Monday, April 13, 2009

Seeing the Other Side

As of late, I find myself in the role of the patient.

About six weeks ago, I noticed some short bursts of palpitations and lightheadedness. Then during a weight training workout, I felt my pulse racing for about a minute before it would stop. I had only four hours of sleep the night before, it was 5 am at the gym, and I figured it was just due to fatigue.

A week and a half later, it occurred again while lifting. I looked down at my Polar heart rate monitor -- 180 beats per minute. That can't be right. My first instinct was to keep on exercising and hope it would stop, but trying to do squats with a racing heart doesn't work so well. I tried carotid sinus massage, pressing on the neck to try to stop the racing heart rhythm. Then I laid down, and by bearing down I was able to break the endless loop, watching my heart rate monitor flash from 180 suddenly to 73 beats per minute.

Being a cardiologist, I knew that this was likely a supraventricular tachycardia -- in other words, an abnormal circuit in the heart that can cause the heart to race. I obtained a portable heart rate monitor that I could carry with me wherever I went -- on long runs and bike rides, or in my lab coat pocket. If the palpitations recurred, I could capture the electrical impulses so that the rhythm could be diagnosed and appropriately treated.



Two and a half weeks went by without any palpitations. I hoped that meant that I was cured, but that was quite unlikely. Then, after a challenging bike climb, it occurred again. I pulled out my trusty event monitor to record the rhythm and sent in the recording.

My suspicions were correct. I have supraventricular tachycardia, also known as SVT. And the episodes are becoming more frequent, and at times are lasting longer, up to 25 minutes at a time!

There are two ways to treat this. The first option is medication. That would decrease the frequency of the attacks. However, it would cause my heart to be slower all the time and would limit my capacity to swim, bike, or run, and in all likelihood would not cure me. The second option is an invasive procedure called an ablation, which involves feeding a catheter from the large vein in the upper leg up to the heart, localizing the abnormal rhythm, and burning through that abnormal electrical circuit. The cure rate with the latter option is 90-95%.

I'm opting for the latter, more invasive procedure. I need a cure. If I had SVT while running or bicycling, it would be disruptive, and I'd have to stop. Worse yet, if I had SVT while swimming in open water, that could be downright dangerous.

Until my ablation procedure is done, I cannot race. Which absolutely kills me, because I was looking forward to my first race of the season this weekend.

I am nervous -- even though the complication risk is very low, normally I'm the one performing the procedure, and now I will be the patient on the table. I think this will give me a different appreciation for my patients' experiences.
Image from http://kirstyne.files.wordpress.com

15 comments:

Dan said...

Sorry to hear about this.
I remember when I was a med student one of the pulm crit care docs said to him it seems like physicians wind up getting conditions they treat. He gave an example of a pt we had who was a pediatric neurologist who was suffering from some rare neurologic disease and then asked me what I was going into. When I told him EM, he told me I would probably be shot. So, look on the bright side...had you been a gastroenterologist you may have wound up with a huge GI bleed or a rectal prolapse...
Hope all goes well.
-Dan-

Anonymous said...

Oh, dang! I'm so sorry. But I'm glad you have a clear diagnosis and a 90% shot at a cure. -victoria

Pacer Sharon said...

Wow -- Amazing that this would happen to such a dedicated athlete, and that you could diagnose it and weigh the best treatment. Hang in there,
Sharon

Anonymous said...

My son is also a triathlete and he had this ablation procedure done some years ago, for the same reason. It worked like a miracle. Amazing. I hope that you have the same success that he did.

Jo

The Girl said...

Good luck with the procedure! I have been on staff for a lot of these, too (although it is nothing like being the cardiologist - you must have nerves of steel) and can understand how scary it would be to be the patient.

I also thought I would add that your blog is great. As a vegan, it is fantastic to have somebody around who I can look to when I wonder whether I really am mad or not for eating this way, in spite of the support of all of the evidence base. :)

Christie said...

I'm sorry to hear about this. I hope everything works out with the procedure.

VeganLinda said...

I'm so sorry to hear this, but glad there is a possibility for a cure. I am amazed at how complex our hearts are. How wonderful that you knew to pay attention to the signs and what to do about them. My son has a Congenital Heart Defect and it makes me much for conscious about listening to things that don't "feel right". I hope all goes well with the procedure. I can imagine it is tough being on the patient side. When will you be able to be back up and racing after the surgery?

Crash Course Cardiologist said...

Hello there... I'm so sorry you have to go through this, but I'm hoping once you're back on your feet, you'll view it as a great gift from the Universe.

As a young heart patient (I had an MI at 37 -- no cardiac disease and no risk factors -- and ended up with a triple-bypass), I often reflect on my week in the cardiac care unit as the worst days of my life. Why? Not just because of the pain, shock and fear, but also because of the lack of compassion from many of the staff (doctors and nurses included). I never questioned their competence, and I had no doubts about their medical expertise -- but none of them seemed equipped to relate to the deep despair and helplessness I felt as a previously healthy woman struck down in her prime and finding herself in a hospital bed unexpectedly the week before Christmas. Even 2 years later, it's hard to really put those feelings into words, so I often just refer to that week in the hospital as "my Auschwitz." And a large part of it has to do with the callous way I was treated by the medical staff. (As you can tell, I'm still angry.)

So, I think being able to see the other side gives you a tremendous advantage -- a perfect complement to your skills as a physician. There's no gift greater than being able to walk in the shoes of your patients. It may enable you to participate in the total healing process -- the MIND as well as the body.

BTW, you seem like a cool person and a great doctor, and I really enjoy your blog. Best of luck to you, and best wishes for a speedy recovery!

Katie M. said...

Good luck today, Heather! Hope it goes well and you are back on your bike soon :)

HugeMD said...

Glad the ablation went well, and you're doing fine. I'm also secretly a little glad to see a cardiologist blew off her first epidsode, too. Now I don't feel so dumb. Thankfully, I've only had two, but I don't know if kicking the coffee addiction is worth it. Maybe I'll have to rethink that ablation...

Heart Disease said...
This comment has been removed by a blog administrator.
Weight Loss Wendy said...

That is very scary to think about. There are a lot of heart problems in my family and being overweight contributes to them. But it seems totally out of the norm for someone in shape to be faced with cardiac problems as well. I'm sure you stay within the recommended daily sodium intake and eat a diet low in fat.

I hope the procedure works for you. I have a brother that suffers form " left ventrical non compaction" which kept him from playing football. Is there any medical procedure to cure that as of yet?

Mike said...

I am an avid cyclist and experiencing what I believe to be my first SVT early in the riding season last year. Since then, they have continued getting worse to the point where my HR is over 200 for nearly the entire ride (which sucks). So, I am mostly off the bike and waiting for an appointment next month. Hopefully an ablation is an option in my case as I would prefer not to treat this with meds. In any case, your story was great and I hope my results turn out as good as yours...

Deb Hadden said...

I really appreciated your blog post. An interesting story. I started having SVT's in July, just when I am walking briskly or running up and down the stairs. My second to last SVT prompted an adenosine push in and ambulance and a follow up appt. with my cardiologist. My husband went with me and mentioned he had chest pains, and my doctor ordered a CTA angiography for him. He wound up finding out he had two 99% blocked arteries. Needless to say, I appreciate what interventional cardiologists do, as he is a vital man now thanks to his two stents. We have also become low-fat plant based vegans and appreciate the fact that our cardiologist is also and supports our lifestyle. Your post on your own experience with SVT's is a comfort to me. Thank you for sharing your story and for dedicating your life's career to saving others like my husband. I've chronicled our journey and many of our recipes on my blog http://www.coronarychronicle.blogspot.com

Wilfred Weihe said...

Hello. I'm also a triathlete, former athlete with similar condition like yours. My tachycardia kicks in after recovery and not during exercise. I can ride bike normally for hours and after I fully recover I get sometimes some rapid heart rate up to 160 lasting for few seconds to few minutes. My resting HR is in low 40s. I just need to be careful not to ride/run if having an episode. Not hard to miss it because I can fell heart racing. Nothing else, no pain, no sickness... If I start exercise when having an episode I get over 200HR in very moderate tempo.

I discovered this 3 years ago (my episodes in this time lasted for hours after exercise). Had holster monitor for 24 hours, was diagnosed with PSVT. Was put on beta-blockers which only lowered my HR, no fewer tachycardia's. Another holster for 24 hours and then I had ablation done but they could not found source of miss firing nerves. Re-scheduled for check up in a year and doubled my beta-blockers dosage. After consulting with my general doctor I stopped with beta-blockers (they lowered my HR to 35 - sitting and doing work by computer).

In time after this I changed my diet. Lost a few pounds, stopped drinking coffee and alcohol. Increased magnesium and potassium intake with food and ZIPVIT V0 Electrolyte Tablets during exercise.

What irritates me is that I cant zoom in on source of a problem. Sometimes I get episode and sometimes I don't. And if I do warmup run (up to 130HR) and then some distances I can get episode after warm up. Usually I can en an episode with valsalva maneuvers, but sometimes it wont end for few minutes and I have to sit down and hold my breath.

So did your ablation totally removed your problems? Any tips how should I proceed further?
Thanks.