arrhythmia, economics and ice-cream

“This is not normal”.  I’m at the cardiology clinic, showing my latest arrhythmia graph to the consultant.  It shows a more or less horizontal line of dots (splodges rather – thanks to the cheap printer paper I’ve used) spaced at random intervals, as if Jackson Pollock had splashed his paintbrush through a narrow slit.  The horizontal line represents time and the splodges represent arrhythmia events (attacks?)  I explain that some of the events are ectopic only, some tachycardic only and some a mix of both.

I can see no rime or reason as far as the frequency is concerned – the shortest gap between events is 2 days, the longest, 36 days.   Nor can I fathom cause and effect.  Last year, when the voice operation was postponed a couple of times because of various arrhythmia events, I was advised to try anything to keep my heart stable; so I stopped drinking alcohol and cut down on heavy meals and spicy food.  If I did lapse – a glass of fizz to toast a wedding or a beer on holiday, an arrhythmia would inevitably follow later that night.

We discuss options; “how do you feels about another ablation?”  I’m not sure.  If this is Atrial Fibrillation rather than Atrial Flutter (which is what he suspects) then an ablation might not work – and the risks are far greater the second time.  He’s also concerned about the ‘clotted stump’¹.  He’s waiting for a report from the cardio-vascular surgeon who carried out the original lung resection.  If it poses a risk I may need to go back on Warfarin.

I remind him that when I saw him back in January, he had asked that the next time I had an arrhythmia, I should go to A&E and get an ECG.  I confess that as they almost all happen in the middle of the night I had not bothered.  He nods and suggests a 48hour heart monitor.  “I want you to try and provoke an arrhythmia – eat, drink – do all the things you think might cause this”.  Hmm – should I really go to town? “Anything.  I really need to see what’s going on”.

He gets his chance sooner than we both expect.

Two days later: it’s about 9.00pm and I’m watching TV.  I feel the first telltale da da dum da dum da …. and realise my heart beat is ectopic. I try deep breathing but to no avail; then my heart goes into overdrive – 141bpm, before dropping back to 55bpm then up to 141 again.   I recognise the signs – it’s building up to a ‘big one’ and so decide to go to A&E this time to get an ECG.

It’s a cold and rainy Thursday night and A&E is packed.  I explain to the receptionist why I’ve come – show her a letter from the cardiologist asking me to come in to A&E for an ECG – and she understands straightaway; “I’ll put chest pains – you’ll be seen quickly.”  I feel a bit guilty about queue jumping, but a quick ECG and I’ll be out of their way.  Besides which – I need to take the pill-in-the-pocket but can’t before the ECG.

I’m called in to the Triage nurse in a matter of minutes.  I explain again – he hooks me up to the machine, switches on and then goes very quiet.  He leaves the room and then comes back a moment later; “I need to do another one in about 15 minutes.”  Before I know what’s happening I’m lying on a bed and a nurse is putting a cannula in my arm.  I explain that I don’t need a line in – I’m just waiting for my ECG.  The nurse fixes me with an ‘I’m only doing my job – and they’ve told me you’re not going anywhere’ look.

Another ECG and I’m whisked off to the resuscitation unit.  I protest (sweetly) and explain I have CT scan in Oxford the following day and so can’t stay in hospital.  My pleas are ignored – no information, just confirmation that I’m stuck here.  I need my pills.  A cup of water and we’re (long-suffering Annie is hunkering down for another night in A&E) left to our own devices.

After a couple of hours a doctor comes by.  I explain the situation, show her the letter and wait.  She takes her time to read it – my whole history is summarised – and to her credit sympathises with our plight.  She explains that the ECGs suggest ‘acute infarction’ – heart attack.  No, no I say – it’s always like that – the fleconaide (pill-in-the-pocket) will sort it out.

“As a doctor, I can’t let you go home until your heart rate drops below 100bpm.”  As she walks back to the monitoring station, she says very quietly “You can always leave.”

I look at the monitor; my heart rate is up and down like an up and down thing that can’t keep still; 150bpm, 120bpm, 140bpm.  We decide that we don’t want to get the doctor into trouble – the fleconaide usually kicks in after an hour or so – so stay put.

Time drags on and I’m getting fed up stuck on a bed that’s too short.  Annie’s head is resting on the bed.  I fell guilty putting her through this yet again.  I look round at the monitor, willing my heart rate to fall.  Each time I turn my head it shows a different value – some times down, at other times back up.  The doctor comes back; “it went down to 95bpm.”   But when we look again it’s 130bpm.  Like one of Dr Who’s Angels, it moves when we’re not looking.

Then suddenly after about an hour and a half it stabilizes at 90bpm.  And it is sudden, surprising the doctor at the monitoring station; “I see the fleconaide has kicked in”.  She unplugs the ECG leads and gives me copies of the printouts.  The cannula is removed and we’re finally able to go home.  Just like that. 

It’s almost one o’clock by the time we’re in bed.  I feel fine, but it’s relatively short lived.

Next day I do a few chores then drive to Oxford for the CT scan.  In the evening I start to feel unwell; my resting heart rate rises to 98bpm and I’ve a pain in my upper left arm – like a ‘dead arm’ reminiscent of school days.  Waves of nausea come and go and I’m breathless climbing the stairs.  I sense something is wrong – my heartbeat is not ectopic nor is it tachycardic – but something’s not right.  I wonder whether or not to go back to A&E.  Annie trusts my judgement; “you know your body pretty well and if you say there’s something wrong, there usually is.”

I go through the options – and all the things playing on my mind:  It might be something to do with the CT scan; I felt weird afterwards, which was a first.  The consultant says my heart is basically sound – it’s the rhythm that is abnormal.  It’s not gone over 100bpm.  My risk of stroke is low.  I am extremely anxious about the hot spot in my abdomen.  It could actually be the hot spot or it could just be the worry.  I’m also anxious about the kitchen – we’re refitting – will the new fridge fit in the gap I’ve left?

It may all be in my head (and my head does feel funny).  Perhaps I’m making a fuss about nothing.  It’s a hard call, but I take the pill-in-the-pocket and go to bed with the proviso that if I still feel bad in half-an-hour I’ll go to A&E.  (I can imagine heart and stroke campaigners having a fit at this decision).

I fall asleep.  Annie apparently checks that I’m OK at various stages through the night.  My resting heart rate is back to normal by morning but I still feel unwell.  The arm pain gradually goes, but it’s three days before I am back to what I call normal.  So something was not quite right.

As far as cause and effect are concerned, I was eating an ice cream and watching a TV programme about the economic crisis when this all kicked off.  I’ll leave you to draw your own conclusions.

¹ See if the nurse comes in we’re doomed July 7th 2012
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