Successful Biopsy Good; Pacemaker Checkup Bad
On Friday, April 21, I went back into Emory University Hospital for a cardiac biopsy. They can handle it as outpatient surgery. Dr. Smith, my cardiologist, numbs my neck with an anesthetic, then inserts a device that creates a portal into my jugular vein in my neck. He snakes a long wire through the portal, down my jugular and subclavian vein into the right ventricle of my heart. At the end of the snakelike wire is a small clamp-like device with sharp cutting edges. By tightening a wire on the external end he can close the clamp on heart tissue and grab a piece of my heart to bring out. He took out 4 samples this time to make sure he got some good tissue.
After the surgery I was resting on a cot and still getting some tachycardia runs. However, one pacemaker nurse noticed these, took some readings and downloaded some data from my pacemaker, then consulted with an electrocardiologist. She came back and made some minor adjustments to my pacemaker, explaining that the tachycardia events may be PMTs: pacemaker mediated tachycardia! Amazingly, after the adjustments my heart stopped having the racing events to the extent that it had for the last 2 months! Instead of being wakened at 6:00AM every morning with a racing heart (The circadian rhythm of the body causes higher levels of cortisol to be pumped out in the early AM, probably speeding up my heart.), I can rest in bed and wake up normally. This one minor adjustment has made a big difference in my heart and feeling more under control.
The results that came back from the biopsy were encouraging. The level of inflammation is down considerably, and the infiltration of white blood cells in my heart muscle is down as well. Dr. Smith gave me a "looks good" comment-- I'm sure he can't say that I'm recovered, but he's optimistic about my future. This is good news!
AND THEN... I went in to the Arrythmia Center on Thursday, April 27th, on what I thought would be a short, one hour visit for them to check my ICD/pacemaker. After checking it for some time the pacemaker nurse noticed some arrythmias she did not like to see and decided to consult with a physician, Dr. Sorescu, who is one of Dr. Smith's partners in the Heart Failure clinic. I spent most of my visit waiting for Dr. Sorescu to come talk to me, and when he did he had some disappointing information. He talked to me about "the burden of scar." My heart tissue that had been damaged and killed by the giant cells and inflammation process had become scar tissue--this is a normal healing process--but that scar tissue did not conduct the heart's electrical current well, leading to some irregularities. He decided my arrythmias were bad enough to warrant some additional prescription drugs, so I got an additional anti-arrythmic drug (Amiadarone), a diuretic to help combat the fluid retention I was getting in my legs and abdomen (Lasix), and a potassium pill to take with the Lasix (since Lasix tends to reduce blood potassium as well). Because these heart drugs slow my heart, the cardiologists worry that blood will pool in the atria and possibly create a clot. If that breaks off the heart wall and travels to my brain I could have a stroke. So I'm now also on Warfarin--a blood thinner to keep that from happening. He decided I should also increase my dose of Coreg (my beta-blocker heart drug). I left feeling depressed I now had 4 more drugs to add to my already long list of prescriptions.
Over the past few days the increased doses of Coreg and Amiadarone have made it difficult to stand and walk. Almost every time I get up from a sitting position I need to take about 30-60 seconds to get my heart rate up and to stop feeling dizzy and like I'm going to faint. I'm going to check if I'm on too much heart control drugs the next time I meet with Dr. Smith on May 9.
So I'm feeling good and happy about the latest status of my heart and the reduced inflammation. The immune suppressing drug, Cellept, that I'm currently taking may have truly slowed down or halted the giant cell myocarditis process. But I feel tired and my heart feels "restrained" with all the medications I'm taking. Still, considering how this may have progressed, I'm looking at this as a temporary condition on my continuing road to recovery. I'll try to post an update after I get news from my May 9th appointment.
After the surgery I was resting on a cot and still getting some tachycardia runs. However, one pacemaker nurse noticed these, took some readings and downloaded some data from my pacemaker, then consulted with an electrocardiologist. She came back and made some minor adjustments to my pacemaker, explaining that the tachycardia events may be PMTs: pacemaker mediated tachycardia! Amazingly, after the adjustments my heart stopped having the racing events to the extent that it had for the last 2 months! Instead of being wakened at 6:00AM every morning with a racing heart (The circadian rhythm of the body causes higher levels of cortisol to be pumped out in the early AM, probably speeding up my heart.), I can rest in bed and wake up normally. This one minor adjustment has made a big difference in my heart and feeling more under control.
The results that came back from the biopsy were encouraging. The level of inflammation is down considerably, and the infiltration of white blood cells in my heart muscle is down as well. Dr. Smith gave me a "looks good" comment-- I'm sure he can't say that I'm recovered, but he's optimistic about my future. This is good news!
AND THEN... I went in to the Arrythmia Center on Thursday, April 27th, on what I thought would be a short, one hour visit for them to check my ICD/pacemaker. After checking it for some time the pacemaker nurse noticed some arrythmias she did not like to see and decided to consult with a physician, Dr. Sorescu, who is one of Dr. Smith's partners in the Heart Failure clinic. I spent most of my visit waiting for Dr. Sorescu to come talk to me, and when he did he had some disappointing information. He talked to me about "the burden of scar." My heart tissue that had been damaged and killed by the giant cells and inflammation process had become scar tissue--this is a normal healing process--but that scar tissue did not conduct the heart's electrical current well, leading to some irregularities. He decided my arrythmias were bad enough to warrant some additional prescription drugs, so I got an additional anti-arrythmic drug (Amiadarone), a diuretic to help combat the fluid retention I was getting in my legs and abdomen (Lasix), and a potassium pill to take with the Lasix (since Lasix tends to reduce blood potassium as well). Because these heart drugs slow my heart, the cardiologists worry that blood will pool in the atria and possibly create a clot. If that breaks off the heart wall and travels to my brain I could have a stroke. So I'm now also on Warfarin--a blood thinner to keep that from happening. He decided I should also increase my dose of Coreg (my beta-blocker heart drug). I left feeling depressed I now had 4 more drugs to add to my already long list of prescriptions.
Over the past few days the increased doses of Coreg and Amiadarone have made it difficult to stand and walk. Almost every time I get up from a sitting position I need to take about 30-60 seconds to get my heart rate up and to stop feeling dizzy and like I'm going to faint. I'm going to check if I'm on too much heart control drugs the next time I meet with Dr. Smith on May 9.
So I'm feeling good and happy about the latest status of my heart and the reduced inflammation. The immune suppressing drug, Cellept, that I'm currently taking may have truly slowed down or halted the giant cell myocarditis process. But I feel tired and my heart feels "restrained" with all the medications I'm taking. Still, considering how this may have progressed, I'm looking at this as a temporary condition on my continuing road to recovery. I'll try to post an update after I get news from my May 9th appointment.
posted by JayVS | 9:48 PM
1 Comments:
Jay,
I very much appreciate that you are keeping us up-to-date on your healing process.
Keep getting better!
Ken Crangle
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