Cardiac Update

The monitor

The monitor

Well, I’ve been using the Life Watch monitor for close to three weeks now. A week ago (or so) I got a call on all three phone numbers (work, cell, home) from my cardiologist. They told me that the feed they’d gotten from the past couple of days had shown an abnormal and rapid rhythm (yep) and that they wanted to get me in to see one of their electrophysiologists STAT.  Last Wednesday I met Dr. Dhir and he gave me the lowdown.

Some background:

When I was in my junior year in high school, our athletic department formed a swim team. A freshman friend of mine and I joined and yeah, I was good. At least at breast stroke; which to this day is my favorite, and got me a gold medal in the 50-plus women in this year’s Corporate Challenge.  Anyhoo, we began practice, but a requirement for remaining on the team and competing was clearance from my doctor. So mom made the appointment for what we thought would be a routine exam. Except that it wasn’t. Said family physician detected a murmur and would not sign off on said clearance, sending us instead to a cardiologist, who, after taking a look at my EKG told me that in no uncertain terms that I could not engage in competitive sports. He told me that I had a pronounced murmer and an enlarged heart, which at the time he attributed to possible rheumatic fever in my childhood (regardless of the fact that my mother and I had no memory of me having said ailment).  He suggested a cardiac catheterization to really determine what was going on, but being uninsured, we passed.

Years passed. I married. In late 1981 I got pregnant and miscarried. By now I was insured and my ob/gyn strongly suggested a visit to a cardiologist to determine if my heart could even withstand a pregnancy. Wow. Talk about motivation. I really, really, really wanted a baby, so off I went. I got EKG’d which again showed very abnormal heart function. Next step, an echocardiogram which according to my cardiologist, showed I had one of two things: Ebstein’s Anomaly, or a hole in my heart. Of the two, he said, we want it to be a hole. We can fix that, he said. Ebstein’s Anomaly is much more problematic. He strongly recommended a cardiac catheterization. After some deliberation, and my cardiologist saying that he didn’t recommend this just because (it was Kaiser, and they didn’t recommend anything they didn’t see as absolutely necessary), I went and got the cath done. Atrial Septal DefectDiagnosis: Atrial Septal Defect which meant that there was a hole between the atria and which caused the blood to just slosh back and forth in my heart, rather than pumping through my body. Based on results of the catheterization, my doctor thought I was only getting about 30% of the oxygenated blood I should have. Hence, the heart has to work harder, therefore enlarging, and on and on. He said I needed to get it repaired or “face major problems” in my 40s.

I had open heart surgery in May of 1982 to repair the ASD  using a dacron patch, and while inside my heart my surgeon discovered that my mitral valve was cleft, and so repaired that as well. Note: my ASD was quite large. Dr. Ahmad thought the hole would be about the size of a quarter, but it was actually about the size of a silver dollar. 

All went well with the surgery, and for the first time in my life, I had pink finger and toe nails. I did have to deal with post surgical inflamation of the pericardia which necessitated me taking Predisone in the early months of being pregnant with my daughter (treatment began before realizing I was pregnant). She was born fine and life went on.

Through the years since my surgery I have had to deal with rapid and pounding heart rates that would come and go. Sometimes an epsisode will last a few minutes and sometimes it can go for hours, after which I am wrung out and exhausted. There appears to be no “trigger” and I cannot do anything to mitigate or control it.

In the last 18-24 months I’d been experiencing some very odd symptoms. Light-headedness, weird sensations from my heart, and of course, the rapid heartbeat. In this year when I decided to get my past due 50-year service check, I told my primary physician of the symptoms and she recommended a 24-hour Holter monitor and and echocardiogram. Got both. Results were not really off, but not really normal, and because of my history and age, she recommended that I at least get hooked up with a local cardiologist. My twenty-five plus years of avoiding the cardiologist’s office had come to an end.

The skinny on my current monitor is here.  My skin has had quite the reaction to the sticky electrodes, as in: redness and blisters under the patches. I was informed the other day that I could move them around, so I did, but still the irritation just moved with the patches. The company sent me some hypoallergenic patches which my husband finally discovered on our front porch yesterday (we never use the front door), so I’ve switched over to them today. Softer, smaller, and hopefully, less brutal on my skin.

Back to paragraph one: the STAT visit to Dr. Dhir. Not that I, or anyone who has observed my carotid artery jumping out of my skin during one of my “episodes,”  would think otherwise, but it was nice to find out that there really has been something going on, and that, hopefully, something can be done about it. From the literature he gave me:

PSVT

Paroxysmal supraventricular tachycardia (PSVT) is a series of rapid atrial contractions. PSVT can greatly increase the heart rate. Although this can be a frightening feeling, it is often not serious. Your type of treatment may depend on how your heart’s electrical impulses reenter the atria. These impulses may return through the AV node [what my doctor thinks is going on] or through a bypass tract.

Possible symptoms: With PSVT, your heart suddenly begins beating very fast. The beats are rapid and regular, may make you feel breathless, dizzy or weak [check, check, check]. You may feel heaviness or pressure in your chest. [check] The rapid hearbeat can last for seconds or go on for hours. Then, just as suddenly as it started, the arrhythmia will stop. [check]

More information here.

I also have atrial flutter.flutter

Atrial flutter, with appropriate treatment, is rarely life-threatening. However, similar to atrial fibrillation, atrial flutter  poses an increased risk of stroke.

Alrighty then.

Solution? Well, as I mentioned, I’ve tried maneuvers to get it to stop on it’s own. Those don’t work for me. Also, I can’t do medication because my resting heart rate is so low (mid 40s) that to put me on anything that would slow my heart rate  down any further would, as Dr. Dhir put it, send me to the floor. Or worse. 

The option that is best for me and the one that I will be pursue is catheter ablation.

A normal heart rhythm is the result of an electrical impulse passing through the heart tissue in one narrow conduction path. Many tachycardias (extremely fast rhythms) are the result of areas of abnormal tissue which cause this electrical system to short circuit. Catheter ablation is based on the idea that by ablating, or destroying, abnormal tissue areas in the heart, its electrical system can be repaired and the heart will return to a normal rhythm. During catheter ablation, your physician will insert several special long, flexible tubes with wires—called electrode catheters—into your heart. Some of these, called diagnostic catheters, are used to study your abnormal rhythm, or arrhythmia. However, one of these catheters will be used for the actual ablation. Once the doctor determines exactly where abnormal tissue in the heart is located, it can be ablated. Your physician will position the ablation catheter so that it lies on or very close to the abnormal tissue. High-frequency electrical energy is then sent through the ablation catheter into this abnormal tissue. The small area of heart tissue under the tip of the ablation catheter is heated by this high-frequency energy, creating a lesion or tiny scar. As a result, this tissue is no longer capable of conducting or sustaining the arrhythmia.

Dr. Dhir strongly suspects that the short circuit is coming from around the area of my ASD surgery which is the area of the AV node, but he won’t really know until he gets in there and has a look-see. In the meantime, to cover all the bases, I’m scheduled for a stress test on the 27th. I anticipate getting the ablation in early November. It will be a bit more complicated than the usual EPS (electrophyisiology study) because he will have to deal with the scar tissue resulting from my ASD repair. Consequently, the procedure will probably take a bit longer and he’ll be keeping me overnight for observation. If all goes well, this should provide a solution to my arrhythmia and provide me with long-desired relief.

I’ll keep you posted.

11 thoughts on “Cardiac Update

  1. So you will be sedated for this procedure like i was for my upper GI? Do you know where it will be done? How often does your Dr do these?

  2. Yeah, sweetie, I’ll be sedated, lightly for part of it, then knocked out for the actual ablation. He’ll go in through my femoral artery, just like they did my heart cath before you were born. He’s part of Reno Heart Physicians group.

  3. Wow, you’ve done really well to have carried on with that all this time…I remember you having tachichardia episodes back when DJ & Ali were wee ones! We’ll be thinking of you, and worrying…
    Of course, we know how strong you are, so we won’t worry too much…
    Love ya,
    MaryBeth

  4. I hope all goes well for you in this. I can only imagine how distressing these episodes must be, not to mention the knowledge of the increased risks your condition imposes.

    Do your docs have any feeling that your overall condition is worse because you had to leave it untreated so many years, because you were uninsured when it was first detected? Wouldn’t that be yet another example, if so, of why the current “healthcare system” serves us so poorly as a society, in addition to how poorly it serves us as individuals.

    • Actually what went untreated was my ASD, which, frankly, if I’d had surgery for it when a child, would have had a much lower chance of getting of the table alive. When I was born, open heart surgery was in its infancy, so-to-speak.

      As for the arrhythmia, no, I don’t think so. It’s a chronic condition, and one that I’ve just gotten fed up with, and become more concerned with as I’ve grown older, especially since I’ve been having the more recent symptoms. I got worried that I’d be driving along the road and pass out, crash the car and kill myself and take someone else with me.

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