Jhonatan de Martine, 29, has always led a healthy life. He went to the gym six times a week and had a regular diet with the help of a nutritionist and nutritionist. In other words, he was in “up to date” health.
So, when the severe stomach pains appeared, Jhonatan found it strange and went to a hospital. He took medicine for two days and the discomfort went away. On the last weekend of January this year, he went to a party with friends in São Paulo, where he lives.
On his way back, he slept at the house of a colleague who lives near him and, when he woke up, he decided to leave. But a journey that would take 5 minutes took 40 minutes. “Every 5 or 10 meters, I was completely out of breath. I had to stop, rest and walk a few more steps”, recalls the publicist. Stomach pains also reappeared at this time.
When he finally got home, he went to rest. “But I couldn’t breathe. I knew something serious was happening. I thought it was covid due to respiratory symptoms and decided to go back to the hospital”.
When the doctors performed an echocardiogram, an exam that analyzes the heart, the shock came: only 16% of the organ was functioning, it was an acute heart failure. As a result, he was immediately admitted to the ICU (Intensive Care Unit).
Heart failure without causes
To this day, it is not known for sure what caused the heart problem – even the organ biopsy was unable to conclude anything. In this context, the publicist remained hospitalized, taking intravenous medications. But he didn’t get any better. On the contrary, Jhonatan was progressively getting worse.
“I went out for 3 days, but it got worse and I came back. When they did an MRI, they saw that I had myocarditis [inflamação no coração] old, which I would have had 6 months ago”, he says. “But to this day, we don’t know for sure what caused all this. We only have a few theories.”
When the doctors realized that the case would be more complex than expected, Joe, as he is called, had to be transferred to another hospital, where the first conversations about the heart transplant began. Therefore, he was referred to InCor (Instituto do Coração, Hospital das Clínicas, FMUSP), in São Paulo, a reference in cases like this.
Doctors said they didn’t know if there was any other solution besides the transplant. It was a shock and I understood the gravity of the situation. Jonathan in martine
According to Bruno Biselli, a cardiologist at the InCor Heart Failure Clinical Unit, who followed the young man’s case, none of the hypotheses about the causes of the problem were confirmed – neither covid-19, which Joe had twice, nor a possible disease with genetic origin.
“He had no history, no risk factors for heart failure, no exposure or clear cause to indicate the problem,” explains the doctor. “We also don’t know if it was myocarditis. That’s why, as in most cases, he was left with the idiopathic condition [quando não há causa definida]”.
‘Suddenly, I was in the hands of a disease that I don’t know the cause of’
After arriving at InCor, things happened quickly. He was hospitalized on January 31 of this year, found out that he would need a transplant on February 25, and a week later he was already in line.
The medical team continued with the medications that only alleviated the advertiser’s symptoms. Even so, he still felt sick at times, mainly due to weakness in his body. With that, the specialists opted for the intra-aortic balloon, which gives more support to the “work” of the heart, mainly in the blood circulation – the procedure was the main point that placed it as a priority in the transplant waiting list.
“During this time, I was very well, I had no symptoms for a few days, but I couldn’t get out of bed or sit. The catheter was inserted in the groin, so I couldn’t bend my leg, which was tied up. Sleeping and going to the bathroom were a hell. Everything was very complex to do”, he says.
Jhonatan says that this period was very difficult, that he came close to “kicking the boots”. At various times, when his pressure dropped, the entire team would run to the room. Despite this, he was never intubated or needed to be resuscitated.
Precisely because of this serious, progressive and worsening condition, he entered as a priority on the heart transplant list. “I passed in front of everyone. I was taking the maximum dose of medication”, he says.
It was really all very fast and that was good because I didn’t have time to think straight. It was crazy! Jonathan in martine
When is heart transplantation necessary?
It is important to explain that Jhonatan’s case is not the most common, according to the cardiologist. “Within heart transplants, these are usually patients who had a previous diagnosis of heart failure treated for years.”
In most situations, the person has this acute condition in the heart, takes medication and gets better. Then, in the future, if she gets worse, she may need a transplant, but after years — somewhere between 5 and 7 years, according to the doctor.
Also according to the InCor cardiologist, heart transplantation is the last line of treatment for those with heart failure. “It is when the patient is persistently symptomatic or with heart failure that the use of medication or other mechanisms is necessary. It is when there is no alternative”, says Biselli.
And that was the case with Jhonatan, who showed no improvement at all.
When he arrived, we had no more scope or prospects for him to get off the medication and stay alive. That’s why we recommend the transplant. Bruno bezelcardiologist at InCor
Unlike other organs, the heart has some details that make donation a little more difficult, according to Biselli. First, there is not enough organ for the amount of people who need a new one.
In addition, it is an organ that suffers a lot in a brain death. According to the doctor, 80% of possible donors are not accepted due to several factors, such as age, previous heart disease and this organ suffering.
Another point is the time that the heart can be outside the body, waiting for the receiver. “It needs to be placed, ideally, in the new body within 3 to 4 hours at the most, otherwise I lose the heart and the receiver,” he explains. Other organs, for example, can wait up to 48 hours for the new body.
There were 8 hearts offered until the transplant was successful
Normally, a person spends about 4 months on the transplant waiting list. But Jhonatan stayed a month and a half waiting for his new heart. “It ended up being faster because of gravity. It took first place and ended up being prioritized.”
But until the day came, 8 hearts were offered and refused for various reasons – some mentioned above, in addition to size compatibility (Jhonatan is 1.85 meters).
On April 12, he finally had the transplant surgery and received a new heart. Without organ rejection, today, Joe is undergoing cardiac rehabilitation and, recently, he has returned to his routine activities.
In addition, you will be taking immunosuppressants forever, as they prevent organ rejection. It’s been 4 months with the new heart. “I can’t put into words or explain the moment I woke up from the surgery and saw that everything had worked out.”
I’m very grateful. I learned a lot in this experience, to look at things in a different way… Mainly this madness of just thinking about my career, of working hard. This all helped me to see what really matters in life. When I stop to think about it, I know I was very lucky. Jonathan in martine
From everything that went through, Jhonatan took a lot. In addition to being an advocate of organ donation, he started doing volunteer work at InCor, precisely to demystify the subject. “It’s to show that there is life after this,” he says. “I have some dietary restrictions until I am one year old and I always need to wear a mask, but I can leave the house, see my friends. There is life after a transplant”, he reinforces.