I'm writing a story in which a background character has a heart attack followed by surgery for it. I need a reason for him to stay out of communication for at least a few days after that. Would there be any sort of complication that would require him to be sedated? If so, how serious would it be long-term/would it be like coming out of a coma when he regained consciousness wrt emotional/physical/mental conditions? (FWIW, this character doesn't /have/ to survive if that would be too unrealistic.)
Hey there! So you need a critical illness as a side effect of a heart attack, huh? Well, let’s get this party started!
I’m going to give you a path that this character could go down, but not the one true only path this could happen. So keep in mind that things like pulmonary emboli, surgical site infections, internal bleeding, and much more can keep your character in the hospital for months after surgery.
First, a great reason to be out of touch would be if he had to be intubated for any reason. Putting a breathing tube down someone’s throat is a pretty good way to render them ineffective, especially because often times these patients are sedated, at least at first.
Now then. Your character has a heart attack. Boom. First step is (usually) calling 911.
Paramedics will arrive, perform an EKG, and diagnose something called a STEMI (ST-Elevated Myocardial Infarction; the kind of heart attack you can see with an EKG. Others require bloodwork to be sure; this is someone whose MI is BLATANT.)
He might be cool to the touch, pale, sweaty, and have his fist clenched over his chest -- this is an actual thing patients do. He may be convinced he’s going to die.
He’s right, but only temporarily.
Okay. So he’s having his STEMI. A particular kind of STEMI, an inferior wall MI, will produced EKG changes. (If you want some medspeak, have the medics give a notification: “I have 4-mm tombstone elevations in II, III and AvF” sounds smart, adding “... with a 2-mm elevation in V4R” sounds SUPER smart and will win you points with medical readers, trust me on this.)
He’ll be given aspirin, but not a medication called nitroglycerine, because Reasons(TM) . Medics may also give him an IV and some fluid, maybe 500mL.
Next he will arrive at the hospital. He may stop in the ER for a quick look by the ER doc and a few hundred mg of Plavix (clopidogrel). After that he’ll be brought very quickly to what’s called the cath lab, or cardiac catheterization lab. This is where your character will undergo catheterization. Namely, they’ll thread a catheter in through his groin up to his heart and try to clear the blockage by placing stents in his heart.
But before they can do that, they’ll take a look at his arteries by injecting contrast dye to see what’s blocked and what isn’t.
This is where your character goes from cath lab patient to surgical patient. If he has 3 or more vessels that are occluded by plaque -- triple vessel disease -- he’ll be going for a CABG instead (a coronary artery bypass graft, AKA a “bypass” or CABG, pronounced “cabbage”). In fact, he’s getting 3 of them.
Now, mind you, his blood pressure may continue to deteriorate all this while, because both sides of his heart are involved in the heart attack. He will be a very sick man by the time we’re done with him.
So next he’s brought to the OR, likely with some kind of pressor (dopamine, norepinephrine) hanging now to keep his blood pressure up. He’ll be anesthetized and intubated (breathing tube placed) in the OR.
And as they try to perform the coronary bypass, with his chest open on the table, he’s going to have a cardiac arrest.
Cardiac massage (aka “squeezing the heart to make it pump, literally, just grab it and squeeze”) will be done. If it’s a shockable rhythm, yes, they’ll apply paddles directly to the heart and shock it.
Anyway, let’s say they get the triple bypass done. Let’s say he lives. Let’s say he doesn’t even have massive damage to his heart.
He may still have trouble weaning off the ventilator. He may have developed some edema (fluid) in his lungs, and he may simply not be able to come off the vent right away. It may take a few days to get his pressures under control, to get him perfusing everything well again.
Meanwhile, he’ll be sedated, in a lot of pain, and unable to get up (because he’s had his chest opened up).
In the long term, he may be a relatively healthy man. Years down the road he may be able to exercise well, play poker with his friends, or volunteer at the shelter. But in the first few weeks after his surgery he’s going to have limited exercise tolerance and a lot of medication. He’s going to have some diet changes, some exercise changes, and he’s going to follow up with his cardiologist on a regular basis.
But he can live, and live well, and actually live long, after this event.
I hope this fulfills your requirements, and that others have learned from it too!
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