Valentine’s Day Broken Heart

Last week, I told you how I had planned for this year, 2012, to be the year of me, the year when things really started to pick up. Unfortunately, it seems that the year has already started badly, with the news that my heart damage is likely permanent. To find out if this is indeed true, I underwent a scan of my heart this past week. Much to my chagrin, it was discovered, beyond a shadow of a doubt, that my heart is truly damaged beyond repair.

When I asked the doctor… he laughed and told me that it would feel like a gorilla punched me in the chest.

As you can imagine, finding out that your heart is not functioning at 100% efficiency can be sobering. Now, I am facing a procedure in the next month to get a defibrillator installed. This is ultimately due to the fact that my heart is pumping about 20% percent less blood per beat than it is supposed to. To determine this percentage of damage, I had an ejection fraction test last week.

Sounds mathematical, doesn’t it? Ejection fraction (EF). The phrase seems like something that you would hear in a college calculus class. If you break it down, though, it actually makes a weird sort of sense. It goes like this: Every beat of the human heart pumps out a certain amount of blood. As you know, the heart beats in two stages, usually described as a “lub-dub” sound. Well, the “lub” is the heart contracting, and the “dub” is the heart going back to it’s resting position. This two-stage action is why a blood pressure reading has two numbers – the pressure at rest and the pressure at full heart contraction are both measured. The ejection fraction, on the other hand, is the numerical value that represents how much of the blood inside a filled heart is pumped out when that heart contracts. A normal human being has an ejection fraction measurement of around 55% percent. My ejection fraction is now, and forever will be, 34% percent. As you may have figured out already, my heart is operating about 20% percent less efficiently than it should.

The next question you have is probably the same one I had – why does a heart attack make the heart work less efficiently? Well, the answer is two fold. Before we go any further though, you have to understand what arteries actually do, and how a heart attack affects those arteries. Arteries are the vessels in the body that supply fresh, oxygenated, blood to the body’s cells. The heart muscle cells are usually supplied by thee main arteries. When you have a heart attack, a series of events take place which result in the body blocking it’s own blood vessel with clotting agents. (For those of you who are interested, the full mechanics of a heart attack were covered in one of my previous columns.) When that blood vessel becomes fully or almost fully blocked, the blood flow to the cells on the far side of the blockage stops, and they start to die from a lack of oxygen. In essence, the cells suffocate.

Depending on how long the blockage remains in place, a percentage of the heart muscle dies. This dead scar tissue no longer moves when the heart pumps, and if enough of the heart loses its power to contract, then the patient can die. Fortunately, I only lost 20% percent or so of my heart muscle tissue, so my heart can still pump blood well enough for me to survive. Unfortunately, I am now at a higher risk for something called an arrhythmia. An arrhythmia is when the heart beats very, very, fast in an irregular fashion. This results in the heart pumping very little blood or no blood at all. I don’t need to tell you that no blood pumping is not a good thing.

My next question was obvious – why does scar tissue create a higher risk of arrhythmia? Unfortunately, there is no answer to this question. The doctors simply don’t know why arrhythmias occur, and why people with scar tissue and an ejection fraction of below 34% percent are more at risk. All he could tell me was that studies have shown that lower ejection fraction coefficients mean higher risks of arrhythmia. Luckily, I was used to hitting a brick wall when asking medical questions from my years of dealing with my R.A., and I just accepted the fact that I would need to address my increased risk of arrhythmia.

In order to deal with my now increased risk of an irregular heartbeat, I am having a defibrillator installed in the next month or so. I’m sure most of you are familiar with a hand-held defibrillator from movies and TV shows. For those who aren’t, it’s the thing that doctors use to restart someone’s heart with an electrical shock. (You know, the device that someone always yells “CLEAR!” before using.) Well, since that big machine probably won’t fit inside my body, I’ll be getting the miniaturized version. About the size of a Tic-Tac box, it will sit underneath the skin of my chest and monitor my heartbeat. If it detects an arrhythmia, it will attempt to speed up my pulse until it reaches a speed greater than that of the arrhythmia. If it works, this will make the heart beat regularly again (albeit fast). If this does not work, then the defibrillator pulls out the big guns and administers a shock of energy equivalent to about 20 joules. When I asked the doctor if I would feel this shock, he laughed and told me that it would feel like a gorilla punched me in the chest. The doctor saw the look of horror on my face and immediately added “but you’ll be alive! That’s a great thing!” “Oh yeah,” I said. “I’m livin’ the dream.”

So, here I am now with yet another procedure on my plate, and yet another hospital stay in my future. There is something different about this operation, though – about the whole problem, in fact. This entire ordeal did not have to happen. If my pre-operation stress test was done properly, I could have probably avoided the heart attack that took 20% percent of the most important organ in my body. It is one thing to live with R.A. and know that there was nothing you could have done to prevent it. It is quite another thing to realize that your heart was damaged due to the fault of someone else and could have been prevented. It is a new experience for me and I am doing my best to deal with the emotions it has stirred up. So this Valentine’s day, I am, quite literally, suffering from a broken heart.

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