Thursday, September 25th, 2008
Yes it’s my heart and my health. My way of handling medical issues which I think are scary or threatening to my lifestyle is to learn a lot about the subject, and to ask intelligent questions of my doctor. Then to question everything that doesn’t make sense.
After my first salvo of SVTs I saw my cardiologist for the first time (July 3rd, 2007). He is specifically a rhythm specialist (or cardio electrophysiologist). At his suggestion I started wearing a heart monitor for the next month. Unfortunately the issue did not come back during the month. He suggested the possibility of vasovagal syncope. That is, passing out (or nearly in my case) due to a sudden drop in blood preasure after standing up (or other like event). I tried to explain to my doctor that this didn’t sound like my problem and that I had never had any problem like this. However I didn’t mind eliminating a variable. So, we agreed to do a tilt table test.
Tilt Table Test - The tilt table test is an outpatient procedure. I showed up at the hospital and was prepared by changing into one of those flattering hospital gowns. After a few minutes I was transferred to the room where the test would take place. It is exactly what you expect. After laying down and being hooked up to a 12 lead ECG the table is tilted up, but not so you are standing. Instead it’s tilted to about 80 degrees so your weight is distributed between the table and your feet. This sounds easier than it is. When standing you normally tense your legs which counteracts the blood pooling in your legs. When on the tilt table your blood still flows down, but your legs aren’t tensed up enough to counteract the pooling. So, your blood pressure drops. If after 15 minutes you haven’t passed out then they give you a dose of glyceryl trinitrate (A.K.A. nitroglycerin). This causes your heart to race and exacerbates vasovagal syncope. If you pass out during the test then you probably have it.
After 15 minutes I did not pass out (I was really tired of standing though and my feet hurt). So they gave me a spray of the nitroglycerin. I immediately felt the rush and my heart raced. Another 5 minutes went by and I decided to rest my eyes and relax. At that very moment my doctor exclaimed “Ahah!” I opened my eyes and said “what.. what did you see?” He quickly calmed down and said “no… just thought I saw something on the monitor.” So I went to rest my eyes again and exactly the same sequence occurred. At that time I realized I’d have to keep my eyes open or face the false positive diagnosis. Instead… I made it through the 30 minutes and my doctor, despite my protests, declared this a false negative and made the diagnosis vasovagal syncope. In fact he quoted the statistic of 14% false negative with this test. DOH!
That seemed rather anti-climatic and somewhat disturbing. On the one hand I didn’t pass out. On the other I am still no closer to a correct diagnosis than before and my doctor has given up on trying.
At 4am I awoke from my sleep and could not return. On my mind was the clear problem of how I could acquire a correct diagnosis. Without an ECG of this phenomenon I would not be able to prove it.
And so on the internet I searched… To Be Continued
Tuesday, September 2nd, 2008
It’s been 2 weeks since my last post when I was waiting for my cardiologist to call with MRI results. He actually called about 2 hours after the last post but my vacation got in the way of this update. Anyway it turns out that all of the “abnormalities” are not an issue. The aneurysm is very small and because the muscle wall thickness is normal it doesn’t pose any danger. The akinesis is for a small area and doesn’t pose an issue. The 40% ejection factor is still within the normal range for this MRI.
So the final word is “All Good.” We will continue to monitor these issues by echo cardiogram every couple of years to make sure they aren’t getting worse.
Now that my cardiologist has had his word… I’ll likely get a second opinion. I really don’t expect to get any different answer, but it still helps to have correlation.
Tuesday, August 19th, 2008
Last week my cardiologist was on vacation and I was curious about my MRI results. So, I called the imaging center and asked them to fax me a copy of the report. They can’t do that without my doctor’s OK. Hmm… I’m pretty certain I have a right to my medical records, but I’d rather get them than fight about it. So I asked if they could fax them to an alternate doctor and the answer was absolutely yes. So, I had them fax it to my aunt who is an M.D. Not much to my surprise, the records showed up on my fax within a few minutes.
I read the report and I was surprised to find that there were some abnormalities observed. I truly expected that, after all the other tests, there would be nothing of interest on the MRI. A few of the terms are downright concerning (at least from my perspective).
“Aneurysm,” “borderline systolic,” “akinesis” were all used to describe parts of my right ventricle. The report also indicated a 40% ejection fraction for the right ventricle which is marginal at best. I should add that the “aneurysm” was qualified by a normal cardiac wall thickness (the thickness of the muscle) which indicates the aneurysm is likely an artery. From my “google understanding” coronary artery aneurysms rarely burst because they are supported by the pericardium (the sack which surrounds the heart). That makes me feel a lot better… really.
After discussing with my aunt we agreed that there was probably no reason for immediate concern. However I should contact the cardiologist’s office and make sure that the covering cardiologist has reviewed the results.
Their office had not reviewed the results and I had to specifically indicate that I knew something was abnormal and that they should probably review it to make sure it wasn’t an emergency issue. The covering cardiologist did review the report and indicated it could wait for my cardiologist to return.
So now I wait 
As of today, Tuesday August 19th, I haven’t yet heard from the cardiologist. I’ll give his office a call today to see if I can get some results.
Tuesday, August 5th, 2008
WOW! Didn’t expect the cardiac MRI to last that long. One hour and fifty minutes is a long time to have to lay still on a cold hard table. The technician set me up with some tunes (Pink Floyd, Dark Side of the Moon) to pass the time, but my arms got tired quickly of sitting in one place and it got really uncomfortable real quick. Not to mention that breathing in and holding my breath for 15 seconds out of every 30 seconds was starting to make me a bit loopy. I knew it was getting long when “Breathe” came on for the SECOND time (no reference to my breathing in and out over and over intended… really). Then “Time,” and “Money” for a second time. “The Great Gig in the Sky” was in there too, but you can’t help but remember the beginning of both “Time” and “Money.” He then switched me to some U2… a nice change, but I’d like to be off the table. Anyway, this post is starting to feel like my time on the table. I’ll be picking up a copy of the MRI on CD. I don’t know if I can make it available on this site yet. If I can I will.
At about 75 minutes into the MRI the tech got the imaging center’s cardiologist to come look at the photos. Presumably to check and see if there was anything of interest which needed further imaging. After about 15 minutes of waiting we got back to it and took a bunch more images. Seems there was some question about what could be fat in or around the pericardium. Unfortunately I don’t really remember the conversation that well. So I’ll, uncharacteristically, wait for the results instead of guessing 
Saturday, August 2nd, 2008
I just received a phone call from my cardiologist (actually a cardiac electrophysiologist). He called to review my Nuclear Stress Test results. All good news! Stress test itself showed no arrhythmias and the tomographic images showed good blood flow to the heart. This indicates that the arrhythmias are not life threatening. This is what I expected, but still good to have positive evidence :-). I’m still going to do the cardiac MRI next week to rule out any other issues. I’ll post those results when I have them.
Saturday, August 2nd, 2008
So, on 12/30/07 I finally caught an SVT on the monitor (ECG: 12/30/07 SVT), that’s great. The problem is, that evening, I kept having them. While it was a bit uncomfortable it did give me an opportunity to capture some good information. Later in the evening on 12/30 I was monitoring myself when I caught a complete SVT and more… This SVT was particularly painful and had a feeling of significant pressure in my chest in addition to the usual light headed feeling. At about three and a half minutes into the SVT the pain and pressure went away, but I still had the arrhythmic feeling in my chest. The ECG still showed an arrhythmia, but it wasn’t regular like the SVT. The next morning my mom identified the irregular rhythm as Atrial Fibrillation. FYI My mom is a retired cardiac care nurse who has been a big help for me to understand (in a novice kinda way) what I’m looking at on the ECGs.
This strip (Click Here For The ECG) shows the beginning of the SVT. At about 14 seconds on that strip a “glitch” in the SVT causes it to speed up from what was 190 BPM to 232 BPM. That’s when the SVT became particularly uncomfortable.
This strip (Click Here For The ECG) shows the conversion from SVT to AF. It is pretty noisy because I was moving around at the time. After a few minutes the AF settled into about 140 BPM (Click Here For The ECG) and lasted for at least 15 minutes when I stopped monitoring. It did eventually, spontaneously, convert to a sinus rhythm.
I built the little ECG machine to capture an episode of supraventricular tachycardia (SVT) for the doctor. After waiting several months for something to occur I captured this SVT on December 30th 2007. It lasted several minutes. This SVT ran at about 220 beats per minute. This strip shows the last 2 seconds of the SVT and the conversion to sinus rhythm: Click Here To View
One of the first recordings I took with my homemade 3 lead ECG is this one. I took it on August 26th 2007. It is a normal rhythm: Click Here To View
I had my first noticeable arrhythmias about 18 years ago. One quiet night I had sat down after work with a beer in hand barely had a sip when I noticed what felt like a hiccup. I knew it wasn’t really a hiccup, but it still felt like one. A few minutes later I felt another one. And another. They were my heart skipping a beat, and that scared me. So after some typical male hesitation I headed for the Emergency Room (which was about 2 blocks away). They didn’t actually record anything of interest on an ECG, but I now know that these were PVCs or PACs (without an ECG it’s hard to tell which). Either way they were palpitations.
In that same general time frame, give or take a year, I remember playing racquetball with my dad and brother when I felt my heart racing, light-headed and no pulse. Very similar to what I feel now when I have supraventricular tachycardia (SVTs).
After those two incidents I didn’t really feel anything for many years. I do remember occasionally feeling the palpitations, but never more than a few here or there.
Fast forward to maybe 2006 (probably earlier). Occasionally when I would wake up in the morning I would notice the palpitations. Usually they would go away quickly and not be an issue. Then I had them occur for a couple days in a row. So I decided one morning (August 2006) that I should go by the doctor’s office and run it past him. They took a chest X-Ray and an ECG. The ECG did reveal a PVC/PAC. So that was the diagnosis. During that day I continued to have the palpitations. All day long. Several per minute. At about 4:30pm I decided that I needed to make sure these were benign. So I called the Doctor’s office to find that he wasn’t available. So after some thought I decided to play it safe and went to the emergency room. They hooked me up to the ECG and found some PVCs. They explained that these were truly benign and that I should not worry about them, but follow up with my doctor.
So PVCs/PACs are benign. I’m good with that. After this day I did on occasion have more of these, but they rarely lasted more than a few hours and I really don’t have an issue with them now that I knew they are benign… That is until July 3rd 2007.
I’ll post more later… this is where it gets more interesting.
Saturday, July 26th, 2008
My Nuclear Stress Test (earlier post) was prompted by an emergency room visit where I appeared (by my own account) to have short runs of ventricular tachycardia (VTAC). It had been my understanding that any VTAC was dangerous.
On Wednesday (7/16/08) I had been having some rather strong arrhythmias some felt like Supraventricular Tachycardia (SVTs). In the mid afternoon I had a few of these which caused me to have a light headed feeling. This has happened before when I’ve had SVTs. So, I hooked up my little 3 lead ECG and monitored my heart for a few minutes when I had a run of PVCs. At first it was 3 in a row every couple of minutes and occasionally it was 4 in a row. I ran these past my mom who is a retired cardiac care nurse. She confirmed that these were technically VTAC. She also indicated that I should be concerned. Moderately concerned I attempted to contact my doctor for an opinion (yeah right… just try to get a doctor on the line at 4:50 pm). A few minutes later I had a run of 9 beats of VTAC (3 seconds) (Click Here For The ECG). Now I’m concerned. If it can run for 3 then 4 then 9 beats… it can continue. “I’m going to the ER.” So I printed a copy of the ECG and headed there in earnest.
When I arrived in the ER the triage nurse took a look at my ECG and said “looks like VTAC.”
…skip a few hours of being hooked up and monitored plus blood tests…
ER Dr. says we want you to stay over night for monitoring. Ok… they agree this is concerning. I usually get “Benign Palpitations. Have a nice day.” With the tone: “Don’t let the door hit you in the ass on the way out.”
…skip being awakened every two hours for blood tests DOH!…
The next day my Cardiologist eventually came by to see me (about 1:30pm, and yes that’s an annoyed tone in my typing). He indicated these too were benign, but that I should probably be on a higher dose beta blocker and we should do a few more tests. Specifically a Nuclear Stress Test and a Cardiac MRI. He did confirm that technically this is VTAC. But it isn’t dangerous unless it becomes prolonged (i.e. I pass out). So if I pass out I should dial 911. Yeah right 
I’m not so certain about the beta blocker thing. About 2 weeks ago I started a daily extended release beta blocker and this is the first time I’ve seen runs of PVCs. I monitor my heart whenever I have strong feelings of the arrhythmias. I would know if I had seen these before, and I haven’t. The cardiologist wants to basically double that dosage. I’ll discuss the beta blocker thing next time we talk.