One Heart Beating As Two*

As we approach our two-month anniversary, many people have begun to ask, "So how's married life?"  Truthfully, it's not much different from before except now Cameron has a ring, which is often not on his finger but rather being twirled, spun, or otherwise played with much to my chagrin.  We didn't expect it to be much different though, and honestly I'd be kind of worried if it was.  The biggest challenge often facing traditional newlyweds is learning to live together.  We lived together for almost three years before we were married, which means we've already worked out those kinks of first learning to live with another person - our habits and quirks, both good and bad.  Other than that, the only differences in married life so far are being referred to as "The Wife" and trying to remember to introduce Cameron as my husband.  However, we are already in the middle of facing what you could call our first "trial" - Cameron's heart is no longer under warranty and it needs a tune-up.

Back in June when I first returned from Arizona, Cameron and I went for a short bike ride.  Though it was mostly flat, Cameron had a lot of problems breathing.  He also mentioned it had been getting much more difficult for him to climb the three set of stairs to his office at work.  He thought he'd just gotten out of shape since the most exercise he was doing was walking the dog.  Since Cameron was drinking several cups of coffee in addition to Monster energy drinks on a daily basis, and he knew a lot of caffeine had impacted his ability to exercise before, he decided to quit caffeine and we started a walk/run program together.  While I moved through the program steps ahead of schedule, it was really hard for Cameron.  He would get fatigued and out of breath very easily - sometimes in a matter of seconds.  As we continued, he could go longer, but when the fatigue always set in and it was always very abrupt.

Then, we had to move, we had our wedding, etc., and we stopped exercising regularly with so much going on. But he was still getting easily fatigued and out of breath with any amount of physical exertion. As many of you know, Cameron wasn't feeling well after our wedding ceremony - again he was fatigued and short of breath - and actually passed out.  We thought it was a combination of the heat and thinking he'd locked his knees during the ceremony, but now we know it may have been something else.

Four weeks ago from this coming Thursday, Cameron was sitting at his desk at work and just didn't feel well.  He'd had ringing in his ears for most of the week, his chest didn't feel right, he was lightheaded when standing up, and out of breath with just a few steps.  He went to an Urgent Care where he had high blood pressure and the doctor noted an irregular heartbeat.  The doctor did an electrocardiogram (ECG - "EKG"), showing the irregularity, and sent him to the local emergency room with it.  The ER gave Cameron oxygen, ran another ECG, took a chest x-ray, and did blood work.  He was diagnosed with atrial flutter (AFL).

AFL means the four chambers of his heart aren't working in sync like they should. Specifically, the right atrium (one of the top chambers - "atria") beats much more rapidly than the ventricle (bottom) chambers. This is caused by an electric short circuit in the heart.  This means the heart is working inefficiently and blood is not circulating properly - resulting in poor oxygen circulation and fatigue/ shortness of breath, etc. When this happens for extended periods of time, blood can pool in the heart, which increases the risk of blood clots and thus strokes and other complications The ER put Cameron on an anticoagulation medication (blood thinner) and referred him to a cardiologist.

We met with the cardiologist, Dr. Warner, the next Monday.  In that time, even walking from the couch to the kitchen and back was extremely difficult for Cameron.  At the cardiologist's office, Cameron's blood pressure was back to being more normal, but his resting heart rate was 110! She did another ECG and Cameron was still in AFL.  Many people can go in and out of AFL and may not even know it.  Though there is not much reason to worry about morbidity due to AFL, AFL patients are at a 5% greater risk for stroke due to potential blood clots, which is reduced to 3% with the anticoagulation medication.  There is, however, a small population of people whose hearts cannot handle being in AFL for extended periods and it actually damages the heart muscles.  They are able to look at the response and health of the heart using an echocardiogram (ultrasound).  Based on both the external and internal ultrasounds taken of Cameron's heart, the muscles appear to be normal and healthy.

To fix AFL they use cardioversion ("shock therapy") to reset the electrical impulses in the heart to a regular beat cycle. There are two options for doing this, the first is to be on the anticoagulation medication for a period of at least threes weeks, with constant monitoring of the blood levels to ensure it stays within a certain range so when they administer the shock there are no blood clots traveling around the body causing strokes, etc. Then they do the cardioversion.

The second option is to have a transesphogal echocardiogram (TEE), which means they put an ultrasound camera down Cameron's throat, stop in the esophagus, and take pictures of his heart from there to check for blood clots. If there are no blood clots, then they administer the cardioversion immediately.  Since Cameron felt so poorly, Dr. Warner went with this option.  We checked Cameron in to the hospital that Wednesday.  The TEE went well, and there were no blood clots in his heart so they did the cardioversion. It only took one shock at 200 joules to get Cameron back into normal sinus rhythm.

Cardioversion is not a cure for AFL.  There is a possibility for Cameron's AFL to reoccur - things like stress, stimulants (caffeine), and alcohol can all contribute, among other things. If it reoccurs in the future, Cameron has 48 hours to get in and do cardioversion (before blood clots can form) or go through the whole anticoagulation process again. There is also the possibility of additional oral medications to regulate the heartbeat or even surgery (radiofrequency catheter ablation or a pacemaker in extreme cases). 

Cameron had a followup appointment with Dr. Warner about two weeks ago, where, because Cameron is so young, otherwise healthy, and currently has spectacular medical insurance, she strongly encouraged proceeding with the radiofrequency catheter ablation (RFCA) surgery.  In RFCA, a catheter is threaded through the femoral artery up to the heart and then used to map the electrical impulses of the heart. Once they find the "short circuit" that's causing the AFL, they ablate the abnormal tissues/nerves.  This is a simple surgery for AFL since the right atrium is the easiest to access.

Before scheduling any procedure, Dr. Warner sent Cameron for a heart stress test, which he did yesterday morning.  The test starts you on a treadmill inclined at the highest level a typical gym treadmill has and then increases in the incline and speed from there.  Cameron made it to the fourth level (out of seven).  The test triggered an irregular heartbeat.  

Today we met with Dr. Rodrigues, the electrocardiologist who will perform the RFCA and one of its earliest pioneers, and learned Cameron's irregular heartbeat yesterday was not AFL, but atrial fibrillation (AF or a-fib).  This means the left atrium is also beating more rapidly out of sync. AF is a much more unstable irregular heartbeat than AFL and often cannot sustain itself (Cameron was fluctuating in and out of AF during the stress test).  However, AF can often trigger AFL, which is likely what happened to Cameron before.  RFCA can still be performed on AF, but requires the catheter to be maneuvered through the thin membrane separating the right and left atrium.

The success rate of of RFCA surgery for someone Cameron's age is in the 90% range.  AF and AFL can return after surgery, but this is not because the surgery was unsuccessful, but rather because the heart tissue heals/regenerates in a way that allows the irregular electric impulses to reoccur.  Risks and complications can include stroke (from blood clots already formed in the heart) and bleeding (from the blood being too thin due to the anticoagulation medication).  However, the probability of these risks occurring is less than 1% if Cameron is thorough and diligent about his anticoagulation medication schedule.  The procedure is performed under general anesthesia and takes about three hours.  They will keep Cameron in the hospital overnight, after which he is supposed to recover at home for about a week before returning to work and other activities (though he can work from home if he wants).

Currently, we are looking at possible surgery dates of Friday, November 18 or Monday, November 21. This means we have to cancel our Thanksgiving vacation plans to Victoria (sorry Aunt Elaine! Again!), but hopefully Cameron won't fall too behind at work since it coordinates with the holiday break.  We'll know the surgery date for sure on Thursday.  Next week we have the first pre-op appointment to go over the procedure in more detail, receive instructions on how to proceed with the anticoagulation medication, and set up a CAT Scan of Cameron's heart, which will serve as a 3D guideline during the electrical mapping process of the surgery.

Though this is all scary, I should add this is actually a relatively common heart issue and non-life-threatening.  The doctors have referred to it as a nuisance condition.  I should also note that since the cardioversion, and except the stress test yesterday, Cameron has felt fine.  

We'll keep you posted.

Want to know more?  

http://atrialfibrillationcatheterablation.com/

*I was going to title this "One Heart Beating As Two (or Three)" since both his right and left atrium are out of whack with the ventricles, but thought people might jump to conclusions about me being pregnant or something instead.