​Fighting for Life During Sudden Heart Failure

Introducing the new Lifesaving Cardiogenic Shock Treatment Approach

PULSE Issue 42 | February 2024

In the prime of her youth, Kang Zi Ying, a polytechnic student, never anticipated that a heart condition could leave her fighting for her life. Despite having no history of heart problems, she suddenly found herself in the grip of a condition known as “Cardiogenic Shock”, a harrowing situation where only 10% of her heart functioned at one point. Nausea, dizziness and chest pain were the common symptoms that led to this unexpected battle. 

Seeking help at the National University Hospital (NUH)’s Emergency Department, much of what happened next was a blur for the 24-year-old, who only recalled feeling unwell and passing out after an operation. Unfortunately, Zi Ying’s condition deteriorated rapidly after her admission, with her heart facing an incapacity to function and efficiently pump blood to meet her body's needs. 

Due to her life-threatening condition, the National University Heart Centre, Singapore (NUHCS) cardiogenic shock team stepped in to save Zi Ying by deploying a new treatment strategy known as the “ECPELLA” support. This approach simultaneously integrates the Extracorporeal Membrane Oxygenation (ECMO) Circuit and Catheter-based left Ventricular Assist Device (cVAD) to maximise her chances of recovery. The ECMO device took over her heart and lung functions, ensuring sufficient blood circulation in the body, while the cVAD allowed blood from the heart’s left chambers to flow out of the body, thus reducing cardiovascular burden and preventing further complications. 

As a national specialty centre, NUHCS is the only public institution in Singapore equipped with a multidisciplinary team of cardiogenic shock specialists trained to provide this lifesaving “ECPELLA” support. Due to the complexity of deploying both ECMO and cVAD approaches simultaneously, the team comprises of experts from across 10 disciplines, including cardiologists, cardiothoracic surgeons, intensive care doctors and critical care nurses, all working closely together.

Asst Prof Lin Weiqin, Clinical Director of the Heart Failure Programme and Senior Consultant, Department of Cardiology, NUHCS, explains that for patients below the age of 40, acute infection of the heart (myocarditis) is usually the cause of cardiogenic shock. This inflammation may result from the common cough or cold, which can trigger an allergic reaction from the body’s immune system, potentially leading to heart failure. 

While distraught, Mdm Yau Mei Fun trusted NUHCS' experts to employ the most suitable treatment approach to increase her daughter's chance of survival. After spending 22 days in the hospital, Zi Ying was finally discharged, well on her way to recovery. She has to continue her medications and follow-up regularly with her doctors at NUHCS, while working steadily towards a full recovery. It is worth noting that a majority of patients affected by myocarditis experience mild symptoms. However, only a very small percentage, estimated at less than 10 young patients a year, will go on to develop fulminant myocarditis, as shared by Asst Prof Lin. Nevertheless, it is important to seek medical help if you experience symptoms such as unexplained chest pain and shortness of breath. 

Formed in 2020, the multidisciplinary cardiogenic shock team at NUHCS continues to keep updated with the latest mechanical circulatory support devices for life-saving patient care. Their dedication and expertise continue to offer hope and second chances at life for individuals like Zi Ying.