Virginia Heart's Multidisciplinary Team Saves a Young Life

What at first appeared to be COVID-19 or a common virus turned out to be a life-threatening illness for Andrew (Drew) Hooks, a 21-year-old college student from Purcellville, VA.

While home for fall break from James Madison University in October 2022, the soccer enthusiast played a vigorous game with a friend and woke up the next morning with a sore throat, aches, chills and a fever as high as 103-degrees that continued for almost a week.  When the symptoms progressed to chest pain, he sought emergency care at Inova’s Cornwall Campus in Leesburg – the first step in a roller coaster journey that would last almost a year. 

“Drew’s case was very complex and rare,” explains Hampton Crimm, MD, one of several Virginia Heart cardiologists who cared for Drew. “The combined expertise of many Virginia Heart doctors trained in numerous cardiac subspecialties enabled us to reach a resolution to what otherwise could have been a fateful outcome. It is also very fortunate that Drew didn’t ignore his symptoms and sought treatment early.”  

Emergency care

Although Drew tested negative for COVID-19, blood tests showed elevated levels of troponin, a protein associated with damage to the heart muscle. The medical team suspected myocarditis, inflammation of the heart’s muscular wall, often caused by a viral infection.  While usually not serious, a severe case can lead to heart failure.

Drew was transferred by ambulance to Inova Loudoun Hospital’s Emergency Department, where he was examined by Virginia Heart cardiologist  Tariq Aziz, MD. Dr. Aziz suspected myopericarditis – an inflammation of both the myocardium and the pericardium – a fibrous sac that encloses the heart and its major blood vessels. Drew was admitted to the hospital.

Inpatient at Inova Loudoun Hospital

Despite ice baths and round-the-clock doses of anti-inflammatories, Drew’s symptoms persisted for another week. His heart rate remained elevated and he slept in a sitting position to reduce the chest pain.

“We performed a number of echocardiograms to monitor his condition of ongoing inflammation and we noted that those were beginning to look worse despite the treatment,” notes Dr. Crimm. “That told us that the virus was not what we typically see. Ninety-nine percent of the time when people get these kinds of viruses, they recuperate and that is the end of the problem. However, Drew was one of those unusual cases when the body’s natural response to a viral infection becomes severe.” 

“This is going to get interesting”

On the morning of October 25, Drew developed a very rapid heart rate and his blood pressure dropped dramatically. The medical team hurried to his bedside, including Ibrahim Saeed, MD, Virginia Heart’s medical director of nuclear cardiology. This time, the echocardiogram revealed significant fluid building up around the heart – a condition called cardiac tamponade. The excess fluid compresses the heart and prevents it from filling properly. The sudden drop in blood pressure can be fatal and emergency intervention is required.

As his doctors explained what would happen next, Drew remembers thinking: “Now, this is going to get interesting! For a few seconds I developed tunnel vision and couldn’t see or hear. I told myself I had to keep fighting. I remember telling my mom that I loved her.”

A life-saving procedure

Drew was rushed to the cardiac catherization lab, where Virginia Heart interventional cardiologist Eric Pauley, MD, performed a pericardiocentesis. “Guided by ultrasound imaging, I used a needle to drain the fluid from the pericardial sac,” explains Dr. Pauley. “The procedure was successful in removing the fluid that was causing Drew’s heart to fail and enabled his blood pressure to start to return to normal.”

“The team saved Drew’s life for sure that day,” says Dr. Crimm.

The journey continues

Drew remained in the hospital for a few more days and his doctors added more medications to his drug regimen, including prednisone, a steroid. He started to improve and was discharged into outpatient care, where he continued to see Dr. Crimm as well as Haena Bryant and Alicia Campbell, advanced practice providers at Virginia Heart. He was also followed by Timothy Welch, MD, a Virginia Heart advanced heart failure specialist.

Despite the medications, some of Drew’s symptoms continued and he was unable to return to college to complete his junior year.

A breakthrough therapy

Drew needed a different approach to treatment. Dr. Crimm relied on his experience as a physician in the military to identify a potential new medication.  “Pericarditis was very common among young adults in the service who were exposed to viruses and exotic diseases while serving around the world,” he explains. “We occasionally utilized a drug called rilonacept – a fairly recent and potent anti-inflammatory that is administered by injection. And that is what turned the tide.”

Drew started to feel better, and follow-up blood tests and MRIs showed that the rilonacept had resolved the lingering inflammation. He was able to stop the medication in August 2023 and return to college to repeat the junior year he had missed because of his illness.