Tuesday, November 20, 2007

The Heart of the Matter.......

Most of you don’t know that I have been undergoing a series of tests on my heart over the past 4 weeks. I went to the school nurse the week before Halloween complaining of some “heart burn”, and to get some TUMS and she asked if she could have a listen to my heart (the discomfort was right in the middle of my chest). After a few minutes of listening, she expressed concern that my heart was beating irregularly. I shrugged it off, telling her I knew that my heart beat irregularly, and she questioned how I knew this. I went on to tell her that 6 years ago, right before we moved here, my OB-GYN expressed some concern about an irregular heart beat and I had an EKG right in her office and it was fine. I haven’t given it a whole lot of thought since then.
Because of the discomfort, and the irregular beat, and my low blood pressure (she monitors it for me, because when it drops lower than the normal 90/60, I get dizzy and lightheaded) she strongly suggested I go to the Dr. and just have them check it out. Because she’s a wonderful nurse, and she works at the Clinic part time and knows her stuff, I agreed to go and she made me call from her office. 
 I had an EKG that day, that was normal.. a chest x-ray, that was also normal.. lab work done, that showed an elevated level of potassium, but 2 blood draws since then have both been lower, and the way they draw your blood can affect your potassium level so this isn’t a concern.. and a visit with the Dr. Turns out I was having what they refer to as PVC’s(premature ventricular contractions, which just means that some of my beats were early, and close to the one prior to it, and then there is a long pause while the heart “catches up with itself”). She explained that the irregular beats were happening rather frequently, and that they wanted to do some tests just to make sure that there wasn’t anything wrong with my heart that was causing these beats, because some pretty serious health issues can mess up your heart beat. She also explained that it could be anemia, low thyroid, liver/kidney damage etc etc. Or, it could just be a normal heart rhythm that I have, but they needed to find out.
On the 8th, I went in and had an Echo-cardiogram at the hospital. I have to tell you.. I’m not a fan of science, but it was really cool. The tech showed me all the parts of my heart, and explained what I was seeing. She also showed me what the irregular beats look like on the EKG readout, how the different “bumps” show where the beat is originating from, what happens when the early beat is going on, and what my heart is doing after the long pause while it resets itself. (they call it a slam, and that is the discomfort I feel sometimes). After the Echo they hooked up a holter monitor which is a portable EKG that monitors and records your heartbeat for a period of time, in my case 24 hours. On the 9th I went back and they took it off and today I had a follow up with the cardiologist.
I want to mention here, that I had a discussion with my father the day they unhooked the monitor, and he mentioned that when I was a very little girl, the doctor mentioned to him and my mom that my heart was beating irregularly, and that it was a common thing and not to worry about it. When I asked him why no one ever told me about it he said that once they told him it wasn’t a big deal, he never gave it another thought until I mentioned it in that conversation. Anyhow.. I met with my cardiologist this morning, Dr. Burke (who is neither hunky or personable) and he reviewed the results of all the tests with me.
What they have concluded from all this is that my blood pressure is low (duh!).. but on top of that I also have postural hypo-tension, which is a rapid drop in your blood pressure upon standing (or in my case, standing, bending over and then straightening, going from a squatting position to standing, getting up from a lying down position, spinning around too fast.. etc. etc). Normally, when you stand up, the blood vessels constrict to maintain your normal BP in the new position. In people with postural hypo-tension, this mechanism doesn’t work correctly, and when you change position, a temporary reduction in the blood flow to your brain causes dizziness/faintness. Add this to the fact that my BP is normally low, and that my heart is beating irregularly, and it’s all kind of magnified. There is nothing they can do for either my low BP, or the postural hypo-tension.. I just need to be aware that it’s there, and make accommodations.. try not to stand too quickly (although in my case, the speed of standing has no effect), make sure I have some type of support nearby for the brief episode of dizziness, and to make sure I stay hydrated. When you are dehydrated, even slightly, your BP drops. Most people don’t notice or have any effect from this. In my case, I don’t have any wiggle room, and when I am even slightly dehydrated, even if I’ve been drinking fluids and don’t feel dehydrated, my BP drops and I feel it right away. Last week I was feeling lightheaded all morning, and when Patty (my school nurse) checked my BP it was 84/50. 16 oz of water later.. and it was fine. Dr. Burke explained that even though you are drinking fluids, working inside a building all day, especially this time of year when the heat is on and the air is dry.. causes slight dehydration. (Who knew that you lose fluid through your regular breathing, especially in dry air?) So I have to drink more than the normal amount of water they recommend in a day, and make sure I drink more often.
The 24 hour monitor logged 116,000 heart beats, and 13,000 of them were premature beats. He went on to show me all the different places that heart beats originate from, and they have concluded that my premature beats originate from the atrium more often than not, and these are called PAV’s. My echo was “normal” and there is no damage in my heart that is causing my heart to beat irregularly. The beats are what they consider “benign”, which means that they are not dangerous. I don’t have hypothyroidism, nor do I have anemia, or liver/kidney damage. I do probably have allergy induced asthma which doesn’t help the situation any, and contributes to the “winded feeling” I get sometimes, on top of the reduced oxygen flow caused by the irregular beat. Based on all this, and the large amount of irregular beats going on, they consider this to be a normal function of my heart. They have concluded that I have most likely ALWAYS had this, and WILL always have it. All of this combined is why I have swelling issues with my hands, have unexplained bouts of nausea, and why I have such a severe sensitivity to the cold. Sometimes I can feel the “slam” of my heart going back to a regular beat.. but more often than not, I don’t. I notice it most when I am on my daily walks (I have 2 hills in my travels) or when my heartbeat is increased (lots of rushing around at school, etc). It’s not something that they can make go away, or fix, because really nothing is broken. I do not have to go for any follow up visits (for this particular issue) and I do not have to worry about it getting “worse” or anything like that. It is what it is.
I march to a different beat.. but we all knew that didn’t we? (grin)


Meghan said...

I am glad you got checked out.
Now next time you have a scare, you better tell me so I can hop in the car & drive up there & take care of you while you are having your tests.

Sgt said...

Crazy. I have almost the same conditions.

When I was very young, they dismissed it as a simple Heart Murmur. When it started making me feel light headed and odd feelings of heart burn when there was no real reason to have it (long after a meal or drink). They finally figured it out to be Extrasystole (which I presume is pretty much the same thing you have)

I also have Postural Hypotension which is a story in itself of how sometimes the military just doesn't diagnose well. I heard everything from sodium related issues to "just drink more water". Finally they did the lying, sitting, standing BP check and said.. oh.. well there you have it.

Apparently our drummers went to the same music school.

OneScrappyChick said...

Yup.. same thing.. your beats are just originating from a different place than mine... wacky!!

Don't even get me started on the military Drs.. they tried to tell me I had some optic eye disease... someday I'd be blind.. blah blah blah. Turns out, I just have really big "cups", which are the empty space in the back of your eye (that yes, can get larger as your optic nerves "die")

tspwlv said...

I am so relieved that you got good results. I've been very concerned about you young lady. Glad you got checked out. Now take it slow and take good care of you.