TheBanyanTree: Rhythm Man

[Jim Miller]

This Friday will be four weeks in. I can hardly believe that I've been
here that long already. While I may occasionally allow time to sit and
think, I have more than enough to keep me busy. A small stack of
bookkeeping is beginning to pile up on the desk next to me. I've ignored
it long enough. Tomorrow, I'll clear the spot again. Then I'll start
researching material for Linda's next newsletter due out before the 4th
of July. I've also got people to call about listing their company as a
preferred service business on the website. See, I told you I've got more
work than time. 

I've been learning about heart rhythms for several days. As much study
as I've undertaken in the last eight years, I know just about zero
regarding the heart's electrical system. What I do know; the electrical
pulse starts at the SA node and causes a uniform contraction of the
Atrium. (upper heart chambers - a pre pump to the work chambers) As the
pulse follows a prescribed pathway, it reaches the AV node where the
signal passes to the ventricular chambers causing muscle compression.
The heart is divided left and right. The right ventricle pumps blood to
the lungs for oxygenation. The blood returns to the left side, where it
is pumped to the body by the left ventricle chamber. This is the largest
chamber in the heart and carries the bulk of the workload.

In a normally functioning heart, the left ventricle moves its volume in
about two beats.  With a normal sinus rhythm, you will actually hear two
beat. The first is the small beat from the atria, followed by the more
pronounced beat of the ventricle chambers. Sort of a pa-whump, pa-whump,
etc. I confess, it's been so long since I've heard a normal heart beat
that I've nearly forgotten what one sounds like.

My heart is enlarged. I'm told that the ventricle chambers are about
five times normal size. Picture an over inflated balloon. The muscle
attempts a squeeze, but is weak and inefficient. The atrium chambers
gave up trying to help years ago. They beat without pattern, and more
wildly with any exertion. The pulse passed to the AV node is erratic and
results in an extremely erratic heartbeat. Listening to my heart, you
will hear a strong beat followed by several small beats with another one
or two stronger beats continuing ad infinitum. It easy to wonder what
keeps it going. Fortunately, every cell of the heart has inherent in
it's structure, the ability to initiate a pacing pulse. If you watch a
transplant surgery, you will see that the old heart will continue
beating for a short time while lying in the pan. Even a dissected piece
of heart muscle will contract and attempt to beat until it experiences
oxygen starvation.

So here I am; wired for both sound and picture. The only time the
monitor is remove is while I shower. The rest of the time it's
transmitting every electric pulse my heart is generating to a monitor
tech at the nurses station. I bent over the counter to see my heart rate
one night and the monitor tech said, "you don't want to look at that.
It's the worst junk I've ever seem". I assured him I already knew that.
I just wanted to see how fast it was beating.
Several years ago, when the defibrillator was first implanted, I wrote
that the concern was ventricle tachycardia (V-tach rapid consecutive
beats). V-tach can lead to fibrillation or flutter of the primary pump
(left ventricle). A quivering muscle can do no work, thus blood flow
stops and oxygen starvation causes rapid die off. V-tach feels like
staccato beats on a drum. Each time I've been hospitalize in the last
couple of years, I've worn a monitor. Every once in a while a nurse
would come bounding into my room inquiring as to my well being. They
would tell me that I had a run of V-tach and checked my blood pressure.
It was always an annoyance to me, as I felt nothing and never got so
much as light headed. I passed it off as their job. 

The last three and a half weeks has been a repeat of those episodes. At
first I didn't think anything of it. The run would last from three to 20
beats, but never faster than 150-160 bpm. This rate isn't nearly fast
enough to trigger that old demon defibrillator. When you are constantly
being cautioned to slow down because your heart rate is running 160-180
bpm, it's easy to become paranoid. I don't even feel out of breath and
am being told to sit down. I think back about how I pushed myself at
home, and wonder why I'm still standing. The monitor techs have adjusted
to my heart's eccentricities and don't bother me with a three or four
beat run. But it seems to me that they are constantly pasting strips
into the log. I've become more sensitive and usually feel a run, which
can last up to several seconds. I'm frequently sitting at the computer
and can see the nurse station through the open door. The techs and I now
have a ritual. I feel a run, five seconds later the monitor alarm
sounds, they rise up to see over the monitor and I wave to assure them
that I'm still upright. For all my cavalier attitude, I confess that
I've become more paranoid. I spent time with the evening tech recently,
so I could read the strip and understand what it was showing. I
discovered that occasionally a run would approach 200 beats per minute.
That is dangerously close to the self electrocution my defibrillator
induces. It's been several years since I've felt its wrath, but I can
still feel the excruciating pain following a thunderous electrical crash
beginning in my eyes and ending in a mule kick to the chest. No thank
you, I don't ever want to feel that again.

So I sit when admonished. I talked to my cardiologist and he increased
magnesium and potassium dosages. I take an extra diuretic and clear a
slight fluid overload. Today my heart rate holds to a comfortable
130-150 bpm and immediately settles back to 100 and lower when I stop
moving around. So far it's been more than 24 hours since the last V-tach
run. One can only hope, and then, maybe this paranoia will begin to
pass.

Dr. Icenogle, my primary transplant surgeon stopped by this morning. He
listened to my heart and summed it up in one succinct sentence. "Your
heart sounds like a drunk horse on a wooden bridge."