It was a normal Friday for Amir Bacchus, complete with a barbeque of jerk chicken at lunch.
Until the heartburn started. Or, at least that's what it felt like to the 28-year-old car salesperson.
"I just felt weird," he recalls.
By Sunday, Amir's symptoms had worsened to include back pain and a fever. After some coaxing from his wife, Sue, Amir went to a walk-in clinic, where the nurse took his blood pressure and heart rate.
A normal heart thumps anywhere between 60 and 100 times per minute. Amir's was 186, so high that the nurse unplugged the monitor and changed machines, only to face a similar result: Amir's heart rate was abnormally, intensely high.
He was rushed to a hospital where three shocks to his heart accomplished nothing. He was then transferred to the Peter Munk Cardiac Centre (PMCC) at around 4 a.m. acutely ill (he was almost unconscious) where Dr. Patrick Lawler was on duty in the coronary care unit.
It was Monday, two full days since Amir had originally experienced symptoms. Now, he was in trouble, and PMCC's heart failure team was called at 6 a.m. to assess him for urgent life support.
Amir needed life-sustaining therapy – extracorporeal membrane oxygenation (ECMO) – to help support his rapidly failing heart.
He was urgently assessed in the coronary care unit with the assistance of many, including Dr. Lawler, Dr. Vivek Rao and Dr. Juglans Alvarez from cardiovascular surgery, Dr. Carolina Alba and Dr. Billia from the heart failure team.
It was clear the team needed to make a decision, and fast.
Making judgements on the turn of a dime that can fundamentally impact the course of a patient's life is something the team at PMCC is used to doing. But this case was unique. Amir was young and was inching closer to death as the clock continued to tick.
Time was on no one's side, and many from different areas needed to drop their work, come together and brainstorm a series of solutions that would ultimately save Amir's life.
"Our big, overarching question we asked ourselves was 'how do we get him out of this?'" recalls Dr. Billia, who co-ordinated Amir's initial care.
The team transferred Amir to the medical surgical intensive care unit, where he was cared for with the help of physicians, nursing, perfusionists, surgeons and respiratory therapists, to name a few.
However, within 24 hours, Amir's heart had become distended – a consequence of his left ventricle not pumping strongly enough to empty the chamber.
Again, the team needed to act quickly. They transported Amir to the cath lab, where they would map the arrhythmia and attempt to get rid of it by burning it with a tool. And they needed to put a hole in Amir's heart to place a tube in order to shrink the left side.
With the incredible teamwork of Drs. Nanthakumar, Chauhan and Krishnan from the electrophysiology team, catheters were placed in Amir's groin and then blindly through the diaphragm, under the heart.
Eventually, the team was able to map and mark the arrhythmia. But, they couldn't get rid of it.
Meanwhile, Drs Horlick and Osten were waiting in the cath lab, ready to act. Their job was to place a separate tube to help reduce some of the pressure in Amir's left ventricle by making a hole in the upper chambers of Amir's heart.
However, the team was forced to abandon this plan when blood started pouring out of Amir's diaphragm. The team struggled to find the source – was it the liver? Or the heart?
With no time to spare once again, the team worked quickly to take Amir to the OR where his chest was opened. At this point, Dr. Yau was able to confirm a small hole had been made in the heart. He did this by placing the catheters through the diaphragm.
The hole needed a stich to stop the bleeding. As surgery continued, Dr. Yau lifted up Amir's heart, found the markings made previously and applied a cryoablation tool that freezes the area of the heart where the arrhythmias originate.
Sure enough, the first application of the tool settled Amir's abnormal rhythm. And eventually, a cannula was inserted into the tip of Amir's heart to shrink that left ventricle.
Everyone in the operating room was astounded.
"We had tried everything else, this was really our last resort," says Dr. Billia.
This is the first time staff and clinicians at PMCC had performed an ablation in a critical ill patient supported with an ECMO machine.
"This story is an example of the 'pit crew' approach to patient care: clinicians across disciplines and programs pulling together to help this young patient," says Dr. John Granton, who was involved in Amir's care. "It was extraordinary."
In a few days following his life-saving procedure, the catheters that were previously inserted to help rest and support Amir's heart were removed.
But his recovery took several weeks, and wasn't without some bumps: he developed confusion and pneumonia once he was conscious again. And, his heart sometimes beats a couple of extra times – a typical reaction after an arrhythmia has been banished.
"He's getting progressively better, and his heart continues to recover," says Dr. Billia. "And his family has been by his side every day."
Throughout all of this, his wife, Sue, has been Amir's rock, his advocate, his partner and his lifeline. She balanced a sick child at home, frantic, panicked and emotional family members, and an onslaught of news, professionals and information with an ailing husband.
"Every day, I woke up wondering 'what is this nightmare?'" she says.
For now, his family remains focused on his recovery at home. And, since he's likely had an arrhythmia since he was quite young, Amir and Sue are intent on having their one-year-old screened for heart disease in order to prevent him from enduring Amir's challenging journey.
"Dr. Billia is a godsend, our angel," says Sue. "She made him a priority, and we are so grateful Meliodas [our son] can see his Daddy – it's a gift."
