Getting to the heart of the matter

The last couple of months have been unusual for me, at least in a medical sense. It seems like I have been going to doctors and having procedures a lot more than I ever have before.

It started earlier in the summer when it occurred to me that a pulse rate of 35 was too low. I have a home blood pressure monitor, and it was showing a reasonable blood pressure, but a very low pulse rate. I looked back in the history the machine stores and realized it had been low for months. There were no normal pulse rates since some time last year. So I called my primary care physician and set up an appointment. That was at the end of July.

At my appointment it turned out that my pulse rate was not low, I was just having some unusual rhythm problems that the blood pressure monitor couldn’t handle. So my doctor put a Holter monitor on me for a day.

A Holter monitor is like a portable EKG machine that records your heart activity. I wore it for 24 hours and then returned it at the end of the week when I got back from working in Huntsville. The doctor sent off the recording and, the next week, on the basis of that, sent me to a cardiologist.

The cardiologist was not too worried. I wasn’t having symptoms. No shortness of breath, no faintness, no chest pain. I have a history of fairly strenuous exercise, although that has tapered off since my knees wore out. Back when I was in graduate school, I was a runner. When someone called me a jogger, I thought, no, I don’t jog. I run. I did eight miles a day at a pace I thought was pretty good. Not great, but pretty good. And when my knees hurt too much, I started bicycling. As recently as a couple of years ago I was biking up Fouche Gap Road to our house. That’s not a long climb, but it’s a steep climb. It’s a respectable climb that you don’t do with a bad heart.

The cardiologist said I was having PVCs, or premature ventricular contractions. A lot of healthy people have them with no symptoms and, for the most part, no need for treatment. Of course, I was having a lot of PVCs. The Holter monitor record was pages and pages long, with normal beats in black and PVCs in green. There was a lot of green. A lot. So the cardiologist wanted an echocardiogram, just to make sure my heart function was good.

So I had an echocardiogram. That’s a simple procedure that just requires a little jelly on the chest. I had that test in the middle of August. A few days after the echocardiogram, the cardiologist’s office called and told me that the echo was abnormal and showed a weakened heart, and I should make sure I keep my next cardiologist appointment in three weeks.

So I had three weeks to come up with the worst-case scenario. I started thinking of what Leah should do if I died suddenly. I was thinking that now, at last, I could retire.

Three weeks finally passed and I made sure I went to the cardiologist. He told me that my heart’s pumping efficiency was about 60 percent of what it should have been. He sat staring at the echocardiogram results and saying, “I didn’t expect that.” And neither did I.

According to the cardiologist, 98 percent of cases of compromised heart function are caused by one of two things. The first is blockage of a coronary artery. The second is idiopathic, which means they don’t know what the cause is. So he ordered a heart catheterization to find out which it was.

My cardiologist’s appointment was last Thursday, two days after my colonoscopy. The cardiologist prescribed medication, which I started immediately. Today, Monday, I had the heart catheterization.

When they do a heart catheterization, they stick a wire up an artery in your groin and run it up to your heart, where they look around for blockages. If they find a severe enough blockage, they can do an angioplasty, or put in a stent, or both. If it’s really severe, they schedule a coronary artery bypass.

The idea of wires stuck up my arteries was bad enough. I’m the guy who got faint while watching a documentary that showed a vat of slushy plasma on black and white TV, and plasma isn’t even red. I did not look forward to this.

But my friend Errol assured me it was quick and easy. And it was. I was lucky because they went in through my wrist instead of my groin. Of course they had to prep my groin anyway, just in case. It’s not a full cut, but it’s still scratchy.

The result? No blockage. The cardiologist who did the catheterization, who now becomes my very own cardiologist, said to continue the prescription the other cardiologist ordered and he might increase it in a month. He was pretty upbeat about the whole thing.

Before the procedure, the staff kept asking whether I smoked, did I have a family history of heart disease, was I suffering chest pains, shortness of breath, fainting spells. No. No to all of that. So what brought me to this point, they asked. And I had to explain about the blood pressure monitor and the apparent low pulse rate, and how it wasn’t really low, just hard to count because of all the PVCs.

And that, along with the negative heart catheterization result, is what’s encouraging me right now. After I started taking the medication last Thursday, I noticed a couple of times over the weekend that my blood pressure monitor was able to count my pulse and show a pretty-much normal result. I’m not a cardiologist, but my conclusion is that if PVCs were causing the BP monitor to be unable to count heartbeats accurately, the fact that it seems to count much more accurately now must mean there are fewer PVCs. It makes sense to me, and I’m going with that conclusion for now.

7 thoughts on “Getting to the heart of the matter

  1. Wow, Mark, that’s quite a journey. I like your conclusions about the test results and that there are few PVCs. That makes sense. These aging bodies can really send some interesting messages. We are each just one human in a species of seven billion, but each one has a very specific DNA message written down and hammered out in time. Pretty tricky stuff when trying to get to the root of things.

    This post reminds me of one we did several years ago when Roger had his echocardiogram. http://newdharmabums.blogspot.com/2007/09/sound-of-heart.html

    Stay well and healthy.

  2. I kind of remember the one you did about Roger’s echo.

    I just took my BP, and my little home machine said my pulse is 34, so the PVCs are not completely gone. I’m hoping they are reduced sufficiently to make a difference in my heart function, and perhaps with some additional medication, will be reduced to something more like “normal.” Of course, as I said, I don’t notice any reduction in my abilities from the reduced heart function, but I’m not really stressing myself to the max much any more.

  3. I’ve never heard of this. I imagine it must have been quite alarming the first time you read a 30 something pulse.

    So, the medication. I’m curious, because whatever it is, I’m always asking, mechanism, mechanism.

    I’m glad you’re well, no matter how squicky the procedure to determine such.

  4. Wayne, the funny thing is that I looked back at the history the BP monitor stores and it was showing a very low pulse rate for months. I have no idea why I didn’t notice it for so long. Maybe because I was concentrating on my BP. The medication is carvedilol, a beta blocker. Most web sites say it’s mostly used to control high blood pressure, but some give the first use as a medication to treat a heart that is not pumping efficiently. That would be my heart.

    Leah keeps asking how they can treat something if they don’t know why it’s happening. I think that’s not an uncommon situation in medicine.

  5. Mark: How interesting… I used to run (not jog) when I was in graduate school and for a while beyond that. I even completed three marathons. Then, ten years ago, my right knee gave out on me, so no more running. I turned to bicycling (which I like more than running anyway), but (1) it’s tough to ride a bike in the winter and (2) the old colonial roads around here are so narrow and choked with traffic that most are really unsafe, so I have to haul my bike to a bike-friendly trail to ride. Long and short: I don’t ride nearly as much as I’d like to (or should).

    I can relate to your medical travails right now. In late June, I was very sick for two weeks with a virus that attacked my liver. In the course of trying to diagnose my disease, my doctor ordered an ultrasound and a CT scan of my abdomen. The two tests revealed a (symptomless) lesion on my right kidney. I saw a urologist yesterday who suspects strongly that the lesion is cancerous, so I’ll be going under the knife after I see a urological oncologist in the next few weeks. The urologist thinks the prognosis is excellent since the lesion is small and looks localized and contained, but who knows. I guess that the viral illness in June was somewhat of a blessing in disguise; the urologist said that a majority of kidney ailments are found in exactly the same way–tests for another condition reveal a hidden urological problem.

    It sounds like you may be in for a long series of doctor’s visits trying to get your situation stabilized and resolved.

  6. Scott – it’s funny how similar our exercise histories are, except that I really prefer running to biking. I gave up biking in some places because of traffic, but we live in a good biking environment now. Lots of bicyclists ride the roads near us. There is a near-perfect loop down in the valley to the north of us that gives a little over a 20-mile ride, finishing up by climbing the mountain back to our house. We have fairly frequent bicycle and handcycle races over Lavender Mountain (by frequent I mean usually more than one a year).

    I sure hope your kidney problems are resolved. That must be pretty scary.

  7. Just catching up on some blog reading on this rainy day. Thanks for the comment at my blog this afternoon.

    Heart problems always seem so unsettling, but fortunately there is so much that can be done to correct or control whatever is amiss. Also, the heart is such an amazing organ – it copes and rebounds so well once a problem is sorted out. I hope that everything will be resolved in a good way over the next while.

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