can do. But ambulances are equipped with medicines and defibrillators to keep you alive and bring you here.”

Mehta says the ultimate key lies in pro-active prevention measures, not waiting for symptoms to strike. “It’s about managing risk factors, making lifestyle changes early and having a good relationship with your primary care doctor. Then we can help stop something bad from
happening in the first place.”

Mehta stresses that denial happens to everyone at one time or another. “What you have to understand is that you’re not the person
who can recognize what’s important or try to figure it out. This is your doctor’s job. “If my car makes a funny noise and I don’t know anything
about cars, I can’t say that nothing’s wrong. I bring the car to the shop and have a mechanic check it. “It’s the same thing.”

Life, which he came perilously close to losing five years ago, is good for Andy Ziller. He and Kerry, married since 1989, are turning the corner to their 30th wedding anniversary. The couple’s three daughters, ages 18, 23 and 25, stretch their wings as they pursue studies, careers, dreams — and are grateful that Dad is here to watch. Yet much has changed for Dr. Ziller, in both subtle and pronounced ways. The death of his brother and only sibling David from pancreatic cancer at age 56 has always permeated his awareness. “When I deal with my own mortality, I deal with my brother’s mortality,” Ziller says. “It’s all mixed up into one thing. And I think of my children, and nephews. “We live on in their eyes, our good deeds and helping one another.”

Despite consistently good numbers, Ziller was placed on cholesterol medication because doctors want at-risk patients’ cholesterol to drop even lower. Genetics and a family history of heart disease play a significant role in the development of CVDs. “I flash back to a family photograph where my grandfather, the one who had a heart attack at 60, was holding a cigarette,” says Ziller, who assumed smoking was the prime suspect. Armed with new insight, he can no longer discount genetics. Ziller, who attributes his survival to an expert medical team
and a quick-witted wife, also credits regular exercise for the positive outcome.

“I went into this with a strong heart. I think that helped.” He says that smoking cessation should always be part of the doctor-patient conversation.

"I don’t care if they’re seeing you for a sprained ankle. Tell them to quit!”

While emergency medicine is as professionally satisfying as ever, Ziller now brings an added dose of empathy to the ER. “‘I’ve been through this,’” he reassures patients. “ ‘You’re in good hands.’”

Finally, Ziller urges anyone in the grips of a cardiac crisis to choose the nearest emergency room over a nice lunch. “Don’t do what I did,” he cautions. “Call 911. Get to the hospital quickly. Get evaluated. Don’t disregard your symptoms. Don’t be in denial, like me. “I was lucky.”

Contact Denver Heart at Rose Medical Center at 303-320-6342.