Several months ago I wrote about my medical journey, starting about seven years ago when my internist discovered a very slight murmur in my aortic valve, technically called Aortic Valve Regurgitation. As the valve opens and closes with each heart beat to pump blood into and out of the heart, my aortic valve doesn't close all of the way, so some of the blood leaks back, making the heart work harder to pump a sufficient amount of blood. I also gave you my general background and told you that I would most likely require a new valve within the next year or two. I said that I was writing this blog to share, in non-medical terms to the greatest extent possible, my symptoms, doctor visits, tests and medications so that I could remove some of the mystery and anxiety for anyone facing a similar journey. Today, I will write about my referral to a cardiologist three years ago, and my visits and conversations with him over that time, including descriptions of the visits, the tests and medications. In future posts I will describe the valve replacement surgery, after it happens, and my recovery.
My internist discovered my heart murmur when he listened to my heart at my annual physical. Although I had no symptoms (fatigue, shortness of breath), the murmur became more pronounced each year. After about four years, he said it was time to visit a cardiologist and referred me to one of whom I had heard: Dr. Berger. I was fortunate, as Dr. Berger has a great sense of humor, is a straight talker, and has an overall great "bedside manner." More importantly, he has a great reputation and is included in my health insurance group.
On my first visit to Dr. Berger, I filled out a medical history and signed about a dozen consent and privacy forms. Then, a nurse took my "vitals" (height, weight, temperature, pulse and blood pressure), and then went over my medical history with me. Then a technician rolled in a machine to preform an Electrocardiogram (EKG). I had had several EKGs a a part of my annual physical. If you have never had one, this is what it is: The technician applies several small, round sticky patches to your chest and legs. Then, wires from the machine are attached to the patches. While you lie still for just a few minutes, the machine reads the electrical activity in your heart and converts them to a running graph that the doctor can then read. There is no discomfort or pain (except when they pull off the patches if you have a hairy chest, which I do. Think Band-Aids). Then Dr. Berger came in and we discussed my medical history (concentrating on the murmur); my symptoms, if any; the EKG results (normal); and what lied ahead for me. He told me that eventually I would have to have the valve replaced, but, until that time, he wanted to see me every six months. Since my blood pressure was a bit high (140/62), he prescribed a 5mg capsule of Ramipril once a day. Since my heart was already working extra hard because of the murmur, he didn't want to add to the stress on the heart caused by high blood pressure. I don't know what Ramipril costs, as it is covered by my insurance, but it is a generic. I can only speak for myself, but I haven't had any side effects.
Six months later, my second visit was much like the first, with the addition of another test: an echocardiogram. This test is an ultrasound of your heart. You lie on your side and the technician moves a transducer (wand-like device) around your chest. A gel-like substance is used on the end of the transducer. The transducer emits high pitched sounds which bounce off parts of your heart, and the machine converts these signals to color pictures of your heart, valves and blood flow. This allows the doctor to measure the size of your heart and the efficiency of the heart and valves at pumping blood. Like the EKG, there is no discomfort or pain. Not even sticky pads to pull out chest hairs. This test does take longer -- 20-30 minutes -- and you do have to lie still. Dr. Berger then discussed the results of the EKG and the Echocardiogram, both normal except for the leaky valve. He did tell me that my heart was a little bigger, due to the extra work (think biceps and curls). My blood pressure was still a bit high (130/62) so he told me to go to 2/day on the Ramipril, and he added another medication, Amiodipine Besylate. Again, I haven't had any side effects from this new medicine.
I have followed this same procedure for three years. A visit every six months with an EKG and an Echocardiogram every other visit. On my last visit, four months ago, Dr. Berger substituted a "stress echocardiogram" for the regular test. I had a regular echocardiogram, and then I got on a treadmill, while hooked up to an EKG and had some colored die injected, through my hand, to better show the blood flow. When I had gotten my heart rate up near maximum, I got off the treadmill and immediately had another echocardiogram. The purpose of all of this was to see how my heart responded to exercise/stress. It was a little weird running with the wires hooked up, but, unless you hate exercise, there was no pain or discomfort. After he had reviewed the test results, Dr. Berger came in and said, "What am I going to do with you?" My heart and I am in great shape except for this crappy valve (my term, not his). We again discussed timing of replacement surgery. Here is the issue. Most surgeons use a "tissue" valve for replacement, which comes from a pig or cow. The advantage over an artificial valve is that artificial valves can throw off blood clots so you have to take blood thinners for life. However, artificial valves last forever while tissue valves usually last 10-15 years. Thus, the longer you can wait for the surgery, the better. I told Dr. Berger, "better a year early than a day late." He agrees. He now wants to see me every four months and, of course, I am to contact him immediately if I experience any symptoms.
That's all we have room for today. Next time I will discuss my upcoming visit, and I will write a bit about the mental aspects of all of this, or "looking for symptoms of a heart attack every time you sneeze."