iRhythm "success", Part II

Exhaustion has been my best friend since the hospitalization in November 2010.  Being instructed to go to the local emergency room is where I left off in my last entry regarding the iRhythm, so here is the rest of the story, as Paul Harvey would say.

We arrived at the local emergency room (after having to walk through several cigarette smokers at the entrance - who does that!?).  Unlike past trips to the emergency room (E.R.), as soon as I told the staff my name they took me directly into a bed.  My spouse found it amusing (for lack of a better word) that as the E.R. staff were taking me back, I found it necessary to make them aware of the aforementioned smokers.  I have zero tolerance for smokers, much less individuals huddled around the entrance to a hospital.  We live in California for heaven's sake, so it's not as though it was freezing outside (not that it would matter to me if it were a blizzard; get away from the building!).  

It was a long night.  We arrived before midnight and I was finally moved to a hospital bed around 4:30 A.M.  I always feel so guilty being moved into a room in the middle of the night where another patient is already sleeping.  Fortunately I was sharing a room with a woman who didn't seem to mind my arrival as she began to talk to my non-stop asking who I was and what was wrong with me.  I could write a coffee table book regarding some of the odd roommates I've had in hospitals (I'm sure many have plenty of stories!).  Once I had a woman who kept meowing like a cat.  I digress...


The only negative experience I had at the hospital was with the radiology technician.  Around 2:00A.M. the radiology technician arrived and stated he would be taking images of my heart.  He turned around, at which time I assumed he was reaching to get an apron for our baby, but instead he pushed the button on the mobile x-ray device.  At the same moment my spouse tried to stop him, exclaiming, "She's pregnant".  I was speechless.  It takes a lot to leave me speechless.  The radiology technician told us that nobody had told him I was pregnant.  So, my new rule is to tell everyone I am pregnant.  I don't know why he didn't ask the obligatory, 'Are you pregnant?  Is there a chance you could be pregnant?', which are the two questions I have been asked every time I've had x-rays (including dental) since young adulthood.  I try to tell medical personnel everything I can think of as a rule.  Now I state what should be obvious, "I'm pregnant!".   My spouse has tried to reassure me that no harm was done to our baby as have the doctors I told following the incident.

I was very happy with the nursing staff, they have been wonderful at my local hospital.  I am thankful for them and everything they do.  My heart (and vitals) in addition to our baby were monitored the entire time at the hospital.  To my knowledge, Ventricular Tachycardia (V-Tach) was not detected once at the hospital.  Good news!  In layman's terms, my body/heart had automatically reset itself following the V-Tach detected using the iRhythm.  I am so thankful my cardiologist provided me with the iRhythm!  I struggle on a daily basis with wondering if something I am experiencing is or isn't life threatening.  I imagine other's feel the same way trying to decipher the signals being sent to the good old central nervous system.  While I have never solely depended on a diagnostic device such as the iRhythm to alert me to a medical emergency, it does give me a sense of relief.


It has been two and a half years since the myocardial infarction (heart attack) I had and until Thanksgiving, there had not been any detection of V-Tach from my heart.   As I understand it, an anti nausea medication (Ondansetron) prescribed by my Obstetrics/Gynecology physician is to blame for the V-Tach.  I only took the medication as needed rather than full strength as prescribed, so I can't imagine if I'd taken it full strength how my heart would have felt.  I don't like to take medications period, so I have really tried to avoid everything (including over the counter remedies such as Tylenol).  I don't drink coffee or consume caffeine (I don't even like chocolate unless it is hot cocoa).  Following the myocardial infarction, the hospital nutritionist and nurse practitioner at the cardiology office went down a list of things I should avoid.  [Un]fortunately, I already avoided them.
   
I was released from the hospital and continued to use the iRhythm heart monitoring device for a couple of weeks.  I've continued to experience palpitations since November.  My cardiologist has partnered with another cardiologist who was on-call over Thanksgiving.  I greatly admire both cardiologists.  The newer cardiologist came to the hospital to run tests prior to releasing me.  I was re-prescribed a beta-blocker (I had stopped taking Sotalol due to the pregnancy).  I don't have high blood pressure, in fact my blood pressure has always been very good, if not on the low side.  The beta-blocker is prescribed for other reasons.  The same evening, before my new prescription was ready, the cardiologist phoned my spouse to say that he didn't want me to take what he had prescribed as he had spoken with an electrophysicist who didn't believe it was a good medication during pregnancy.  I greatly respect the new cardiologist for following up, as well as being forthcoming regarding changing to a different medication due to my pregnancy.  It's wonderful to have physicians who aren't afraid to admit that they are human!  

iRhythm "success"

On Thanksgiving 2010, I felt like I was "off" all day.  One of our cats woke me up at 5:30AM.  I have been exhausted over the last few months anyway.  

I hadn't previously shared this via the Internet, but I am pregnant for the first time.  I have only been this exhausted once before:  prior to the myocardial infarction (M.I.) I survived in 2008.  Nausea is also a common theme during this pregnancy.  My nutrition has been non-existent since becoming pregnant (I could tell early on that I was pregnant).  Excitement has carried me through the last few months of pregnancy.  I've done my best to block out the 'what if' ideas and instead think positively about having a healthy baby.  

Back to Thanksgiving.  Preparation in the kitchen kept me busy until about 10AM when I decided to take a nap.  The smell of food cooking woke me up a couple of times, but I fell back asleep unable to get up.  A little before 2PM, I made myself get up even though I still felt tired (I needed to help with the cooking, but it was already all done, hooray!).  After showering and dressing, I tried to set the table, but felt like I was about to faint in addition to palpitations.  My pulse was rapid compared to the usual rate.  I decided to use an electronic blood pressure/heart rate device.  My pulse was on average at 100 which is a high rate for me.  My shoulder blades were also extremely painful (another symptom during the M.I. I had).  Unfortunately I had walked our wild dog the day before and wasn't sure if that was the cause.  When we sat down for dinner at 3PM, I had no appetite.  After dinner, I "retired" to my recliner.  I finally asked my husband to call the on-call cardiologist because I eerily felt similar to the day(s) leading up to my M.I. (heart attack).  Soon I spoke with the on-call cardiologist who told me to record and transmit anything I felt via the iRhythm medical device and assured me that Zio Event Card/IRhythm would contact the cardiologist should something be received that needed immediate attention.  Needless to say, I later found myself at the local emergency room.

Arrival at the ER was a result of using the iRhythm.  I recorded an event later in the evening around 8pm while watching football.  The cause for the recording occurred when I felt a dull, repetitive pain below my left breast.  About an hour later, I phoned iRhythm and transmitted the recording.  I know, I shouldn't have waited.  Unlike previous transmissions, the representative asked me to record another event while they remained on the phone and then transmit the event.  After doing so, I asked why I was instructed to complete the task and was told that the event (that I recorded while watching football an hour earlier) met the criteria to notify the on-call cardiologist.  After waiting about 20 minutes, I called iRhythm back and asked if they had contacted the on-call cardiologist.  The representative stated that they were in the process and that if I wasn't contacted, that would mean the on-call cardiologist deemed the event not an emergency.  Thankful for the fact that I was wearing the Zio Event Card/iRhythm, I asked if it was okay for me to call back if I didn't hear from the on-call cardiologist.  I found it hard to believe that given the fact I had already spoken with the on-call cardiologist, that I wouldn't be contacted.  The representative stated I was welcome to call back.  Fortunately I received a call from the on-call cardiologist about 10-15 minutes later.  I was told that it was a good idea for me to go to the hospital and that the doctor would call ahead of my arrival.  


More on that later.  I'm tired and my husband just handed me a homemade piece of apple pie!  I'm very thankful for every day I have and need to go spend time with the ones I love.

Heart Attack vs. Cardiac Arrest

Heart attack vs. cardiac arrest: Reports indicating a Michael Jackson cardiac arrest generated much interest in the difference between sudden cardiac arrest (SCA) and a heart attack.

According to the American Medical Association (AMA), a heart attack occurs when the blood supply to part of the heart muscle itself — the myocardium — is severely reduced or stopped. The reduction or stoppage happens when one or more of the coronary arteries supplying blood to the heart muscle is blocked. This is usually caused by the buildup of plaque (deposits of fat-like substances), a process called atherosclerosis. The plaque can eventually burst, tear or rupture, creating a "snag" where a blood clot forms and blocks the artery. This leads to a heart attack.

If the blood supply is cut off for more than a few minutes, muscle cells suffer permanent injury and die. This can kill or disable someone, depending on how much heart muscle is damaged.

Sometimes a coronary artery temporarily contracts or goes into spasm. When this happens the artery narrows and blood flow to part of the heart muscle decreases or stops. We're not sure what causes a spasm. A spasm can occur in normal-appearing blood vessels as well as in vessels partly blocked by atherosclerosis. A severe spasm can cause a heart attack.

The medical term for heart attack is myocardial infarction. A heart attack is also sometimes called a coronary thrombosis or coronary occlusion.

The Sudden Cardiac Arrest Association has an excellent cardiac arrest fact sheet available for download. They write,

"Sudden cardiac arrest (SCA) is a leading cause of death in the U.S., killing nearly 300,000 people each year. That’s more than the total death rate for breast cancer, lung cancer, and HIV/AIDS combined. SCA can strike persons of any age, gender, race, and even those who seem in good health, as evidenced by world class professional athletes at the peak of fitness.

During SCA, heart function ceases abruptly and without warning.

When this occurs, the heart is no longer able to pump blood to the rest of the body, and in over 90% of victims, death occurs. This is usually caused when the electrical impulses in the affected heart become rapid (ventricular tachycardia, or “VT”) or chaotic (ventricular fibrillation, or “VF”), or both.

These irregular heart rhythms are arrhythmias. The general public and media often mistakenly refer to SCA as a “massive heart attack.”

SCA is an electrical problem, whereby the arrhythmia prevents the heart from pumping blood to the brain and vital organs. There is an immediate cessation of the heart. In most cases, there are no warning signs or symptoms.

A heart attack is a “plumbing” problem caused by one or more blockages in the heart’s blood vessels, preventing proper flow, and the heart muscle dies. Symptoms include chest pain, radiating pain in left arm, between shoulder blades, and/or jaw, difficulty breathing, dizziness, nausea and vomiting, and sweating. In some cases, a heart attack may lead to a sudden cardiac arrest event."

Media interest in cardiac arrest
The day after Michael Jackson's presumed sudden cardiac arrest death, cardiac arrest was discussed in all the major media, a (very slight) silver lining to Michael Jackson's tragic end, since sudden cardiac arrest awareness is frightfully low and publicly accessible defibrillation is also low.

The LA Times noted, "The L.A. County coroner’s office will determine a cause of death. A Los Angeles Fire Department source told The Times that Jackson was in full cardiac arrest when rescue units arrived."

USA Today wrote,
Q. What might have happened in Jackson's case?

A: Jackson most likely had ventricular fibrillation, an electrical disturbance of the heart that occurs when the heart begins beating 400 to 500 times a minute — much more than the normal 70 to 75 beats, says Douglas Zipes, emeritus professor at Indiana University School of Medicine and former president of the American College of Cardiology.

"When you look at the heart in ventricular fibrillation, it looks like a bag of squiggly worms," Zipes says. "The contractions are totally ineffective. ... Therefore, no blood is pumped to the brain, causing him to black out.

"The heart's pacemaker is the sinus node," Zipes says. "It is the conductor of the orchestra, coordinating the heart's electrical rhythm. When all the instruments are playing in a coordinated manner, the result is music. In ventricular fibrillation, it's as if the orchestra is warming up and what you hear is cacophony."

Q: What can you do for someone in cardiac arrest?

A: Sudden cardiac death occurs within minutes unless someone gets the heart working again, either through CPR (cardiopulmonary resuscitation) or with adefibrillator, which uses an electrical shock to get the heart pumping correctly.

Brain death begins in just four to six minutes, so restarting the heart quickly is vital, the American Heart Association says.

CPR can buy patients time until they can be shocked with a defibrillator, says Abhi Mehrotra, assistant professor of emergency medicine at UNC-Chapel Hill. By compressing the chest, rescuers circulate blood and get oxygen to vital organs such as the brain.

A victim's chances of survival go down 7% to 10% every minute that passes without CPR and defibrillation. Few people are revived after 10 minutes, the American Heart Association says.

Resuscitation from SCA
The Sudden Cardiac Arrest Association writes, "When someone collapses from SCA, immediate cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) are essential for any chance of recovery. As many as 30 to 50 percent would likely survive if CPR and AEDs were used within five minutes of collapse.

The AED analyzes the heart rhythm of the victim, and if necessary, a computerized command will instruct the user to press a button to deliver an appropriate shock to restore the normal operation of the heart. [The Powerheart AED G3 Plus Fully Automatic does not require a button press to deliver the shock; the AED delivers the shock automatically.]

These devices are failsafe and will not cause injury to the user, nor will they deliver a shock if none is needed. For patients in “VF”, studies show that if early defibrillation is provided within the first minute, the odds are 90 percent that the victim’s life can be saved. After that, the rate of survival drops ten percent with every minute.


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