A Little History

I went to the emergency room with atrial fibrillation on February 15, 2008. I’d had a few mild episodes of rapid, erratic heartbeat several years before, sometime in 2002. I would feel my heart begin to race, feel anxious and weak, and have to lie down. Within an hour or so, I usually felt a bit better and went about my business. I did ask my doctor about it and he hooked me up to an ECG (electrocardiograph) machine, pored over the paper as the graphs sputtered out, and said everything looked normal. Probably stress, he said. If it really bothered me I could go to the emergency room when it was happening and they should be able to tell me more. I had a few more mild episodes after I saw him, but nothing that would make me want to go to the emergency room, and sometime later, without my really doing anything, the episodes went away.

Last fall, the episodes began again. They always started at night, either sometime before I went to bed (usually around 10:00 or 10:30 PM) or in the middle of the night. My heart would start to race, I would feel anxious and weak, maybe a little lightheaded. I would lie down and feel a bit better after a while, but I would toss and turn all night or be aware, even in my dreams, that my heart was leaping. Usually, after I got up in the morning, sometimes after breakfast, I would begin to feel normal again and wonder, What the heck was that all about?

I also noticed around that time that I had a chronic pain in my chest, a kind of dull ache. I had taken up archery in the fall and thought I must have pulled a muscle or strained something. It never seemed very serious—some days I would barely notice it—so I didn’t pay much attention to it.

The episodes began to come every month or so, then every few weeks. I wondered if it was something I’d eaten. I thought I was a pretty healthy eater—no sodas, no candy (well, a little chocolate and some Chunky Monkey ice cream), limited red meat—and I took a handful of miscellaneous supplements (whatever was touted in the latest Men’s Health magazine). But I began to wonder if I was low in calcium, or wasn’t eating enough salt, or maybe I was allergic to something? In other words, I didn’t have a clue. But I recognized, after the episodes continued to become more disconcerting, that I needed to see a doctor, something I am always reluctant to do.

It took me a long time to see a doctor. My old doctor had switched to a concierge plan, limiting his practice to those patients who would pay a yearly fee to be under his care, with an emphasis on prevention. A good idea, but I always thought of myself as too young (51) and too healthy. I had to do an intake interview with the nurse practitioner to be a new patient with my new doctor and because of various scheduling issues it took me a couple of months to get in. I finally saw the nurse and told him about my symptoms. He took copious notes and said he’d fix me up with a treadmill test, whatever that was, to rule out cardiovascular disease. I had little idea what he was talking about, but at least I was finally taking some steps to solve the mystery.

Emergency

I never made it to the treadmill test. At least, not to the test the nurse practitioner scheduled for me.

The evening after my appointment, I begin feeling anxious. My heart starts racing and I feel weak. It’s almost bedtime, so I think I’ll just go to bed and sleep it off as I have so many times in the past. But this night is different. I feel slightly better for a few minutes—and then it gets worse again.

My wife, Meg, hovers over me, checking in. Should she take me to the hospital? No, let’s wait a few minutes. I already have an appointment to have things checked out. It’s always passed before.

But it continues to get worse. Finally, I relent. We get dressed and get in the car. The hospital is only about five minutes away; no need for an ambulance. I’m ushered into the emergency room immediately. They hook me up to the ECG. They take a chest x-ray. They take a blood sample.

My heart rate is about 190. The doctor comes around—a slender, gentle woman with a soothing voice—and explains patiently (no pun intended) that I have atrial fibrillation. She gives me a simple explanation, very similar to the description on my Discharge Instructions:

“Atrial Fibrillation” is a condition where the heart beats in an irregular pattern. It is due to a disturbance in the electrical pathways of the heart. It is a sign of heart disease or other health problem affecting the heart.

The most common symptom is “palpitations”. This is the feeling that your heart is fluttering or beating fast or hard or irregular. When the heart beats too fast it does not pump blood very well. This can cause other symptoms such as anxiety, fatigue, shortness of breath, chest pain, dizziness or fainting.

Atrial Fibrillation may come and go, lasting from a few hours to a couple of days. Or, it may become chronic, lasting for months at a time or longer.

I’m given a drip of Cardizem and “convert” (my heart returns to normal) a short time after. They keep me awhile to make sure I’m okay, then send me home with a prescription for Diltiazem (Cardizem) and the number of a cardiologist. I’m scolded for having Meg drive me to the hospital. I’m instructed to take one 120 mg tablet “if rapid palpitations recur”, wait and hour, then take another one. “IF LIGHTHEADEDNESS, SHORTNESS OF BREATH, CHEST PAIN, NAUSEA, SWEATINESS, THEN CALL 911 IMMEDIATELY.”

But I think I’ll be good for another month. A few weeks, at least.

911

The next night, I wake up in the middle of the night to pee. When I crawl back into bed again, the race horse breaks out of the stable. I give Meg a little nudge and tell her my heart is at it again. Should we call 911? No, I’ll just pop one of these tablets.

A few minutes later, my heart is still galloping and I begin shivering. Should we call 911? No, let’s give it a few minutes to work.

Minutes later, I’m shaking. I can’t lie still. I feel nauseous and lightheaded. My chest hurts. What did they tell me in the hospital? “IF LIGHTHEADEDNESS, SHORTNESS OF BREATH, CHEST PAIN, NAUSEA, SWEATINESS, THEN CALL 911 IMMEDIATELY.”

Meg calls 911. Within a few minutes, the doorbell rings and five athletic guys walk in with a stretcher. I’m not sure why it takes five guys, but they’re young and buff and Meg isn’t complaining, and they hook me up the ECG and begin quizzing me about my symptoms. I don’t feel any worse, but I can’t stop shivering. I’m rattling the bed. They can’t get a read because the electric blanket is on, but they give me some nitro and cart me out to the ambulance. I half expect the neighbors to be out, standing on their lawns in their pajamas and bathrobes, but it’s probably about two in the morning and the cul de sac is quiet. In the ambulance, they give me some more nitro for the chest pain. I’m still shaking, they don’t know why, but I’m beginning to relax.

At the hospital, my heart rate is only around 120. Why was I lightheaded and nauseous? Oh, that’s probably just a side effect of the medication. But since I’ve had episodes two nights in a row they decide to keep me for the day and overnight the next night. They have to move me from the emergency room, though, and most of the hospital is booked. I get an upgrade to a private room in Intensive Care. I think I may have the IC Unit to myself. They hook me up to the ECG and the blood pressure cuff and tuck me in.

Do I Hear an Echocardiogram?

It’s now Sunday afternoon. As I’m undergoing an echocardiogram, the cardiologist arrives. They have trouble getting a clear picture of my heart from every angle—something about my rib cage getting in the way—but one thing is clear: I have pericarditis, inflammation of the pericardium, the thin membrane that surrounds the heart. Oh, and pericardial effusion, fluid in the pericardium. This in itself, I discover later, can cause arrhythmias, including atrial fibrillation.

On Monday morning, the cardiologist stops by again. He wants me to wear a Holter monitor, a device about the size of a beeper that records the heart’s rhythms, for 30 days. In the meantime, I should also have a treadmill test. When that’s out of the way, I should see him in his office for a follow up appointment.

He prescribes Cardizem CD 180 mg once a day, plus an aspirin (81 mg once a day). I’m given my discharge papers.

DISCHARGE DIAGNOSES:

1. Atrial fibrillation in sinus rhythm.
2. Hypokalemia [low blood potassium], resolved.
3. Normal lipid status, except low HDL.
4. Borderline elevated blood sugar of 109.
5. Mitral valve prolapse [a heart valve defect], anterior mitral leaflet mild.
6. Small pericardiac effusion, probably due to pericarditis.

This post will be updated. There’s more to the story.