Kay Adkins (Subtitle: Listen to your body better than I did!)
“It sounds like you have a heart murmur.” Since I was in my 20’s, doctors had made that observation during my checkups. But I am your classic minimizer, believing I’m too healthy to have health issues. So, I didn’t really understand what “heart murmur” meant until I was in my early 50’s. I began noticing some changes. At night, when I put my head on my pillow, I could hear my heart beat. Some days I could feel it pounding in my chest. Some nights it raced all night long, making it difficult to fall asleep. I experienced no other symptoms, and felt fine otherwise. So, I thought, “Just some signs of getting older.” (Listen to your body!) The first turning point was a visit to my Primary Care Physician for a wellness check. “I can feel your heart beat,” she commented as she began to lay the stethoscope on my chest. Doctors are sometimes not as reactive as I would like them to be. She was just stating a fact, so I still was not concerned. However, she recommended that I see a heart specialist, so I did. The first visit to the Arkansas Heart Hospital Clinic was kind of an adventure. I had never had an EKG or any kind of ultrasound. So, I found the Echo-cardiogram fascinating. I could see the image of my heart pumping and hear the sounds it was making. The technician explained what the colors on the screen meant, and she commented, “You’ve never smoked have you? You have a pretty heart!” She showed me the valve causing the murmur, and how the blood was not flowing properly through the valve. The doctor explained that I had mitral valve prolapse with regurgitation, a valve with an extra bit of skin that prevented it from closing completely. He felt it was nothing serious, and prescribed a beta blocker to help with the palpitations. For several years, that was the routine—annual EKG, EEG, and “just keep doing what you’re doing.” Until this summer. Late in the summer my heart began beating erratically almost all the time. When walking, I had to stop occasionally to catch my breath, which was new. Again, I thought little of it. Just getting older and a little out of shape. After all, my blood pressure was lower than ever. That can’t be bad! . . . Can it? (Listen to your body!) A month or so later, back to the PCP for my wellness visit. “They still haven’t gotten your arrhythmia under control???” she inquired after listening to my heart. Back to the heart doctor. The nurse taking my EKG was a close friend. When she read it, she was obviously concerned. “Let’s do one more. Can you hold your breath this time?” I told her my heart had been racing for a while. The verdict: Atrial fibrillation/flutter that had been going on for a few months, maybe more. A-fib and A-flutter, my doctor explained, are caused by extra electrical impulses firing off in an area of the heart that should not be firing off impulses. Thus the extra, ineffective beats. If left to continue, it can wear your heart out, and lead to heart failure. My heart was getting very tired. My doctor prescribed a blood thinner to prevent clotting (a hazard with a-fib) and referred me to an a-fib treatment specialist. Over the next few weeks, I saw 2 other doctors, had several EEG’s, and 2 procedures done that I’d never heard of before—cardio version, and catheter ablation. Cardioversion shocks the patient’s heart back into a normal rhythm. When a heart is beating erratically, as with any muscle that gets a strenuous workout, the heart gets bigger. I had been feeling pressure in my chest. Now I knew why. An enlarged heart also explained the persistent minor cough I experienced when taking a deep breath, a symptom that some a-fib patients report. The cardioversion was a quick procedure. General anesthesia, then a Trans-Esophageal Echo (down the throat with a camera) to confirm that no clots were already forming. Then the shock treatment. But while quick and painless, cardioversions, I learned, are typically effective only for the short-term without a medication that will maintain the rate. I remained hospitalized for about 3 days while testing a new medication. The medication, however, created another issue—a delay in my heart beat cycle that could be very dangerous. When my EKG’s showed that the medication wasn’t an option for me, they stopped it. I went home, and my rate was good and steady—for about 7 days. About a week after the cardiovert, I went to bed feeling fine. Suddenly, before I fell asleep it was back—racing heart and pounding chest. On to the next step: ablation. The Physician’s Assistant diagrammed for me what the ablation procedure would do. He pointed out areas of one of the upper chambers generating the extra impulses. Then he explained that tiny burns around those areas would create scar tissue to prevent transmission of the extra electrical impulses. A first ablation, he said, is successful in stopping the a-fib in about 70% of the cases. If a second is necessary, there is a 90% success rate. Pretty good odds, I thought. To make sure I was a good candidate for ablation, a few additional tests were needed: blood tests, more EKG’s, an MRI (another new experience for me). The surgery required incisions in my groin area on both legs. One incision was for the camera they would thread through a vein to my heart. The other was for threading the tool that would burn areas in the atrial chamber responsible for the extra impulses. Upon being wheeled into the surgery, I remember (1) seeing an enormous computer monitor at the foot of the surgery table, (2) noticing a glassed-in room full of people and computers, (3) moving onto the surgery table and removing my hospital gown, (4) sitting up for surgery techs to place the cardiovert pads on my front and back (as another cardioversion was necessary before the procedure), while (5) the anesthetist said, “I’m going to start your drip.” Then nothing. Until recovery. I woke up shortly after all the equipment had been removed. Nurses were applying pressure to the incisions to stop any bleeding. For the next several hours, my job was to lay perfectly still while the incisions got good and clotty -- (not much of a challenge when you’re still pretty much ‘under the influence’). I went home the next day to finish recovering. I didn’t feel too bad at first. I was breathing deeply without coughing for the first time in over a year. My heart rate was back to a normal, regular rate, but my blood pressure was elevated higher than I’d ever seen it. And the first few days were exhausting. I had zero energy and I started to worry. One helpful article I found said (in my paraphrase), ‘Don’t expect to bounce right back. Ablation is a major deal. You just had equipment run up through your body. Your heart probably had 50-75 burns applied to it. It’s a big deal, and your body needs time.’ The degree of success is typically determined in 6-8 weeks. Complete recovery could take up to 3 months. It’s been 12 days since my surgery. My previously low, (then high after surgery) blood pressure is now right in the pocket- 120/70-ish—what it ran before any symptoms ever began. My heart rate is a steady 65-80 (rather than 100-115). I can take a deep breath without coughing. I can take walks without stopping to catch my breath. I can sleep well. For now, I’m calling it good, and am so thankful for the doctors, surgical team and nurses at the Arkansas Heart Hospital in Little Rock! And maybe I’ve now learned, I should listen to what my body is telling me.
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