Tag Archives: Heart disease

In heartfelt company

I spent Saturday morning in a room full of broken hearts. Some were beating a lot faster than they should have been. Some were being monitored electronically. And some were beating only with the help of a pacemaker.

It was two days before Valentine’s Day, and I had taken my mom to a heart symposium at St. Joseph’s Hospital & Medical Center. The topic was atrial fibrillation, something my mom has experienced for herself. (Her husband and I experienced it too, one Saturday morning when I was visiting them in Green Valley. One second Mom was stirring oatmeal at the stove and the next she had fallen over backwards in a dead faint, whacking her head on the tile floor near my feet.)

Atrial Fibrillation (also called AF or AFib) is a common heart rhythm disorder caused by rapid and uncoordinated conduction of electrical impulses from the upper chambers of the heart, according to materials created for the session, which was conducted by physicians from the Heart & Lung Institute at St. Joe’s. AFib affects more than two million people in the U.S. and is a leading cause of stroke. It can also lead to early heart failure and the need for a pacemaker if not properly treated.

My mom’s first indication that she had heart disease occurred one fall a few years ago, when she and her husband were driving from Arizona to Pennsylvania. She didn’t know that her fatigue, swollen ankles and difficulty breathing were related to her heart. When she got home and reported the symptoms to her doctor, she was immediately hospitalized for congestive heart failure. Some time later, she underwent a catheter ablation procedure to stop the wildly firing electrical signals in the left atrium of her heart. Since then she has been been relatively symptom-free and can take aspirin (not the rat poison Coumadin, which is commonly prescribed) to keep her blood thin enough to prevent formation of a clot that could travel to her brain and cause a stroke.

While my mom’s heart condition is stable, it was sobering to learn during the Saturday session that the catheter ablation procedure is not a definitive cure for AFib. At some point she may have to consider other options.

It was jaw-dropping amazing to listen to cardiac electrophysiologist Wilber W. Su, M.D. describe the cryoballoon procedure he can do to cure some types of AFib. (Su was the primary investigator on a device that was just approved last Christmas. The Heart & Lung Institute is now the only site in Arizona where this minimally invasive procedure can be done.)

Then cardiac surgeon Lishan Aklog, M.D., director of The Cardiovascular Center at the Heart & Lung Institute, described surgical cures for AFib that were unheard of as recently as six years ago.

In January, during research for an independent writing project, I witnessed one of those procedures during a six-hour open-heart surgery. Brian deGuzman, M.D., associate chief of cardiovascular surgery at the Heart & Lung Institute, invited me to observe a complicated surgery that included an open maze procedure, in which calculated burns are made to the upper chambers of the heart to block the scattergun effect of uncontrolled electrical signals and channel them through a “maze” that helps them more efficiently signal the ventricle to contract.

My mom and I left the heart symposium inspired and grateful for the opportunity to have a greater understanding of AFib and the cutting-edge options that are available to her should she need them. We both thought sharing that educational journey was a perfect way to say  “I love you.”

For information about the Atrial Fibrillation Clinic at St. Joe’s, call 602-406-2651 or email info@atrialfibclinic.com.

What it was like to watch open-heart surgery (Part 1)

A lot of people have been asking me what it was like watching open-heart surgery. Many of the questions emanate from all-too-human fears that such an experience could be upsetting. There is, after all, the blood. The open chest. The saw.

I won’t lie; I was more than a little bit worried about how I might react. After all, I almost fainted in the doctor’s office once when my son had to have stitches removed from a deep cut in his arm.

But the last thing I wanted to do while I was in cardiac surgeon Brian deGuzman, M.D.‘s operating room yesterday was become a problem for him or his team. So when one of the operating room nurses wheeled a chair up behind me before the procedure began, I took note. And when she warned me that “most people lose it when the surgeon  starts the saw,” I paid attention.

I was not sitting in a room high above the operating theater, separated from the reality of the surgery by a wall of glass, like you see in “Grey’s Anatomy.”  I was on the floor in the operating room itself, right behind deGuzman, who is associate chief of cardiovascular surgery at the Heart and Lung Institute at St. Joseph’s Hospital & Medical Center. I was wearing dark blue scrubs. I had a surgical mask over my face, protective eyewear (“which you’ll need in case the blood starts shooting out,” I was told) and a shower cap-style hat over my hair.

Oddly, what bothered me most was the surgical mask and eyewear. It was claustrophobic, and my eyewear kept fogging up with each breath I took. I had to do some serious talking to myself about settling down and staying focused on the experience before I finally adjusted to the uncomfortable sensation.

When deGuzman and surgical resident Christina Lovato, M.D., began preparing for that first incision at 11:18am, I trained my eyes on the monitor above my head to my left. Somehow, watching what was taking place two feet in front of me on the overhead monitor gave me the distance I needed to adjust to the experience. I glued my eyes to the screen, taking deep, full breaths as I realized that skin and tissue was being cut, and as some of the tissue was burned away from the sternum to make a clear path for the saw. (The smell of burning flesh takes some getting used to.)

The first whir of the saw was a bit jolting but I quickly became absorbed in what I was seeing. Lovato needed only four seconds to separate the thick bone. “It’s all in the teaching,” deGuzman said, jokingly, clearly proud of his confident, capable student.

I could no longer focus on the screen. I was ready to see the real thing. So I cautiously peeked over deGuzman’s left shoulder,  wide-eyed as I saw the open chest cavity and the beating of the heart.

The surgeons cut away the pericardium (the sac of tissue that contains the heart and major vessels) and there it was: the heart itself. Yellowish, not red as I expected. Pumping away and yet, I knew, not pumping efficiently. There were problems with two valves that open and close between chambers. The valves are supposed to close fully after every attempt the heart makes to push blood forward. But in this heart, two different valves were allowing blood to leak back into the starting chambers because the damaged valves could not fully close. That was forcing the heart to struggle and push even harder. And there were other problems with this heart that caused the patient, a woman, to experience the unsettling symptoms of atrial fibrillation (cardiac arrhythmia).

One by one, with infinite patience and calm, deGuzman tackled each one.

Tomorrow: The view from the anesthesiologist’s chair.

That beautiful heart

I had a new appreciation for the heavy pounding of my heart as I trudged up the mountain trail near my home late this afternoon. I will never again take for granted the miraculous choreography of muscle, tissue and resilient fibers that keep my heart functioning and strong.

This morning, I attended a two-hour symposium, “Living with Heart Valve Disease,” at St. Joseph’s Hospital and Medical Center. Almost everyone in the audience was there because they have some type of heart disease — or a loved one who does.

Lishan Aklog, M.D., director of The Cardiovascular Center and chief of cardiovascular surgery at St. Joseph’s Heart & Lung Institute, gave a crash course in heart valve disease, diagnosis and repair. “Plumbing 101,” as he called it. He and Brian deGuzman, M.D., the hospital’s associate chief of cardiovascular surgery, take turns doing these Saturday morning presentations, typically once or twice a month. Some of the symposiums focus on valves; some on atrial fibrillation. All are free to the public. All are presented by two very busy doctors with families of their own who volunteer time to do this  because they believe that patients deserve to be fully educated about their options and involved in decisions about their care.

Aklog showed lots of diagrams, pictures and even audio/video clips to support his explanations. He used analogies to facilitate understanding. (“Think of valves as the doors leading to the rooms that are the chambers of the heart.”) At one point, he played two audio files — one with the steady “lub-dub, lub-dub” of a healthy heartbeat, the other with the eerie, whooshing sound of a narrowed aortic valve.

Imagine a valiant heart struggling to pump gallon of blood every hour through a tiny pinhole. That can happen with severe aortic stenosis. Imagine a determined heart working overtime to prevent the backwash of blood when the “parachute chords” that typically yank the flaps of the mitral valve closed have evaporated or frayed. That can happen with mitral regurgitation.

As Aklog explained complex terms, flipped through visuals on his PowerPoint presentation and patiently answered questions from the audience, I saw anatomy as poetry, anatomy as art.

One morning next week I will don scrubs and watch an open heart surgery. It’s background for some future writing, part of a larger story that involves deGuzman, the adoptive father of four Ethiopia-born children, and Aklog, his Ethiopia-born colleague, collaborator and friend.

That day, I will see anatomy as adventure.

For information about future Heart & Lung Institute symposiums, call 1-877-602-4111 or email info@heart-valveclinic.com.