Young farmer died on way to hospital from complications after 'silent heart attack' days earlier, inquest hears
THE widow of a young farmer who died from complications after "a silent heart attack" while being transferred between Waterford and Cork hospitals has pleaded with Health Minister Simon Harris to urgently review cardiac services in the south east.
Bernadette Power issued the plea as a Cork Coroner's Court jury heard that the death of her husband, Thomas (40), was due to a side effect from a heart attack "most feared" by doctors and so severe that even had a Waterford cath lab been open it would have made little difference to saving him.
Mr Power died from a large 3cm rupture in his cardiac wall brought on by "a silent heart attack" sustained between three and seven days earlier.
The inquest jury returned a verdict of death by natural causes - but issued a recommendation that Mr Harris review resuscitation drug packs provided in ambulances for patient transfers between hospitals.
The recommendation came after it emerged the ambulance transferring Mr Power ran out of special adrenalin doses during the trip from Waterford to Cork.
Speaking after the inquest, Bernadette Power revealed she had only been married to Thomas for nine months - and had been pregnant with their first child when he died on June 18 2017.
Mrs Power gave birth to her baby boy, Thomas Junior, on November 22, five months after her husband's death.
"Today is a very sad day because on September 17 2016 when I married Tom I never thought that on April 19 2018 I would be attending the inquest into his death.
"I would now urge the Government to improve cardiac services in the south east region and to reconsider the provision of a second permanent cath lab at University Hospital Waterford (UHW) to serve the people of the south east on a 24/7 basis.
"This is a service sadly lacking at the moment," she said.
Despite the south east region having a catchment of 500,000 people, the UHW cath lab only operates from 9am to 5pm between Monday to Friday.
Major cardiac surgeries also cannot be undertaken in Waterford - with patients having to be transferred to Dublin, Cork or Galway.
"Silent heart attacks are worse than heart attacks with severe pain," cardiac consultant Dr Ross Murphy explained, pointing out that people often don't have symptoms sufficient to seek urgent medical assessment.
Mr Power had told her husband as he left UHW for transfer to Cork that she loved him and she would see him shortly.
Mr Power went into cardiac arrest as the ambulance undertaking his transfer passed Dungarvan en route to Cork University Hospital (CUH) from UHW.
The young farmer had to be transferred to CUH because the cardiac cath lab at UHW was closed that Sunday.
Coroner Philip Comyn also heard that the ambulance rushing Mr Power to CUH under a Protocol 37 transfer ran out of adrenalin en route to Cork and had to be resupplied en route by another ambulance.
Because of emergency treatment stops along the road in Dungarvan and Midleton, the trip by road to CUH took one hour and 41 minutes.
The inquest heard that no air ambulance transfer was sought.
Despite desperate attempts by nurses and doctors in the ambulance to resuscitate him, Mr Power was pronounced dead shortly after arriving at CUH at 1.50pm.
Assistant State Pathologist Dr Margaret Bolster conducted a post mortem examination on June 19 and found that Mr Power had a large 3cm rupture in the free wall of his heart.
The young man also had 400ml of blood in the pericardial sac around his heart instead of the normal 10ml.
This had the effect of compressing his heart and stopping it from filling with blood to pump around the body.
Dr Murphy said the outcome from such major ruptures in the heart wall are normally "dismal."
"It is a very, very big tear - you can die from a 0.25cm tear. It is a most feared complication (from a heart attack)."
Dr Murphy said he did not believe having a cath lab operational in UHW would have made any difference in this particular case.
"I have no evidence that it (a cath lab) would have made a difference. A cardiac theatre, perhaps."
The inquest heard that Mr Power would have required immediate draining of the fluid around his heart - and immediate emergency open heart surgery to repair the 3cm tear.
Such procedures would have had to be undertaken in minutes to save him.
However, UHW does not handle such major cardiac surgery which is only available in Dublin, Cork and Galway.
Mr Power's death sparked a major campaign last year for a major expansion of cardiac cath lab services at UHW.
The campaign has been led by Mr Power's family including his parents, Michael and Eileen, and his siblings, Joan and Catherine.
Mrs Power wept as she recalled to the inquest the day of her husband's death.
"The last words I spoke to Tom were: 'Love you and see you in Cork.' We were going out for six years. We were married nine months," she wept.
Mrs Power said her husband had not complained of any health issues before June 18 2017.
"He displayed no sign of ill health and did not complain of being unwell," she said.
Her husband was in such good health he did not have a GP.
The only time she recalled him going to the doctor was to have a thorn taken from his hand.
On June 18, Mrs Power was off work and the couple planned to go for lunch once they had jobs on the farm done.
"At 11am, Tom rang me. I thought he was ringing to say he had done his work and was coming home. But he said he had a pain in his chest."
Mrs Power told her husband to stay at the farm and she would collect him to bring him to UHW.
"Tom was standing by his van. He got in (to the car) himself. On the way in he was alert and talking to me. He had his hand on the rail by the window."
"During the trip to hospital he said he was in pain."
"(But) at no point during the trip to hospital did I think he was going to die," she sobbed.
"He said he had a pain in his chest but nothing that I thought he was going to die from."
On arrival at UHW at 11.25am, she told him to wait in the car while she alerted medical staff.
He was then assisted into the emergency department by two nurses and, a short time later, around 11.42am, was diagnosed following tests as having suffered a heart attack, mostly likely some time earlier than June 18.
Mrs Power was told her husband was being transferred to CUH with the ambulance leaving at 12.10pm under a Protocol 37 emergency.
Waterford medical staff had contacted CUH doctors about the transfer.
Mrs Power was advised to travel to Cork with a family member before the ambulance left so she would not get upset at its departure.
"They said he may possibly have to get a stint."
"It was horrible...," she wept.
"When I was leaving the hospital I thought I was going to see Tom alive in Cork."
At 12.45pm, just as the ambulance was passing Dungarvan, Mr Power's condition dramatically deteriorated and all vital signs were lost.
He was treated multiple times with adrenalin but the ambulance ran out of the specific adrenalin dose involved.
More adrenalin was rushed to the nurse and paramedics by a Cork-based ambulance.
Another cardiac expert, Dr John O'Dea, said the adrenalin would have made no difference to addressing Mr Power's critical underlying problem which was the "gaping hole in his heart wall."
Dr Bolster estimated that Mr Power had suffered his "silent heart attack" between three and seven days before his death.
This weakened the free wall of the heart which subsequently ruptured with catastrophic consequences.
Dr Murphy said: "I have never seen a (heart wall) tear like this."