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The Sound of an Emergency

Read how a stethoscope helped a cardiologist with The Iowa Clinic save a life.


Your Local Health | Written by BJ Towe
Emergency

Doctors routinely use stethoscopes to listen for abnormalities in heart and lung function. Recently, the instrument helped Frank Haugland, M.D., save Ava Davidson's life.

“It was an amazing and unusual thing,” says Frank Haugland, M.D., Ph.D., a Cardiologist and Cardioelectrophysiologist with The Iowa Clinic. “In my career, I will likely never again hear what I heard that day.”

The Sound

It was early April 2014. Ava Davidson, then 56, had just arrived by ambulance at Iowa Methodist Medical Center from her local hospital in Pella, where she had received emergency care for a heart attack. But because Davidson had persistent and extremely low blood pressure, the Pella hospital consulted Dr. Haugland and then transferred her to Iowa Methodist for additional tests and evaluation.

Upon meeting Davidson at Iowa Methodist, Dr. Haugland used his stethoscope — as he always does — to listen to blood vessels in the neck (carotid arteries) that supply blood to the brain, neck, and face.

“I heard the sound of a bruit (the sound blood makes when rushing past an obstruction in an artery), which was coming from the aorta, not the carotid,” Haugland says. The aorta is the body's main artery extending from the heart to the abdomen.

Haugland suspected that the abnormally loud, deep sound was that of an aortic dissection, an urgent and life-threatening condition that occurs in just 2 out of 10,000 people — but is audible through a stethoscope in as few as one in a million cases, he says.

The sound suggested that the inner layer of Davidson's aorta had torn, allowing blood to surge through the tear and the inner and middle layers of her aorta to separate, or dissect. But because the blood had nowhere to go, the inside wall of Davidson's aorta began to bulge into the center of the artery.

Without immediate surgery, rupture of the artery was imminent. Less than half of people with a ruptured aorta survive.

Life-Saving Response

Davidson recalls the whirlwind that followed diagnosis: “Dr. Haugland immediately called for an echogram. In a few minutes they had me down in the room running the test, which showed the tear.”

Next, Luke Groben, D.O., a Cardiologist with The Iowa Clinic, performed an emergency TEE (a high-resolution diagnostic test done inside the esophagus) confirming the tear and showing it to be 12 inches long. This was valuable information for the Cardiac Surgeon.

“The hospital staff literally ran to get a surgical team ready. My husband told me Dr. Haugland ran into the waiting room to get him, telling him, 'We have to go now,'” says Davidson.

After talking briefly with her husband and sons, Davidson was rushed into the operating room, where the surgical team spent 9.5 hours repairing that foot-long tear. During that time, Davidson received 27 pints of blood.

Her husband and two sons waited, but had little hope that their wife and mother would survive.

Medically Induces Coma Facilitates Healing

Davidson's surgery went well. Next, to allow Davidson's body to heal without stress or movement, she was placed in a medically induced coma for a week. Medical professionals monitored her around-the-clock in Iowa Methodist's Cardiac Care Unit (CCU).

When she awoke from the coma, “The only thing I remember was seeing a nurse diligently keeping tabs on my monitors. She asked me to wiggle my toes and squeeze her hands. I had been without oxygen for so long, they were afraid of brain damage. When I could do those things they knew there was no brain damage,” Davidson says.

After 50 days in the hospital, Davidson says, “I feel fine today. I am very blessed to be here.”

“It Couldn’t Have Gone Better”

Haugland agrees that Davidson is exceptionally fortunate. Not only was her condition detected just in time, “As soon as we needed doctors, they were immediately there. Dr. Groben was there to do her TEE, Dr. Rundall was there to perform her surgery, and Dr. Komanapalli was there to assist in the operating room,” he says.

“We were at a good hospital. We had a good echo cardiogram lab. We had a good medical team. It could not have gone better,” Haugland says.

Davidson adds, “All of the doctors were absolutely awesome. They listened to me and were interested in every detail. I have nothing but the highest respect for Iowa Methodist and all of the surgeons.”

To contact The Iowa Clinic's Cardiovascular Services Department, call 515-875-9090.

Ava Davidson's Care Team

As a heart patient at Iowa Methodist Medical Center, Ava Davidson received care from these Iowa Clinic physicians and surgeons:

Signs & Symptoms of Heart Attack

Call 9-1-1 if you or another person experiences any of these symptoms, whether mild or severe.

  • Chest pain that feels like pressure, squeezing, or fullness, usually in the center of the chest
  • Pain in the jaw, shoulder, arms, back, or stomach
  • Cold sweats
  • Light-headedness
  • Nausea
  • Numbness, aching, or tingling in an arm
  • Shortness of breath
  • Weakness, fatigue, or changes in mental status, particularly in the elderly
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