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Another trip to the cath lab.

February 20, 2012

I was more fearful going back to the cath lab.  Partly because I had less drugs on board and partly because going back in means I was possibly having a complication.  Sometimes being an experienced nurse makes things easier for me because I feel comfortable in the hospital environment and know what to expect.  Sometimes it makes things harder because I know too much about potential complications and risks.

I remember calling my husband to let him know what was happening.  I think that’s about all I had time for.  The second trip was much like the first.  The doctor had to puncture the left femoral artery this time since he had used the right just a few hours earlier.  I had no pain during this procedure other than the injection of the local anesthetic and the closure of the femoral artery puncture.  My cardiologist told me he had added another stent to the two he had placed the night before because there appeared to be a slight collapse at one end.  He also told me I had significant vasospasm in the artery beyond my stents and he had given me intra-arterial nitroglycerin to help it relax.

I was taken back to my room in the ICU.  I think my husband was there by then.  My six hour bed rest began again.  I was reflecting on the irony of getting to experience all the classic hospital patient situations I had helped (put) my patients through.  The lying flat for hours, having to use the bedpan, the constant inflation of the blood pressure cuff, having my food taken away, etc.  It helps to have a good sense of humor when you’re in the hospital.

I spent this bedrest resting, but not really sleeping.  My husband kept me company.  I contemplated what food on the menu would be easiest to eat when I couldn’t raise my head and what was light enough to actually appeal to me.  I didn’t have much appetite although I did feel a little hungry.  I settled on the fruit plate with cottage cheese and a cookie.

By now word was getting around.  My husband’s parents were on their way to visit.  My supervisor had stopped by to see me.  I don’t remember if I had talked to my mother yet.  I may have delegated that to my sister.  I nibbled lunch and we visited with my in-laws.  Late morning I had everyone step out so the nurse could help me with the bedpan.  While she was there I confided to her that my chest pain was coming back.  I didn’t want to get everyone all worried.  She called my cardiologist and he was at my bedside in five minutes.  He said we would do an echo and see what it looked like.  I was relieved we didn’t have to run back to the cath lab again.

An echocardiogram is an ultrasound study of the heart.  It is done at the bedside by a technician then interpreted by the cardiologist.  The echo tech arrived in minutes and got it taken care of.  I went back to visiting with the family.  I had probably gotten a little morphine, too.  A few minutes later the cardiologist called the nurse to say the echo looked good.  He came later and explained the results to me.  There was hypokinesis of the left ventricular wall and my ejection fraction (EF) was 45%.  He said my heart was stunned from the heart attack, but that things looked good for now.

So let me explain a little more about the physiology of what was going on.  When my chest pain began the night before, it was a result of an area of my heart muscle being deprived of blood flow and therefore, oxygen.  In the cath lab, my cardiologist found 100% occlusion of the left anterior descending artery.  This artery supplies the majority of the left ventricle wall and the ventricular septum.  You sometimes see lesions to this area or the area just before it in the left main coronary artery referred to as a “widowmaker”.  This is because occlusion of the left main or high in the left anterior descending arteries deprives the main pumping part of the heart of blood flow, leaving it severely weakened which can cause sudden cardiac death.  Fortunately in my case I received immediate emergency care before things progressed to that point.

My cardiologist was not able to tell me why I suddenly developed this blockage in my artery.  My other coronary arteries were “clean.”  He speculated that I had some plaque which ruptured for some reason and a clot developed there, blocking the flow of blood.  Plaque is fatty deposits within the artery wall.  As long as it is securely encased in the tissue and does not block too much of the lumen of the artery things are fine.  However, if the plague ruptures, the fatty deposit is exposed and platelets clump on it forming a clot.

My left ventricle, the part of the heart which pumps blood all through the body circulation, was left weakened by the period of time that the muscle was deprived of blood flow.  It would recover in time, due to prompt revascularization (opening the blocked artery), but for now I was weak.  My heart would take several months to recover that pumping power.

One measure of the pumping power of the heart is ejection fraction (EF).  EF is the percentage of the volume of blood in the left ventricle which is ejected from the heart with each squeeze of that ventricle.  A normal EF is 50-55% up to around 70%.  To illustrate, I had had an echocardiogram done in 2006 before a major surgery.  At that time my EF was 65%.  Now, following this severe insult, my EF was 45%.  That is still some good flow, but much less than I had had before.  I had a subsequent heart cath several months later in which my EF was measured at 55% or so.  A pretty good recovery, but possibly not what I had before all this happened.  The hypokinesis refers to the wall of the ventricle not squeezing as well as it is supposed to, not an unexpected finding in my case.

I remained in ICU for another day.  My irregular heart beats settled down as the ventricle wall began to heal.  At first I needed oxygen, as my heart was not pumping as efficiently as it should.  Think of it like the fuel pump in a car not working right.  It’s not getting the fuel (oxygen) out to the rest of the body as quickly as it should.  I had to supplement oxygen for a few days to make it easier to get enough out there for things to work right.

My recovery was not as smooth as many people I had cared for after heart attacks.  This was probably due to the spasming of my injured artery.  I remained in the hospital for five days, with continued chest pain much of that time (though much milder than the pain of the heart attack).  It took some experimenting to get my medications adjusted to help that artery relax yet maintain adequate blood pressure.

It was a huge shock to have a heart attack at my young age, one month after my 44th birthday.  I knew some heart disease ran in my father’s family, but didn’t expect to have a major event for another 20 years.  In time, searching for support on the internet, I happened onto the WomenHeart website.  There I have met many younger women with heart disease or who have had heart attacks.  This support has been invaluable to my recovery.  Also, my journey would have been much more difficult without the loving support of my husband and family.  My progress has seemed awfully slow at times, but I just have to take it a day at a time.

3 Comments leave one →
  1. Melissa permalink
    February 20, 2012 8:50 am

    What a clear picture you paint of your heart event! You are an artist, a great nurse and a fine teacher!
    I wonder, though, how your emotional/psychological self did throughout the event. You seem sort of distant as you describe your experience, which I understand may just be your style of writing. My own experience was fraught with feelings of trauma, fear and loss of hope. Did you have any of these feelings, yourself?
    Thanks for your ongoing series– I wait with baited breath for the next installment! I’m so glad, too, that you’ve had so many hits since you’ve started this project– and suspect that lives will be saved as people realize their own risks, and what to do if they have heart attack symptoms.
    Thanks and love,

    • February 20, 2012 9:02 am

      Thanks for your comments, Melissa. You are right, there have been lots of emotions tied up in all this. In that first couple days there was fear and confusion, but there was also a euphoric sense of having survived and the excitement of new experiences. I’m thinking soon I will write more about the emotional journey, but the emotions are so complex it’s hard to meld into the narrative right now.

  2. February 21, 2012 12:47 pm

    Thank you for sharing that next chapter. Like Melissa, My surgery and cath experiences were very traumatic. Like you, I find the emotions complex, even now three years later. It is for that reason above all others, that I write.

    I appreciate the simplicity with which you explain everything. Even with the medical background I have (years ago and never with a cardiac focus), I need to continually learn and relearn about my own heart. Perhaps it is the short term memory loss at work! You have a wonderful way of making complex functions seems So simple. Thank you!

    I am enjoying your story very much. Should I have to have another cath, I hope hearing of your more pleasant times in the cath lab with help me feel less fearful. Thank you for that, too.

    The miracle of another day is so very humbling, huh. Allie

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