‘Miraculous Recovery’ – She’s Grateful for Baptist Health Teams Treating Her Multi-Organ Failure, Racing Heart Rate

Johanna Chavez, 52, vaguely recalls being driven by her husband, Milton, to the ER of Baptist Health Doctors Hospital at about 3 a.m. on March 30^th. He had noticed her labored breathing and erratic heart rate. He said they had gotten back from a cruise three days earlier and she might have caught a bit of a cold. She had been treated for arrythmia, or an irregular heartbeat, years before. But she had been otherwise healthy.

Shortly after entering the ER, her heart started racing to nearly 200 beats per minute and her blood pressure plummeted. She presented with supraventricular tachycardia (SVT), a condition where your heart suddenly beats much faster than normal.

And, while in the Intensive Care Unit (ICU), she triggered the first of two Code Blue announcements, which means a patient is going into cardiac or respiratory arrest. She was also in cardiogenic shock, which happens when your heart cannot pump enough blood and oxygen to the brain and other vital organs. And it would lead to “multi-organ failure” in Johanna’s case.

Sandra Chaparro, M.D., cardiologist and director of the Advanced Heart Failure Program at Baptist Health Miami Cardiac & Vascular Institute. 

“The first Code Blue episode, as I learned later, lasted 16 minutes,” said her husband Milton. “They revived her. They explained to me that she’s gravely ill. While the doctor was explaining the first Code Blue, it happened again. They sent me out of ICU. I knew what was happening to her.”

Johanna was revived after the second Code Blue, which was more extensive and challenging than the first. At one point, she was declared dead. But a few minutes later, she started breathing again, allowing for the ICU team, under the direction of Arian Bethencourt Mirabal, M.D., to resume CPR. She was then transported to Baptist Health Baptist Hospital, under the care of specialists at Baptist Health Miami Cardiac & Vascular Institute, in hopes that she would be stabilized enough to treat the primary underlying issue by a multidisciplinary team.

She would stay at Baptist Hospital as a heart patient for about a month where she underwent complex cardiac catheter ablation, a procedure during which small areas of the heart are scarred to prevent abnormal electrical signals or rhythms.

‘Everyone was Telling Me That I’m A Miracle’

Johanna’s memory of her life-threatening medical journey is very spotty as she continues her remarkable recovery from her Miami home. She recalls waking up well into her stay at Baptist Hospital. 

“When I woke up, 21 days or so had passed,” said Johanna, who is so grateful for the medical teams at both Doctors Hospital and Miami Cardiac & Vascular Institute that she wanted to share her story. “I couldn’t remember being taken to the hospital by my husband and that I entered the hospital walking. I didn’t remember. I was later told that my heart stopped working, and all my organs stopped working, When I woke up, they were doing dialysis. ” (Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly.)

Mario Pascual, M.D., medical director of Electrophysiology and Arrhythmia Management at Baptist Health Miami Cardiac & Vascular Institute.

 

Johanna added: “Everyone was telling me that I’m a miracle – that it didn’t look like I was going to leave the hospital.”

“When we received her, she was in multi-organ failure and extremely sick,” explains Sandra Chaparro, M.D., cardiologist and director of the Advanced Heart Failure Program at Baptist Health Miami Cardiac & Vascular Institute. “She was not only in multi-organ failure, but she was bleeding internally everywhere. Her hemoglobin (protein contained in red blood cells that delivery oxygen to the tissues) and platelets (which help prevent bleeding) were dropping -- all the numbers were too low. She developed kidney failure. And lactic acid, which is a marker of how bad things are, was extremely high.”

The most common cause of lactic acidosis, the over-production of lactic acid, is a severe illness in which blood pressure is low and too little oxygen is reaching the body's tissues. The consensus: Her condition is heart-related because she was presented with SVT initially, Dr. Chaparro added. But little could be done until her condition stabilized.

“Obviously when you have a young patient, you really want to try everything,” said Dr. Chaparro. “And at that time, we decided that we have to support her with medicines and start her on dialysis to try to remove some of that lactic acid, and start her on antibiotics."

Johanna was given antibiotics and steroids because her medical team suspected that the heart "is the culprit and you have to decrease inflammation in case the patient has myocarditis (inflammation of the heart muscle)," added Dr. Chaparro. Tests for myocarditis, which can be caused by infection, were inconclusive, she said.

After a couple of very rough days, Johanna’s lactic acid started coming down and her overall condition slowly stabilized. At this point, Mario Pascual, M.D., medical director of Electrophysiology and Arrhythmia Management at Baptist Health Miami Cardiac & Vascular Institute, prepared his team to perform a catheter ablation on Johanna to avoid future episodes of cardiogenic shock and multi-organ failure.

Catheter Ablation Slows or Stops Atrial Tachycardia

“At some point, we sat down with the family and said: ‘She's been through a lot. She just had multi-organ failure. But if she continues to have these runs of atrial tachycardia, despite all these medications we have tried, she's at risk to have a recurrent episode of cardiogenic shock and recurrent hospitalizations in the future. We felt it was the best decision to take her to the EP (electrophysiology) lab and try to find this focus of where this arrhythmia was coming from -- and ablate it.”

Dr. Pascual and his team diagnosed Johanna with atrial tachycardia, a type of supraventricular tachycardia (SVT). In her case, the atrial tachycardia was originating from her coronary sinus, a vein which drains the blood of he heart. Dr. Pascual explains: All the arterial blood that goes into the heart eventually ends up in the coronary sinus, and then dumps it into the right atrium to go back into the lungs and get full of oxygen.

“It wasn't an easy atrial tachycardia to target,” said Dr. Pascual. “We had to avoid the ‘AV node’ which controls the passage of the heart's electrical signal from the atria to the ventricles – or risk serious complications. We very carefully ablated within the roof of the coronary sinus, and we were able to slow the atrial tachycardia down.”

But the tachycardia persisted – although at a slower rate. Dr. Pascual’s team then redirected to the other side of the heart. “We did what's called the transeptal puncture, which means we created a communication between the right atrium and the left atrium,” explains Dr. Pascual. “We engaged our catheters into the left atrium, and then we looped it back on itself in the direction of where the coronary sinus is. Using our mapping system and intracardiac echo we were able to map exactly where this coronary sinus is sitting, and make sure we are directly opposite to the ablations that we had delivered previously.”

‘A Truly Miraculous Recovery’

The two-part catheter ablation strategy worked to completely stop Johanna’s atrial tachycardia.

“We ablated from the left atrium -- and boom – the tachycardia immediately terminated and we were never able to re-induce it again,” said Dr. Pascual. “I recently saw her in the office. And she's had no further tachycardia. She has felt fantastic. And we stopped her medications. She has been doing extremely well and had made just a truly miraculous recovery.”

Dr. Chaparro emphasizes that a primary takeaway from Johanna’s story is to seek immediate medical care if you sense something is wrong. In the case of cardiogenic shock, symptoms may include confusion, sweating, rapid breathing or shortness of breath, and loss of consciousness.

“Obviously, her husband recognized that something was wrong,” said Dr. Chaparro. “So, the first few minutes are really important because she was already in the medical system. When she crashed, she was already in the hospital. If this happens on the cruise ship or even at home, there's no chance that she's going to make it. So recognizing symptoms when something is wrong, and going for medical advice is extremely important. Timing is probably what made the difference.”

Johanna Chavez remains in good health and overflows with gratitude for the healthcare teams at Baptist Health who helped her get her life back.

“I am so very grateful for all the doctors and nurses at Baptist Health for their excellent care,” said Johanna. “I cannot truly find the words to thank them. I am really extremely grateful.”