When Scott Pulley was diagnosed with extreme coronary artery disease, it came as a surprise. Healthy, active, and with no history of heart issues or any other serious health problems, Scott wasn’t expecting such devastating news when he found himself far from home in a Chicago emergency room. What doctors told next him came as even more of a shock: his disease was so advanced he would need a heart transplant.
Scott and his wife Jill were visiting family in Chicago when he began experiencing chest pain. The pain wasn’t unfamiliar – he’d noticed similar discomfort behind his sternum during a Pickleball tournament a week earlier. At the time, Scott wrote it off as nerves or being out of shape. When the pain worsened between matches, Scott decided to go to the hospital the following Monday to look into the issue. There, doctors performed an EKG test and suggested further stress testing the following week, but were unable to reach a conclusive diagnosis. In the meantime, Scott and Jill made the trip to Chicago, where Scott found his pain returning. Jill rushed Scott to a local hospital, where they discovered things were much more dire than expected. Scott was diagnosed with advanced coronary artery disease and was informed that a heart transplant might be his only option to survive.
Far from home and facing drastic news, Jill immediately began searching for a way to save her husband.
“They asked what hospital we wanted to go to, and I knew I wanted him to go to Barnes-Jewish,” said Jill. Luckily, the Pulley’s happened to know someone who might be able to help – an old church friend and cardiac specialist at Washington University. Jill called him immediately and was reassured that the Washington University heart team would explore every avenue possible to save Scott’s life, and to see if there were any other options short of a transplant.
Searching for a Solution
Coronary artery disease, sometimes called ischemic heart disease or CAD, is the most common heart disease in the United States. CAD is caused by plaque buildup – made up of cholesterol and other deposits – in the arteries. This buildup causes the arteries to narrow over time and can limit or completely block blood flow to and from the heart. Over the long term, CAD can weaken the heart or lead to heart failure.
Many patients with CAD don’t know they have the disease until they experience a heart attack, but in Scott’s case, his only symptom was angina, or chest pain. Other signs of CAD can include shortness of breath, weakness, nausea, and pain or discomfort in the arms and shoulders. If experiencing any of these symptoms, it is vital to get to a hospital as soon as possible, as heart conditions can become life-threatening quickly and with little warning.
Heart transplant is considered a last-resort treatment for CAD. While Scott’s CAD was shockingly severe, the Washington University heart team wanted to explore every avenue once Scott was in their care.
“The heart team at Washington University has a great collaborative spirit,” says Ralph Damiano Jr., MD, who is chief of cardiothoracic surgery. “We work together, we communicate, we collaborate. That’s the way to get the best care: having a team where everyone is invested in doing the best thing for the patient.”
After a four-and-a-half-hour ambulance ride from Chicago, Scott arrived at Barnes-Jewish Hospital late at night but in high spirits. He was alert, walking and pain free – showing no signs of the condition he and his doctors knew was plaguing his heart. After a few tests to garner a better perspective of the problem, the team planned either to place stents or attempt a coronary artery bypass to clear the pathways of Scott’s blocked arteries and let him rest for the night. A few hours after checking in, however, his condition changed for the worse.
Scott suddenly arrested and went into ventricular fibrillation. Fortunately, the heart team was prepared.
All Hands on Deck
Jill woke up that night to a phone call, informing her that Scott was in the operating room and doctors were doing everything they could to stabilize and save him. She and her daughter were met at the entrance of the hospital by a member of Scott’s care team, who updated them on his condition.
Matthew Schill, MD, performed CPR on Scott for over 30 minutes while the rest of the team assembled. The heart team prepared Scott for ECMO treatment, which would give them time to develop and implement a treatment plan while Scott’s heart rested.
Amit Pawale, MD, surgical director of the Heart Transplant, VAD and ECMO Program, led Scott’s ECMO care.
“ECMO serves a critical bridge therapy for a patient like Scott, whose heart needs time to recover before we provide a more lasting solution,” says Dr. Pawale. “When it comes to ECMO, experience counts. We lead the highest volume ECMO program in the region and have the expertise to judge the most appropriate course of treatment for patients with heart failure, when every second counts.”
The team came together and formed a plan, thinking on their feet. With Scott in such a dire position, something had to be done immediately to save his life and treat his CAD to prevent this from happening again.
To bring Scott out of ventricular fibrillation, the team administered shocks to his heart with a defibrillator until it regained normal rhythm. Yet there remained the problem of Scott’s heart’s poor ventricular function and CAD. The team consulted with Jasvindar Singh, MD, an interventional cardiologist at Washington University, who then inserted an Impella pump to decompress the left ventricle and placed four stents to revascularize Scott’s heart.
“It really is a testament to a whole team coming together not only to provide the emergency care, but all the steps afterward,” says Chief of Cardiac Surgery Tsuyoshi Kaneko, MD. “Everyone was ready and willing and right there, and Scott Pulley is alive today because of that.”
We work together, we communicate, we collaborate. That’s the way to get the best care: having a team where everyone is invested in doing the best thing for the patient.
Ralph Damiano Jr., MD
Throughout the night, the team kept Jill and Scott’s family members updated. “I felt very reassured that they were doing everything they could to save his life,” Jill said. “When you’re in the hospital and it’s a serious situation, you very much look forward to the time that you get to talk to the doctors so you can get an update and just know what’s happening. They answered all our questions and told us everything that was going on.”
In the end, the treatment was a success. The entire team worked tirelessly to stabilize Scott and restored his heart to healthy function – both in a moment of emergency and without the need for a transplant.
Getting Back to What Matters
Over the next several days, Scott was kept under careful observation while the team weaned him off the pumps helping his heart to recover. Scott’s nurses recall visiting his room one morning and finding Scott alert and playing memory games with his children – and in most cases, winning.
“Scott had just the best attitude through it all, he kept his sense of humor,” says Jill. “It’s been a joy to see him get better every day and work so hard to do that.”
The road to recovery was a long one, but with the help of the heart team, the nursing staff, Jill’s support and Scott’s tenacity, they managed to traverse it one step at a time. Scott made a remarkable full recovery. Today, he still enjoys playing Pickleball and spending time with his family, free of pain and worry.
“The heart team is the best of the best,” Scott says. “They know their stuff and they can help just about anyone. They helped me out when I thought I was beyond repair.”
Jill adds: “He wouldn’t be alive without them.”
After such a devastating diagnosis, a sudden turn for the worse and the incredible life-saving efforts from the Washington University heart team, Scott and his family have found themselves growing closer over the course of his recovery. They look forward to the future more than ever.
“We have a new lease on life,” says Jill. “We’re so grateful for the blessings that Scott and I have, including our grandchildren. We’re just so grateful to have them and so grateful that Scott’s still here to be their papa.”
