Heart attack and aortic dissection: Nathan's story

The first signs of heart trouble: Ignoring warning signs

In 2014 Nathan Krepp believes he had a mild heart attack – not that he knew it at the time. At forty-four years of age, he never thought it possible.

“I had chest pains, and just laid down and slept it off. I didn’t think much of it. That was the first alarm bell that rang,” he said.

He was working a flat-out job and had little time for being sick. Still, there was a family history of heart disease, not that Nathan was living the same kind of lifestyle as his father or grandfather.

But the one thing he shouldn’t have done, he now concedes, is to have ignored that first serious warning sign.

High blood pressure and the advice to slow down

A year later he “went to a physio because I was getting headaches from the hypertension (high blood pressure) I was experiencing”.

Nathan’s blood pressure reading was 170/110. Readings above 140/90 are considered high.

The physiotherapist was direct in her assessment: “Mate, you need to get to hospital. I’m not actually allowed to do any work on you because your blood pressure is so high.”

The doctor who saw him suggested a lifestyle change, with less work. Nathan heeded the advice, giving up the 24/7 grind of managing a team of people and moving his family from Queensland to regional New South Wales. He started up a business trading racehorses, but it was still frenetic.

Heart attack diagnosis: Tests reveal past heart attack

In 2018 his blood pressure was creeping up again. Tests would reveal he’d previously had a heart attack (probably 2014) and the organ had lost about 5% of its function.

“They put a stent in, in 2018 and everything was going well. In early 2020 I started getting a sore chest and sore arms, like I’d done a workout at the gym. I had that sort of muscle fatigue,” Nathan said.

A suite of tests would follow, but doctors could not find a reason for Nathan’s discomfort. Still, he knew “something big was about to happen”.

The diagnosis: Type A aortic dissection

On June 16, 2020, Nathan was diagnosed with a type A aortic dissection that required emergency surgery to repair. “That’s when everything went pear-shaped pretty quick,” he said.

A type A aortic dissection occurs when there is a tear in the inner lining of the aorta (the large vessel that carries oxygenated blood from your heart to the rest of your body). Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). This slows or stops the flow of blood around your body.

Life-saving intervention: Timely action that made the difference

Amazingly, it was spotted by a fourth-year intern, who happened to be passing and saw Nathan’s scans. Within 15 minutes he was flying in a chopper to Sydney and within 45 minutes he was being operated on.

“They said it was going to be a routine operation, but, in the end, they had to replace the whole top of my aorta – while the three valves that came out of it were replaced with arteries from my groin,” he said.

There were other difficulties too.

“Every time they tried to put a stent in it would just go straight through. They said my arteries were the texture of wet cardboard,” he said.

During the marathon 19-hour operation, Nathan flatlined twice, went through 24 units of blood and developed compartment syndrome in his left calf. His chance of survival was approaching zero.

Fortunately, another surgeon colleague was able to step in that time. Rarely available, his schedule was, on that morning, remarkably free.

Jumping in his car in peak hour Sydney traffic, he tore down the freeway at breakneck speed. Pulled over by motorcycle police, he had some explaining to do. When they realised the gravity of the situation, the officers cleared traffic and offered him a 160kmh escort all the way to the operating theatre. It was another lifesaving intervention.

“If it wasn’t for him, I wouldn’t be alive. A lot of luck went my way,” Nathan said.

Recovery and the long road to rehabilitation

Three weeks were spent in intensive care in a coma, four months in hospital and another eight months ridding himself of a golden staph (Staphylococcus aureus) infection. He also had a dual fasciotomy of his calf for the compartment syndrome that saw him placed in an induced coma for five days.

Due to being under sedation for such a long period of time it was thought he had suffered a stroke. He was uncommunicative for several days and finally spoke, much to the joy of his bereft wife.

He also required dialysis due to kidney and liver failure. Add to that, a diagnosis of pneumonia.

After the operation hospital staff would drop by to shake his hand, telling him it was a miracle he’d survived.

Living with new limits: redefining life after heart surgery

Rehabilitation was understandably tough. The family – Nathan, his wife and two young children – slipped back to their native Western Australia one day before the government’s Covid policy closed the border.

These days, Nathan is circumspect. He is trying to redefine what his life means – though regular work is impossible. Walking more than kilometre leaves him exhausted and the heaviest thing he can lift it his laptop.

Nathan's advice: listen to your body

If I could offer some advice to people now: if you’re getting a heavy chest when you lay down and soreness in your pecs and arms, and you’re not working out, your body’s trying to tell you something.

Nathan Krepp

Heart attack survivor

“Something’s going on in the background and you’ve got to go and see a specialist.”

Take it from someone who knows.

Listen to Nathan’s story on the Heart Foundation’s ‘Stories from the Heart’ podcast