Murmurs of the Heart — Part 1

When I was still in high school our family physician, Dr. Nagle, after listening to my chest for a bit, called in his partner Dr. Marshall to give it a listen. They told me I had a heart murmur but not to worry about it.

View fullsize

There matters stood until a few years later I received my notice to report for a physical as a prelude to being drafted into the Army. This was during the era of the American war on Vietnam. The Army doctors noticed my heart murmuring and classified me as 4-F, not acceptable for military service.

A couple years later Dr. Nagle sent me to a cardiologist, who also told me not to worry about the murmurs of my heart, but with one caveat: whenever I went to a dentist, I needed to take some antibiotics beforehand. Apparently some bacteria that live in the mouth could wreak havoc with a heart valve that leaks.

Over the years the antibiotic regimen gradually dwindled until I only had to take one mega-dose an hour before each dental visit. A few years ago even that ended, as it was discovered that the antibiotics were probably doing more harm than good.

About ten years ago my current primary care physician sent me for an echo-cardiogram; there I was told that those Army doctors were probably being too conservative when they rejected me for military service. Let’s hear it for conservatism!

Which brings me to last fall when I was sent for another echo-cardiogram. This time was different. A few days after the test I received a message from my doctor:

“Echocardiogram done on 10/2/13 reveals moderate to severe mitral valvular regurgitation from mitral valve prolapse. We will discuss this in detail at your next appt. Often these valves can now be repaired rather than replaced IF an intervention is required. There are no other significant findings in your other valves or the heart muscle”

Not wanting to wait two months for my next scheduled appointment, I replied:

“Since my appt for a physical is the end of Nov, I assume I’m not supposed to worry about this? I’ve noticed a significant loss in stamina over the last year, and especially in the last few months. By that I mean a half hour walk to get groceries tires me out more than it used to. Might that be caused by this increased regurgitation? I try to do 30 pushups each morning, and those have become harder. Should I curtail any physical activities?”

To which he responded:

“Worrying is not helpful. You do have a leaky valve and this needs to be evaluated by a good Cardiologist. In order to be efficient I will give you a name and number and you can call for an appt. If he can get you in before my visit that is fine. I will send him your last progress notes and they will have the echocardiogram in the same office at their fingertips. Call 215 ### #### for Dr S_____ M____. Yes you should NOT push the exercise until he evaluates you.”

So I called Dr. M____ and set up an appointment for Nov 12. (I like the semi-anonymity of “Dr. M____”; reminds me of 19th century story writers like Edgar Allan Poe.)

View fullsize

I also spoke to the nurse in the cardiologist’s office and she said there is really nothing I can do to make my condition better or worse. She suggested that I keep to my normal activities but if I start to feel tired or short of breath, then I should back down and rest a bit. It’s sort of what I thought, but it was good to get confirmation from her.

When I visited Dr. M____, he asked me a lot of questions, and I explained that while I do tend to get tired after a half hour or so of walking, I had attributed it to getting older. He said it’s sometimes difficult to decide whether a symptom is normal or an indication of heart problems.

I mentioned that I’ve always been a fast walker (faster on city streets than 90% of the people) and that hasn’t changed, although now after 15 or 20 minutes I might slow down a bit. I also told him about my daily pushups.

It had started a couple years ago, when I could only manage about seven pushups at a time, but I gradually worked my way up to 20 every morning. I was feeling pretty good about that until I heard that Ruth Bader Ginsburg does 20 pushups every morning. I decided I should be able to do more than an 80-year-old woman, so I upped the count to 30. That number does leave me a bit winded, so I’ve reduced it to 25, and that seems to be the right amount.

Dr. M_____ seemed to be impressed. He said, “I didn’t know that about Ruth Bader Ginsburg.”

He went on to ask about family history of heart attacks. My maternal grandfather died of one when he was 86, an uncle had one in his 70s, but he’s still going strong at 93.

Dr. M____ continued: “After reviewing your echo-cardiogram I think that although the report calls it a moderate to severe leak, I would actually characterize it as severe. There are two possible courses of treatment, either replace the valve or repair it. Both of them would require open heart surgery.

“There are a few more tests that I’d like to perform to help decide if surgery is actually required; a stress test, a heart monitor, and a TEE procedure. That’s a transesophageal echo-cardiogram. You can look it up on the web. It involves being put under general anesthesia and swallowing a little tube, an ultrasound transducer, positioned on an endoscope–”

I interrupted: “Uh, could I say something?”

“Yes, of course.”

“I started to feel light-headed when you said open heart surgery and I don’t think I heard anything after that…”

“Oh, I’m sorry. Would you like to lie down?”

I did end up lying down, and he had a nurse bring me some water. After a few minutes I felt better. Embarrassed, but good enough to walk again. He apologized for trying to give me too much information at once, and I explained that I really hadn’t expected that I’d need surgery. He said I wasn’t the first person to react like that.

He also noted that my EKG showed signs of an irregular heart beat and that the heart monitor would reveal whether it was serious or not.

Anyway, I made an appointment for the stress test and the heart monitor but decided to wait on the TEE. He wasn’t positive that I’ll need surgery, but the tests should help him decide. The stress test was scheduled for Dec 2.

I did get to ask about recovery time if OHS is needed. The short answer is I would probably be out of commission for about two weeks, the first of which would be in the hospital, the second week I could go to a hospice if I didn’t have anyone to take care of me at home. After two weeks, he thought I would still be recovering but would be able to take care of myself. Full recovery after two to three months. My concern is those first two weeks.

How did I do on the stress test? Could the technicians even find my heart to monitor it? These questions and more will be answered in future thrilling installments. Stay tuned.

View fullsize

Leave a Reply