Thursday, October 03, 2002

Huggins faces long road back, survivors say




By Tim Bonfield tbonfield@enquirer.com
The Cincinnati Enquirer

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Huggins
        Bob Huggins, meet Jim Chikar. Like thousands of Tristate residents, Chikar survived a heart attack similar to the one suffered Saturday by the University of Cincinnati basketball coach.

        And like many fans' hopes for Huggins, Chikar, a 56-year-old bond underwriter for Great American Insurance, was back to work about three months after suffering a heart attack in April 2000.

        But it wasn't easy. Along the way, Chikar was treated with two stents and endured numerous tests and two return hospital visits.

WARNING SIGNS
  If you have heart attack symptoms, call 911. Delays in treatment increase the risk of death and permanent heart damage.
  Common signs:
  • Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts for more than a few minutes or goes away and comes back.
  • Pain that spreads to the shoulders, neck or arms.
  • Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath.
  Uncommon signs:
  • Atypical chest pain or abdominal pain
  • Nausea or dizziness without chest pain
  • Shortness of breath without chest pain
  • Unexplained anxiety, weakness or fatigue
  • Palpitations, cold sweat or paleness
  Source: American Heart Association
        He now lives with a shelf of medications. He struggled to adjust unhealthy habits. And he still goes to cardiac rehabilitation three days a week.

        Chikar knows that the UC basketball coach has just begun the road to recovery, even though Huggins is showing signs of progress and was moved Wednesday from Pennsylvania to Christ Hospital in Cincinnati, where he was to be evaluated during the next several days.

        “The easy part was going to the hospital. After I got out, that's when the real job began,” Chikar said.

        For Chikar, the heart attack came while he was sitting at his desk at work. It wasn't the crushing, elephant-on-your-chest feeling that many describe. It felt more like a sudden, bad case of gas, combined with breaking out in a heavy sweat, he said.

        “I knew right away something was wrong,” he said. “But I never did have a lot of pain.”

        He received two stents at St. Elizabeth Medical Center South in Edgewood. Tests conducted weeks later confirmed that he suffered significant heart muscle damage, resulting in a diagnosis of congestive heart failure, a chronic condition in which a weakened heart fails to pump properly.

        About 47,000 people a year die from congestive heart failure, according to the American Heart Association.

        Dr. Dean Kereiakes, Huggins' cardiologist, was not available Wednesday for comment. Other cardiologists say it will take about a month to fully assess the damage caused by Huggins' heart attack. The extent of that damage will determine whether he will need further treatments and when he can return to work.

        Huggins is likely to face a battery of echocardiograms, treadmill stress tests and other imaging tests to track his heart's recovery.

        “It's difficult to tell early on how much of the heart damage is permanent,” said Dr. Craig Sukin, a cardiologist with Cardiology Associates of Cincinnati. “That's why it's really too early to tell whether he could return to work full-time.”

        During the first 48 hours, which passed Monday, doctors were watching for the possibility of a second heart attack and for any signs of irregular heart rhythms that could be early indicators of significant cardiac muscle damage.

        During the first several days, doctors also check for signs of clogging in other cardiac arteries, as well as for unusual mechanical problems with the heart, Dr. Sukin said.

        If doctors find more extensive artery clogging, they may install more stents. If the clogging is severe, or unreachable for a stent, the patient might need open-heart bypass surgery.

        One reason it takes about a month to assess damage to the heart's pumping capacity is that in some patients the heart behaves for several weeks as if it were stunned, said Dr. Daniel Snavely, an interventional cardiologist with University Cardiology.

        That means early tests indicating a poor pumping capacity might be misleading. In some cases, later tests reveal strong improvements in heart muscle function without requiring aggressive treatment, he said.

        The key measure of the heart's pumping ability is called ejection fraction. Normally, each heartbeat pumps out about 55 percent of the blood inside its chambers.

        Congestive heart failure - the most serious long-term risk Huggins faces - begins to occur when the ejection fraction drops below normal. When the ejection fraction is between 35 percent and 55 percent, a person has “mild” heart failure. “Moderate” heart failure ranges from 25 percent to 35 percent. “Severe” is anything below 25 percent, Dr. Snavely said.

        The worse the heart failure, the higher the risk of irregular heartbeats, which can cause sudden death and typically require a defibrillator to treat. The weak pumping action also allows fluid to build up in the lungs and can affect liver and kidney function.

        Aside from damage to the heart, Huggins faces two kinds of risk from receiving a stent.

        During the first several days, about 1 percent of patients develop acute thrombosis, or sudden clogging, inside the stent.

        A more common, longer-term stent risk is called restenosis. In about 20 percent of cases, scar tissue builds up in reaction to the stent and blocks the artery. If it happens, it typically would be within the first six months after placing a stent.

        This can be treated with radiation or with bypass surgery. In nonemergencies, more patients are getting drug-coated stents that can help prevent restenosis.

        Patients who suffer massive heart attacks typically wind up taking several kinds of medications.

        They take anti-clotting agents, including aspirin and Plavix; cholesterol-controlling drugs such as Lipitor and Zocor; and beta blockers such as Toprol or Coreg to slow the heart rate. Many also take an ACE inhibitor, such as Zestril, to dilate blood vessels and reduce blood pressure.

        Patients typically leave the hospital taking one from each of these classes of medications, Dr. Snavely said.

        And then there's the cardiac rehabilitation. Doctors usually recommend six to 12 weeks of supervised exercise, three days a week, starting about three to four weeks after a massive heart attack.

        Patients often start out wearing a heart monitor while they exercise, using machines that can be programmed to hit target heart rates set by the physician.

        Beyond exercise, cardiac rehabilitation programs offer classes on healthy eating, quitting smoking and managing stress, said Sue Polaski, manager of cardiac rehabilitation at Good Samaritan Hospital and the TriHealth Pavilion.

        Jim Bruckmann, a 69-year-old College Hill resident and retired assistant principal of Western Hills High School, was at Good Samaritan Wednesday to restart his 12-week rehab program after suffering a heart attack in May.

        “They say the best thing to do is do your exercise,” he said.

        Both Chikar and Bruckmann said the hardest thing since their heart attacks has been to adjust their lifestyles.

        “I remember being served my first (egg substitute) right here in the hospital. Blaaaah!” Bruckmann said.

        Bruckmann, a Cincinnati native, says he's been a UC basketball season ticket holder ever since the Shoemaker Center opened.

        Now, he has words of advice for Huggins: “Welcome to the fraternity. Follow your doctor's advice and give up some of those big steaks.”



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