In Which You Maybe Learn Some Stuff About Hearts

On Tuesday, a cardiologist and her happy minion tried to kill me and then assessed how close they came. Fortunately for me, not close enough. *Buzzer sound* Sorry. Try again next year.

The stress test was the least irritating of all the parts of this appointment, but that’s part and parcel with doctors. You wait in the waiting room for 60+ minutes (which is why you’re called a patient) and, when you leave, they’ve said a lot of words but haven’t really actually told you anything.

Travis, the Stress Test Tech Person, was delightful, actually. He called me “baby” a lot, but somehow it wasn’t creepy. Sort of like how diner waitresses call you “hon,” whether you’re three or 103, and whether they’re 55 or…

Wait. They’re actually all 55.

Anyway.

Travis was telling me what he was doing all along. He did an echocardiogram first, propping my back against his in a totally clinical way to position me where he wanted me so he could get the images he needed, and explaining very nonchalantly why I really couldn’t keep craning my neck to see the picture on the screen. (“Look, see what happens? The picture gets fuzzy.”) He also told me that he was super-annoyed that he kept getting 30- and 40-somethings for stress tests that day. “If one more person has to walk for 15 minutes before we get them to their target heart rate, I’m jumping out a window,” he said.

It took me 11 minutes. You’re welcome, Travis. I shaved four minutes off that last guy’s time. What’s that you say? That’s not a good thing?  The last guy is 58 and had a heart attack at 41 and is, from a fitness perspective, the lifespan equivalent of four minutes’ better endurance multiplied by a differential of 21 years and mitigated by one heart attack better off than I am? Well, what of it? You want to get your schedule back on track, right? That’s what I thought.

Travis is a very put-you-at-ease person. My blood pressure was 100/62, and he didn’t like it, because it meant I’d have to walk longer, but it was a testament to his calming presence. (At the beginning of my first appointment, two weeks ago, my BP was 120/80).

Happily, they did not make me run. They just made me walk faster by three-minute increments on a steadily increasing incline to get to the required target heart rate (220 minus age and multiplied by 0.90, or, in my case, 165.).

I basically still have no official comprehensive diagnosis, because doctors are annoying, but here’s what I’ve been able to figure out so far:

I have what’s called a 2nd degree Type 1 Wenckebach block. Wenckebach is pronounced WENK-ee-bock, which sounds really silly and is difficult to take seriously as a heart condition, but I guess that’s okay, because it’s not necessarily a serious heart condition, and Germans have funny names sometimes.

The two days I was beeping from the waist on the Holter monitor, minus the ten total hours required to be off-telemetry so the highly advanced cell-phone-cum-science-gadget could charge, resulted in the revelation that my heart skipped 3,842 beats during the other 38 hours. Which is considered “frequent” in a seemingly half-assed, three-sentence report of said monitoring.  The Wenckebach block is the reason for the dropped beats. It’s an electrical impulse disruption between the atria and the ventricles, in which the length of time in milliseconds between the electrical signal that contracts the atria and the one that contracts the ventricles gets progressively longer until it gets long enough that the whole heart skips a beat. Because it’s Type 1, it’s benign and generally, on its own, does not require treatment. If it were to be Type 2, they’d have to consider some options—pacemaker, etc.

It looks kind of like this on an ECG:

Wenckewonky.

Wenckewonky.

 

You’re looking at a series of waves, cleverly named P, Q, R, S and T. The P wave is the bump just before the spike. The Q wave is the lowest point just preceding the spike. The R wave is the tip of the spike. The S wave is the trailing low point of the spike. And the T wave is the bump right after the spike. A 2nd degree Type 1 Wenckebach block results in that flat line you see between the second T wave in the image and the next P wave. You see it happen again three beats later, on the right side of the image. That longer flat line is where the heart skips a beat entirely because the time between the P wave and the R wave (for some reason, the Q wave doesn’t matter to Wenckebach) got long enough that the heart said, “Eff it. Start over.”

This is where it gets fuzzy: This is not considered an arrhythmia. An arrhythmia happens when there’s a premature beat in either chamber of the heart, independent of the electrical signal conduction we’re talking about here. (It’s fuzzy because it’s still an irregularity and both of them are results of electricity within the heart, but different kinds of electrical conduction. MY thing is not considered “abnormal.” Even though it surely seems abnormal to drop 100 beats per hour on average and not even be a hip-hop star.) I have no actual arrhythmia. Apparently, that’s remarkable. I don’t know why, but the doctor said so. I win.

So, the block shows up on the ECG. Fine. The stress test is to see whether the block is consistent even when exertion makes my heart work faster and harder. Adrenaline naturally forces the heart to function more efficiently, so they were looking for correspondence. Excellent news: my heart does what it’s supposed to when I’m walking a stupidly significant incline at a rather good clip for 11 minutes.

Somewhat less excellent is that, after that, during what a normal person would call either a “cool-down” or a “Jesus, let me sit down for a minute,” and which cardiology types call “recovery,” they pulled me back over by my telemetry straps to the table, flopped me down all sweaty and heavy-breathing on it, and put their hands up my gown. It was the least awesome time that has ever happened.

This is when they do the second echo, to compare heart appearance and function under “stress” to the first, relaxed echo.

The echocardiogram revealed that, structurally, everything appears normal. This means it is not heart failure, cardiomyopathy or disease in the valves or arteries apparent in the ultrasound. Huzzah! Mac and cheese for everyone!

However, while I was lying there all schvitzy, the rhythms went wonky – I could feel and see on the monitor the way my heart tends to trip over itself, even when I’m not doing anything but sitting on my couch watching Orange Is the New Black. This essentially looked like the lines were trying to draw the Rocky Mountains instead of the usual rhythms. I have tried to find an image of this, but it’s tough to do a Google image search for “electrocardiogram that looks like Rocky Mountains.” To the best of my memory, it looked a lot like this highly technical medical thing I drew:

WTF wave

WTF wave

I got no explanation of what this Rocky Mountain Wonkiness was and, as strange as it sounds, couldn’t ask, because in those few moments, I wasn’t allowed to talk, and afterward, the doc who administered the test (different from the one I saw two weeks ago, because he was on hospital rounds) had another patient waiting and had already explained the block and the difference between the dropped beats and the arrhythmia and basically told me she had to go.

I did get to talk to my other doc the next day, and while he hadn’t seen everything at that point, I did manage to get him to look at the report and he said the Rockies were about the “P wave getting buried in the QRS complex.”

I hate it when that happens.

Basically, he’s a little surprised by the frequency of the dropped beats, and he says the fact that I drop them in recovery is “not quite normal.” Clearly, he doesn’t know me well yet, or he would realize that everyone knows I’m not quite normal. The upshot of these two surprises is that he and I will have a standing annual date to make sure things don’t get any more caddywompus. Because that’s possible, and then we’d have to discuss pacemakers or what-have-you.

Remember how half the reason I called the cardiologist with my hair on fire a month ago tomorrow was that I was swelling inexplicably? Yeah, we still don’t know what that’s about. But since my Lyme titer definitely, definitely says I may or may not have had Lyme Disease one time in the last 37 years, I might be able to pursue the 341 other possibilities for swelling with my general physician when I see her tomorrow to find out how many tests and dollars it will take to rule out the Lyme Disease thing.

So. Current diagnosis: Heart-wonk. Treatment: Eh. We’ll see. Recommendation: annual check-up. Follow up with general physician to find 27 other things that might or might not be a problem.

Ah, medical practice. Twenty-four hundred years after its beginnings, it still hasn’t made perfect.

 

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Lub-a-Dub-Dub, Three Cords and a Flub

I am currently hooked up to three electrodes that aren’t transmitting anything.

Just for fun.

Not really. I have a wonky heartbeat, and I have for years —too many for me to care to admit, but almost half my life. Recently, a couple of other things happened that I thought were unrelated, and then all of a sudden it occurred to me that slightly swollen ankles and feet and calves and a few extra pounds and a seemingly undeservedly fluffier midsection might all be related to my wonky heart.

And I freaked. The fuck. Out.

I called a cardiologist and scheduled an appointment, for which I had to wait two weeks, which commenced two weeks of freakout. I stopped all alcohol intake and started paying very close attention to sodium. In 24 hours, I dropped four pounds. In ten days, I lost eight. Some of that might have been because I was never home to eat; for two straight weeks of nightly rehearsals and concerts, I sat on stage, squirming on backless wooden benches for hours at a time, singing Mendelssohn and Adams and Beethoven, and monitored my heart, my ankles, my breath control. Was that racing/thumping/tightness because of adrenaline or anxiety or impending death? Did I need to get a spot on the end of the row in case I felt suddenly morbidly unwell? What if the heat of the lights and the crowded space and the all-black concert dress got to me?

I was convinced it was heart failure or cardiomyopathy.

I’m still somewhat convinced.

The swelling has largely abated, and when I finally did see a cardiologist, he seemed to think it might have been a coincidental result of sodium overload paired with cyclical fluid retention. I’m not sold on that theory, but as long as the swelling stays at bay and the weight stays off, I might be willing to believe it. Though I will be super-annoyed at the new tendency to retain water.

I was so scared that when my friend Eliza joined me at the cardio appointment in case he said something devastating and asked how I was doing, I burst into tears.

I was so scared that I was actually thinking about how I would tell my family, what might happen to my house, how long I might still be able to climb the stairs, how long I might be able to work, and exactly how far shy of, say, 50, I might be gone. I was thinking that maybe this is why I don’t have a husband. I was thinking about how I’ve thought for a while now that I will probably die young.

No kidding, guys. That’s what I was thinking.

I even thought about whether, or when, I would blog about it. I thought about my old blog acquaintance, marjulo, who seems to have lost her brief battle with inoperable pancreatic cancer, whose final post was about her diagnosis and whose site no longer exists. I thought a lot about my friend Amanda, just starting her impossible-to-win battle with stage IV metastatic breast cancer, finally finding her fight even though the tumor in her femur still has her in pain and the thought of fighting for the sake of a bunch of months of weekly chemo and then maybe a little time in remission only to be followed by more chemo and less remission is a lot to take.

“Well, of course you think something terrible is wrong with you,” Eliza said in the hospital lobby after the cardio appointment. “Terrible things are happening to everyone around you.”

There was probably something to that.

I had to have a couple of blood tests, and I’m set for a stress echo, at which time they will first try to kill me on a treadmill and then do the echocardiogram I thought was rightfully mine at the first appointment, to find out whether I have heart failure or cardiomyopathy or some other dysfunction greater than the AV1 block and the suspected pulmonary stenosis the cardiologist mentioned at the first appointment. (An AV1 block is a first degree block of the electrical signal between the atrium and ventricle, which, doc says, means it “takes a little longer to get from the lub to the dub,” but isn’t treated; pulmonary stenosis is when the valve between the heart and the pulmonary artery doesn’t open all the way and builds up pressure in the heart chamber as it tries to force blood out to be oxygenated.) My thyroid checked out fine, but my Lyme titer was “indeterminate,” which is the medical equivalent of “Meh… maybe you had Lyme Disease… maybe you didn’t.” Which is basically irrelevant to the situation at hand, but has forced me to schedule another appointment to find out whether I did, in fact, have Lyme Disease once. All evidence to the contrary.

And now I’m hooked up to all these electrodes that are plugged into a gizmo that sends signals to a former cell phone that is now a PDA, and it is all pissing me off.

The first time I felt my heart go weird, I was 20. I was stressing out in a serious way about a married man who had professed his love for me and with whom I did not want to be involved except that I was already kind of involved, not adulterously, but in that way that you get involved with men you work with who say they are willing to put everything on the line for you because their love is just that strong, and you happen to be a total shipwreck in the self-esteem department at the time. I was lying on the couch in my college apartment, which I shared with three of my friends, and Jerry Springer was on, and it was something ridiculous and gross, and I suddenly realized that my life, at that moment, mirrored the show.

Since then, my heart has been skipping beats not with thrills or joys but with impunity. In recent years, it has seemed to frequently trip over itself in an effort to catch up after a dropped lub or dub: lub-dub, lub-dub, lub-dub…lub-lublublub-dub-dub-lub, lub-dub, lub-dub…

I had an echocardiogram something like 11 years ago. I don’t even remember the name of the cardiologist. In fact, I remember nothing about that appointment except for the echo, and the declaration that nothing appeared out of order. And I haven’t had it checked on since. I’m not the annual physical type, so apart from the gynecologist, there isn’t a doctor I see regularly. I’m off the grid.

For the last 36 hours, however, two small devices have been tracking my heart and sending its patterns to a place that then sends it to the cardiologist. I think. Except for the five hours last night during which I got so monumentally irritated by the incessant beeping indicating low battery or poor connection that I ripped the electrodes off my chest, yanked the battery out of the monitor and turned the PDA off entirely so it could charge and I could sleep.

The PDA, which in a previous life was a Samsung Omnia II cell phone, cannot hold a charge. It prioritizes sending data over charging, which means that even if it stays plugged in all the live-long day, it uses up all its energy and dies, which seems counterproductive to a 48-hour heart monitoring system. When it blinks out, such horrendous beeping ensues that I feel like C3PO in mixed-up pieces on Chewbacca’s back. “OMG! DID YOU DIE?! I THINK YOU DIED!!! OH WAIT, THAT”S ME,” it says.

At the moment, it is turned off and plugged in to charge so that my cardiologist can get some idea of what my heart does while I’m sleeping tonight. Since the jumping my heart experienced last night was due to the damned infernal beeping waking me up juuust as I would doze off, rather than its own screwy, jazz-infused rhythm.

Perhaps unsurprisingly, day one of my 48-hour monitoring just had to coincide with Field Day at work. The PDA and the monitor have to be no more than ten feet away from each other at all times, which meant I had to carry the monitor around in the wristlet I use as a keychain/ID/credit/debit card holder the whole time I was swinging from ropes and walking high-wires and hiking around campus, sweating my boobs off, building team spirit with my coworkers. And since I didn’t really want the coworkers to know I was on a Holter monitor, I had to try to be surreptitious about it.

My wristlet is red, b-t-dubbs.

The monitor was clipped to the waistband of my pants, so the work polo I was wearing had to stay untucked. I was relieved to see most others had left theirs untucked, as well, so at least that didn’t seem weird. And happily, the shirt was long enough to cover it even when I had to reach up to swing from ropes like a goddamned Amazon woman.

I managed to keep my monitoring hidden from the coworkers all day. I did not, however, manage to keep the heavy wristlet from smacking me in the face while I clung to ropelines.

You know what blew me in?

The World Cup.

I went home, started writing an essay for my summer class, and had the USA vs. Ghana game on TV. I don’t know much about soccer, so basically I’m all, “Goal is good,” and that’s it. At halftime, The Colombian texted me to tell me to come over. He had one of other other neighbors there, and said neighbor is a bit profanely vocal and demonstrative during sporting events. Javier didn’t think he could handle it alone.

Since I am still very wary of Javier (his relationship with Lydia, however infirm, endures), I let him sweat it out a little while before I went over, armed with my former Samsung Omnia II and its charger, because it was already showing a yellow battery life level.

After our other friend left, and somewhere between the coach’s interview and Dempsey’s interview, I started beeping.

Not the phone, which lay on the windowsill, plugged into an outlet below. The monitor that was attached to me.

Javi did a pretty good job of pretending not to notice that I was emitting electronic sounds from the area of my panties. At least, he did the first four times it went off. And he pretended not to notice when I got up, heaved a sigh, and went into the powder room to check on the monitor.

But finally, after another loooong beep, he said, “Why are you beeping? Whass going on? Why are you stress?”

I’m a terrible liar, so I had to tell him. I thought for sure that this whole I’m-attached-to-a-bunch-of-wires-that-have-been-largely- unsuccessfully-adhered-to-my-midsection-with-steri-strips-all-day-so-that-a-cardiologist-can-keep-an-eye-on-my-heartbeat thing would be a pretty substantial turn-off.

Evidently, I was wrong. Evidently, it translated to a kind of “The Fault In Our Stars With Hearts Instead of Cancer.” Javi told me he had recently spent 12 hours overnight, alone, in the local emergency room for chest pains, and when we hugged goodbye, he tenderly and briefly kissed my neck.

Hope the monitor didn’t notice.

It was so brief that I didn’t even have time to say, “Stop kissing my neck, you South American seducer!” Which is not to say that it’s not still happening in my head, 24 hours later.

Dammit.

Why am I attracted to emotionally unavailable men? It’s a question for the ages. I have been, by all accounts (mostly his and mine, and also Angie’s because she’s heard about them) very clear with him about why his attempts to kiss me (four of them in the last nine months) are absolutely not going to be met with reciprocity because he is still with Lydia. And also, what I haven’t said is that he is to Lydia what Jack was to me, and I don’t need another Jack. He doesn’t know anything about Jack, but I know enough to know I don’t need Javier to be another Jack. On this I am absolutely resolute.

But those shoulders, and the back of his neck, and the way he has to peer over his glasses to see his phone, and the way he looks in a shirt and tie…

Settle down, heart. You’re being watched.