His heart rate dropped to 40: How a 68-year-old survived a life-threatening condition

Mr. Shivmurthi, a resident of Hassan, began to experience painful symptoms such as gastrointestinal problems, vomiting, and headaches, which affected his daily activities. At the age of 68, Mr. Shivmurthi had laparoscopic surgery after consulting at a local hospital. Life continued normally for nearly a decade, until the symptoms eventually returned and became increasingly difficult to control.

What began as a sharp pain in his abdomen gradually progressed to the centre of his chest, accompanied by worsening headaches. Shivmurthi's son, who was deeply concerned about his father's health, immediately got him admitted to Manipal Hospital Whitefield for a thorough checkup, during which it was found that the heart rate had fallen alarmingly to 40 beats per minute, indicating that the patient was undergoing severe bradycardia, a condition that usually increases the chances of sudden cardiac arrest. He was subsequently referred to Dr. Nikhil Shellagi, Consultant - Surgical Gastroenterology and Robotic Surgeon, who confirmed that the patient was suffering from hiatus hernia, a disease in which a part of the stomach slides into the chest cavity through a small opening in the diaphragm.

After weighing their alternatives, Shivmurthi and his family chose robotic surgery because a repeat operation using conventional techniques would be causing harm to the stomach, esophagus, heart, and lungs.

However, Dr. Nikhil advised that his heart-related issues needed to be addressed first before proceeding with the surgery. “Since the patient was malnourished and had multiple health issues including difficulty walking and a low heart rate associated with spinal problems, his overall condition needed to be optimized before surgery” said Dr. Nikhil.

Shivmurthi's illness has been effectively treated with a permanent pacemaker implant under the supervision of Dr. (GP CAPT) Ashish Chauhan, Consultant-Cardiology at Manipal Hospital Whitefield. After the treatment, Shivmurthi's family was relieved that his heart-related problems had finally been fixed. But he was unable to take medicine orally due to digestive problems.

He was then referred to Dr. Anoop KR, Consultant – Gastrointestinal Science at Manipal Hospital Whitefield who inserted a naso-jejunal tube to allow food and medication to bypass the stomach and enter the small intestine.

“Initially, he was treated with antacids and medications, but as symptoms such as abdominal pain, recurrent vomiting and poor oral intake progressively worsened, a naso-jejunal tube was inserted to support nourishment,” said Dr. Anoop.

Over the next three weeks, Shivmurthi’s condition improved significantly. He was then considered physically healthy enough to undergo the complex, life-changing robotic procedure that would ultimately change his life for the better. Unlike traditional surgery, robotic-assisted surgery involves the use of superior 3D visualization, enhanced precision and dexterity. Robotic instruments also enable doctors to make fine cuts that are minimally invasive and have lesser impact on abdominal organs, reducing bleeding in the scar tissue. After spending anxious hours in the waiting area, Shivmurthi’s family were relieved when Dr. Nikhil emerged with the good news of his successful surgery.



“Despite the complexity of a large recurrent hiatus hernia and prior surgical scarring, the redo robotic-assisted repair was completed successfully with meticulous dissection and restoration of anatomy,” said Dr. Nikhil.

Shivmurthi is recuperating nicely today and resuming her regular diet. In just three months, he has gained five kg and his digestive problems have been fully cured. He still occasionally has some symptoms, but the drugs he takes help manage them to the point that he can lead a more pleasant and typical life.