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Last updated: 11-05-2012
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Montgomery County Man, a Medical ‘Miracle’,
March 4, 2008

Complete Recovery Following Heart Attack and 12 Episodes of Cardiac Arrest

It was still dark when Julie Gerhardt’s husband, Greg, woke her. “Honey, I just don’t feel good,” he said, “it’s like I have gas in my chest, but it hurts.” “How does your left arm feel?” Julie asked. “It hurts!” Julie remembered, “I put my ear to his chest and his heart was racing like crazy.”

Julie didn’t need to hear anymore. She immediately called 911 and started to pray. Little did she know then that over the next five hours, her 52-year-old husband would flat-line over one dozen times.

Greg calmly got up and dressed as Julie waited for the ambulance to arrive at their Spencerville home. Soon, Greg was in an ambulance and on his way to nearby Montgomery General Hospital (MGH) while Julie stayed behind and anxiously waited for her mother to come and watch their three children. “Maybe it’s nothing,” she thought, fighting back the panic, “maybe he’ll come home soon."

At Montgomery General, a team of emergency physicians and cardiologists were well prepared for Greg’s arrival. At first, his vital signs were relatively stable, but an EKG showed Greg was having a heart attack. Doctors administered a clot buster. Suddenly, Greg went into cardiac arrest. The MGH team shocked Greg’s heart back into a normal rhythm and intubated him, then his blood pressure dropped. The struggle to keep Greg alive would continue throughout the morning.

Robert Lager, MD, an interventional cardiologist at Washington Hospital Center was up early that Saturday morning when his partner, a cardiologist at MGH, called to confer on a patient. It was Greg. Lager believed as unstable as Greg was, the best chance to lessen the damage to his heart was to clear the presumed heart artery blockage with a balloon or stent. Lager and his colleague agreed that immediate air transfer to the Hospital Center’s 24/7 cardiac catheterization lab (Cath Lab) was warranted and dispatched MedSTAR Transport to Montgomery General Hospital.

Still at home, Julie was unaware of what was happening. When the phone rang and she realized that it was the Montgomery General Emergency Department, she expected to hear a request to come and take Greg home. Instead she learned that Greg had had heart attack with cardiac arrest and would soon be flown to Washington Hospital Center for emergency treatment. “I couldn’t believe it,” Julie said. As she drove into the District, “all I could do was pray, ‘dear God, please don’t take my husband from me’.”

When MedSTAR arrived at Montgomery General and attempted to move Greg, he became agitated and his condition worsened. The combined team struggled to stabilize Greg’s seesawing vital signs. After about an hour of constant emergent care at MGH, Greg was ready for the 13-minute trip to Washington Hospital Center and the helicopter took off.

Delays in patient transport usually mean bad news to the medical staff waiting for the patient to arrive. The patient may be too unstable to transfer or, worse, has died. So when the med-evac crew rolled Greg Gerhardt in to the Cath Lab, Dr. Lager was expecting a sick patient, but Greg was truly critically unstable. “When Mr. Gerhardt arrived he was unresponsive, had no blood pressure and was in shock,” said Dr. Lager. “I knew the odds were against him and that I would have move quickly if we were to have a chance to save him.”

Almost immediately, Greg went into cardiac arrest…three times. Over the next 40 minutes, the Cath Lab team used CPR and a defibrillator to repeatedly shock Greg’s heart back into a normal rhythm. The team inserted an intra-aortic balloon pump to rest Greg’s heart while the device propelled blood to the rest of his body.

Once able to get images of Greg’s heart and coronary vessels, the team saw something unexpected. The three main blood-carrying coronaries were not blocked. A vessel not usually responsible for major blood flow, the ramus intermedius, was blocked, completely.

It would take three hours for Dr. Lager to clear the blood clot from the coronary. First, using a special catheter, Dr. Lager carefully removed the huge clot. Then, he deployed a balloon catheter to ensure the vessel would remain open and placed two stents.

Throughout the three hours it took to perform the heart-saving procedure, Greg’s vital signs continued to yo-yo. It was a constant battle for the Cath Lab team to establish and maintain Greg’s normal heart rhythm and blood pressure. During the procedure, Greg’s heart stopped beating more than 10 times. “The multiple interruptions of blood flow to the brain while he was in cardiac arrest worried me,“ said Dr. Lager. “Even if he lived, would Greg be able to function? Only time would tell.”

Meanwhile, Julie sat in an empty waiting room on the Hospital Center’s cardiac floor praying for word on her husband. When Dr. Lager emerged from surgery, she heard mixed news. Greg had made it through the procedure, but the degree of his recovery would not be fully known for at least two days.

Within 24 hours, Greg’s vital signs, his heart rate and his blood pressure, had stabilized and the damage to Greg’s heart was completely reversed. It was an amazing physical recovery, but his brain function was still questionable because Greg did not respond to commands.

The next day, an echocardiogram showed normal blood flow throughout Greg’s heart and his body, but he was still unresponsive…and the 48 hours were up.

That weighed heavily on Dr. Lager as he walked in to Greg’s room the next day to check on him. Again, he took Greg’s hand in his and asked Greg to squeeze if he could hear him. This time Greg responded. “It was a tremendous feeling,” said Dr. Lager.
The next day, the ventilator was removed and, to the amazement of his medical team, Greg was completely intact.

A day later when Greg was out of the ICU and on a regular floor, he proudly showed Dr. Lager a t-shirt that was pinned over his bed. It was decorated with small handprints and the names of Greg and Julie’s three young children. According to Dr. Lager, “Greg went home the following day to see those children and show them firsthand his miraculous recovery.”

These days, Greg is his old self again and remembers little of the experience. He is back at work as a construction contractor and life has resumed its familiar routine. It's Julie who recounts the week of worry to friends and relatives, firm in her belief that God was working alongside the teams of medical staff who saved her husbands's life that Saturday.

Media only contact: Paula Faria
202 877-7594
Paula.faria@medstar.net

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