When a Heart Was Sinking — How Advanced Cardiac Support Helped Save a Life (Impella-Assisted Stabilization and IVUS-Guided Decision Making: A Life-Saving Cardiac Case)

December 12, 2025

(A real-world cardiac rescue story under the care of Dr. A. Sreenivas Kumar)

Some heart problems announce themselves quietly.
Others arrive like a storm.

For Dr. VR, a 69-year-old gentleman with a long cardiac history, what started as routine cardiac testing suddenly turned into a life-threatening emergency—one that required split-second decisions, advanced technology, and a highly experienced cardiac team

This is the story of how timely intervention, Impella-assisted stabilization, and IVUS-guided decision-making helped save a heart that was rapidly failing.

A Heart with a Long History

Dr. VR was no stranger to heart disease. Over the years, he had undergone:

  • Coronary angioplasty (PTCA) to the LAD

  • Coronary bypass surgery (CABG – LIMA to LAD)

  • Mitral valve replacement

  • Permanent pacemaker implantation

  • Management for atrial fibrillation

Despite this, his heart function had been stable, and recent echocardiography showed normal pumping ability.

But coronary disease can be deceptive.

The Turning Point: When a Test Became an Emergency

During an Adenosine MIBI stress test, Dr. VR suddenly developed:

  • Jaw pain

  • Profuse sweating

  • Severe breathlessness

  • Drop in blood pressure

  • Rapid atrial fibrillation

  • Oxygen levels falling dangerously low

Within minutes, he slipped into cardiogenic shock—a condition where the heart cannot pump enough blood to sustain life .

From Stability to Shock: A Heart in Crisis

Repeat evaluation revealed a shocking change:

  • LVEF dropped to 15–20% (severe heart failure)

  • Global left ventricular weakness

  • Mitral and tricuspid valve leak

  • Kidney function worsening due to poor blood flow

Despite medications and intensive care, his blood pressure remained critically low.

At this stage, standard treatment was not enough.

A Crucial Decision: Mechanical Heart Support

Given the refractory shock and high mortality risk, Dr. A. Sreenivas Kumar and the cardiac team discussed advanced options with the family.

The decision:
👉 Impella-assisted stabilization with IVUS-guided coronary assessment

This approach allows the heart to rest and recover, while ensuring accurate decision-making inside the coronary arteries.

Inside the Cath Lab: Precision Over Guesswork

An Impella device—a miniature heart pump—was placed through the femoral artery to support circulation.

Using IVUS (Intravascular Ultrasound), the coronary arteries were examined from the inside:

  • Left main coronary artery area was adequate

  • Bypass graft was patent

  • No new critical blockages requiring stents

This avoided unnecessary high-risk intervention and allowed focused medical management instead

The Turnaround: When the Heart Begins to Recover

The response was dramatic:

  • Day 1: Heart function improved to 40%

  • Day 2: Heart function normalized to 55%

  • Blood pressure stabilized

  • Kidneys recovered

  • Urine output improved

  • All medications were gradually withdrawn

The Impella device was safely removed once the heart regained strength.

Discharge: From Shock to Stability

Dr. VR walked out of the hospital:

  • Hemodynamically stable

  • Breathing comfortably

  • Kidney function improving

  • Heart function restored

  • No need for ventilator or inotropic support

A journey that could have ended very differently—rewritten by advanced cardiac care and timely expertise.

Why This Case Matters

This case highlights something crucial:

✔ Not all shock patients need immediate stents
✔ Mechanical support can save time—and lives
✔ IVUS prevents unnecessary procedures
✔ Experience matters in high-risk cardiac care

How Dr. A. Sreenivas Kumar Helps High-Risk Heart Patients

  • Expertise in cardiogenic shock management

  • Advanced mechanical circulatory support (Impella)

  • IVUS-guided coronary decision-making

  • Multidisciplinary critical cardiac care

  • Patient-first, evidence-based treatment

Frequently Asked Questions (FAQs)

❓ What is cardiogenic shock?

It is a life-threatening condition where the heart suddenly fails to pump enough blood to vital organs.

❓ What is an Impella device?

Impella is a temporary mini heart pump that supports circulation while the heart recovers.

❓ Is Impella better than a ventilator or medicines alone?

In severe shock, medicines may not be enough. Impella directly unloads the heart and improves survival in selected patients.

❓ What is IVUS and why is it important?

IVUS allows doctors to see inside the artery and decide accurately whether a blockage truly needs a stent.

❓ Who needs Impella-supported procedures?

  • Severe heart failure

  • Cardiogenic shock

  • Very low ejection fraction

  • High-risk coronary disease

When Should You Seek Expert Cardiac Care?

Seek immediate evaluation if you experience:

  • Sudden breathlessness

  • Chest or jaw pain

  • Unexplained sweating

  • Severe fatigue

  • Known heart disease with worsening symptoms

Early action saves heart muscle—and lives.

Dr. A. Sreenivas Kumar

MBBS, MD – General Medicine, DM – Cardiology, FACC
Senior Interventional Cardiologist | TAVI/TAVR Expert | Complex Coronary Interventions Specialist

📍 Hospital

Apollo Hospitals, Jubilee Hills, Hyderabad

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