Cherie was hooked to a machine which took over her heart functions as she lay in a comatose state for a week. -- ST PHOTO: NURIA LING

A teenager whose heart almost stopped survives after being kept alive by a heart-lung machine. JONATHAN LIAUTRAKUL reports

Teenager Cherie Lim's heart practically stopped pumping for a week - and might have stopped forever - had it not been for a machine that took over the functions of her heart, pumping blood through her body while her own recovered.

The first signs of trouble came in December last year, when she felt discomfort in her chest, coupled with giddiness.

Taking painkillers did not help the Secondary 4 student from Punggol Secondary added.

Three days later, she felt blood rushing to her head. Muscle cramps and giddiness soon followed.

Her mother, 49-year-old store owner, Madam Tan Siew Hoon, was washing clothes when her husband shouted that their daughter's limbs were limp.

Madam Tan applied medicated oil on her and Mr Lim rushed her to a hospital.

'I was so shocked because she did not have any prior sickness. This had never happened before," said Madam Tan.

By the time she arrived at the hospital, her heart was functioning at only one-third of the normal rate.

She was given medicine to help sustain her blood pressure, but it was a race against time as the levels kept dropping over the next couple of hours.

Soon after, she lost consciousness and was moribund.

The National Heart Centre Singapore was then called and its staff arrived in 35 minutes.

She was diagnosed as having an acute form of viral myocarditis, an inflammation of the heart muscles.

This rare infection has hit only nine people here in the last five years, of whom only three survived, including Cherie.

Dr Su Jang Wen, a consultant at the department of cardiothoracic surgery at National Heart Centre Singapore, said: 'The infection is very unpredictable and can strike people of any age and gender, even those living healthily. Once the heart stops and the organs shut down, it means certain death."

Machine takes over heart

With her parents' consent, Cherie was fitted on an extracorporeal membrane oxygenation (ECMO) machine. It took over the functions of her heart, which had almost stopped pumping.

Blood flows out of tubes connected through the groin.

A pump pushes the blood through an artificial membrane lung that adds oxygen and removes the carbon dioxide before sending it back to the body.

There are currently six of these machines in Singapore, all in the National Heart Centre Singapore.

Since 2003, it has performed 205 cases of ECMO support for patients with heart failure or cardiogenic shock.

'For patients who have weak hearts that are still beating but unable to maintain a reasonable blood and oxygen supply to the body, the machine can help augment the function of the heart and lungs. The heart does not need to be stopped," explained Dr Su.

The ECMO gives patients a 30 to 40 per cent chance of surviving myocarditis, he added.

In the intensive care unit, Cherie lay in a comatose state for a week, kept alive by the ECMO machine.

Her family members were told to prepare for the worst.

Madam Tan said: 'I begged the doctors to do what they could to save her. The thought of losing a child was unimaginable."

Both parents stopped working and stayed outside the ward for days on end, keeping watch over their daughter.

Her elder brother applied for leave from the armed forces to visit her as well.

Madam Tan would wash Cherie's face with a towel, encouraging her to stay strong as the whole family was waiting for her to get well.

'Her mouth did move a little, but the nurses told me it did not mean she was going to recover," she said.

To everyone's joy, Cherie's heart started to show signs of recovery a week after it had arrested.

Dr Su said: 'She was incredibly lucky to have access to the ECMO machine in time. Any longer and her organs would have shut down from a lack of oxygen."

Madam Tan said: 'It is a good thing she was treated in time. It's also a really huge burden off my heart, as she could have gone any minute."

Once her own heart began to beat more strongly, Cherie was weaned from the ECMO machine.

Her blood pressure climbed, reaching regular levels to sustain the organs in her body.

For the next two weeks, however, she needed therapy to strengthen her limbs and regain her speech, which had been affected by a mild brain injury as a result of the lack of oxygen.

Dr Su said that younger patients have a better chance of recovery with the ECMO machine as their bodies are more resilient to any injury sustained as a result of myocarditis.

Older patients tend to have more lasting damage.

Cherie finally went home in January. Her heart has fully recovered with no permanent damage from the illness.

A Buddhist and the youngest of three children, she said that she felt immensely grateful to her family, doctors and friends for their support.

'Life is unpredictable and anything can happen anywhere and anytime," she said.

Cherie now tries to live a healthy lifestyle by watching her diet and avoiding stress.

She is also not allowed to engage in any physical activity in school until her next check-up in June.

In the meantime, Madam Tan boils herbal soups with ginseng and red dates to nurse her back to health.

To Dr Su, Cherie's survival is a great accomplishment. 'The loss of hours of sleep are well worth it, for the happiness of the girl and her family. It is a very satisfactory experience."


Myocarditis: Causes & treatments
Myocarditis is the inflammation of the myocardium, or the heart muscle. It can develop at the same time as or just after a viral throat or chest infection, as many viruses can affect different parts of the body.

Even if the virus itself is gone, the immune system may overreact and cause inflammation, said Dr Su Jang Wen, a consultant at the department of cardiothoracic surgery at the National Heart Centre Singapore.

The symptoms of myocarditis depend on the cause and severity of the inflammation. They can include tiredness, an irregular heartbeat, chest pains, shortness of breath, giddiness and fever.

For those who develop acute symptoms, heart failure can occur. These patients have a high fatality rate if medical treatment is not available.

Treatment varies depending on the cause and severity of the infection. Bed rest is recommended at the onset of myocarditis and physical activities should be avoided for six months to avoid undue strain on the heart muscle, said Dr Su. If complications develop, medication is then prescribed to treat heart failure or irregular heartbeats. Pacemakers may also be employed.

In serious cases of a complete heart failure, such as what happened to teenager Cherie Lim, an extracorporeal membrane oxygenation machine, which takes over the functions of the heart, may be used to prevent damage to the vital organs while the heart recovers.

There is no predicting who will contract the disease and no way of preventing it. Anyone of any age can contract myocarditis. However, the incidence is very low.

Source: The Straits Times © Singapore Press Holdings Limited. Permission required for reproduction.