OK then. There’s a problem with my heart. Now what?
It’s very late on a Thursday night in early April 2015. I’m in the emergency department at Fiona Stanley Hospital (FSH) and I’m not allowed to go home.
I’ve had to relinquish control of my entire life which involved:
- Post-graduate studies and assignments
- Working overtime and weekends for work
- Family visiting from overseas
- Exercising 5-7 times a week
- Insomnia (though quite helpful for studying and assignments)
- Sorting out family affairs happening in another country
- My terminally ill, dementia-suffering, elderly mother in hospital and
- Finding residential care for her.
Message to my former life: I’ll CCU later
I watched the fluorescent lights passing overhead as I went down the long white corridors. Just like in the movies.
Being only recently opened, FSH felt bare and hollow. Hand-written directions were stuck onto the walls. It felt terrifyingly new. Room 158 in the Coronary Care Unit (CCU). My room. No soft furnishings. No colour. No view. No activity. No familiarity. Just cold hard fear.
By now I had my siblings and husband with me while the nurse went through the admission procedure.
I had a chest x-ray in bed. X-rays are taken before and after procedures so that the doctors know what’s going on in there.
Some people say that a “chest x-ray is equivalent to a long haul flight” in terms of radiation. If that were true, and with X-rays de rigueur in CCU, then I flew to New York and back to Perth, Western Australia about 4-6 times in 18 days.
When everyone left me alone, exhaustion and bewilderment took hold and I became quite emotional. Intellectually, I knew there was nothing I could do. From now on everything was out of my hands.
I didn’t sleep. How could I? I had ECG electrodes stuck on my torso, IV drips in both arms, an IV pump clicking near my head, and nurses coming to take my blood pressure (BP) every 30 minutes.
This, on top of my hyperactive mind full of worry and rising anger.
Friday, the first morning
What the hell is that dreadful noise?
I could hear a compressor outside my room stopping and starting continuously. It was one of those fancy new robots that deliver hospital meals to patients.
It needn’t have bothered. The food was revolting and I had no appetite.
By now, I was experiencing some rather sharp and nasty angina. It came suddenly and made me gasp in pain and fear. Each time I had an attack, the nurses ran an ECG.
When the cardiologist and her entourage visited, the news wasn’t good.
You have a blocked coronary artery. We don’t know how badly or where it is.
QUESTION: What is a coronary artery?
I recommend you take a peep at this neat little animation. It’s only 7 seconds long (or about 7-10 heart beats).
How can the doctor find the blockage? There were 2 options for me:
- Coronary calcium CT scan – non-invasive, quick, easy, a screening test that only indicates risk level
- Angiogram – invasive, risk of a stroke, but 100% conclusive
By the way, both include a round trip to New York City (x-rays).
So, instead of going to yoga, then seeing my Mum settle into her residential care home, I was being prepared for an angiogram.
Here’s the drugs I needed before my angiogram:
Valium – a benzodiazepine for sedation
Maxolon (metoclopramide) – to stop nausea and vomiting which can be side effects of anaesthesia (and dare I add, extreme fear)
Midazolam – a benzodiazepine pre-operative sedative to reduce anxiety, also useful to prevent memory of the event (Ah, but I did remember!)
They took me to a “cath lab” (Catheter Laboratory) where a team of cath lab staff with silly paper hats were busy getting ready.
As a patient, the cath lab is a strangely solitary place. Everyone stands far away as if you are contagious. Actually, it’s because you are in a sterile area.
A distant voice gives instructions: Hold your breath! Don’t move! Hold still! Breathe now.
To get a really good idea of the cath lab, look at this video. It’s only 180-270 heart beats (3 minutes). Highly recommended!
An angiogram is not a simple thing but it’s a smooth, efficient and frequently performed procedure.
While I was sedated and lying on the x-ray table, an incision was made in my right groin. A thin flexible tube (catheter) was inserted into my femoral artery and pushed gently up to the aorta (main artery of the heart). Dye was injected into my blood.
I could see the blush of dye colouring my coronary arteries on the screen. Action replayed over and over again.
I didn’t feel anything. And frankly, I didn’t care.
The x-ray robot darted and hovered inquisitively centimetres away from my heart.
For me, the 2 memorably unpleasant aspects were
- The warm flush as the dye entered my femoral artery (like I’d pee’d myself)
- What I saw on the screen.
Does anyone remember an English medical drama series called “Bodies”?
Well, I thought the doctor doing my angiogram looked like Mr Tony Whitman (played by Keith Allen who is Lily Allen’s father).
Or maybe it was the drugs …?
I’m not a doctor, but even I could see the problem
There was a huge video screen to my left. As I lay there, I watched my poor heart straining to pump blood through a constricted vessel.
How could I not feel the effort of this? How long had this been happening? Why is it even there? I did everything right! Why me?
It isn’t fair.
It was right then, seeing the blockage on the screen, that I began to feel truly ripped off and intense anger. Thank goodness for all those sedatives.
Can you see the problem?
My stenosis was at the top of the Lateral Anterior Descending (LAD) artery.
Stenosis: blockage, constriction, narrowing
Lateral: side (of the heart)
Anterior: front (of the heart, chest)
Descending: going towards the bottom of the heart
Colloquially known as the “widow-maker”, the LAD causes fatal or massive heart attacks, particularly when the stenosis is at the top of the artery – as it was in my case.
With a stenosis at the top, it’s difficult for blood to enter the vessels beneath it and the whole left ventricle is starved of blood and oxygen. The left ventricle pumps oxygenated blood to the body.
The LAD has 2 other blood vessels branching off it called diagonal arteries. Notice how my blockage is at that junction?
Well, that meant that a stent was out of the question for me.
A stent is tube of mesh with a balloon. It’s placed into the narrowed artery then expanded allowing blood to pass through again. Stents are usually inserted while still in the cath lab and the patient can go home a few days later. Quick. Simple.
No stent for me. I needed the big one. I needed a “cabbage” (Coronary Artery Bypass Graft).
The next move
The cardiologist wanted me to move to a private hospital next door. So on Saturday night at the stroke of midnight, I was transferred, like a stolen painting via underground tunnels…..
Or perhaps that was another drug-induced memory.
Questions, more questions.
- If you’ve had sedation for a procedure, did you remember much about what happened?
- I often wonder how many people are walking around with stents in their heart.
- I feel relief that my situation was clear-cut. What happens if there is a choice (to stent or not to stent)? Has anyone had to go through that?
… Are you hungry for more information? Tuck into these take-away references:
- More about the food robot at FSH
- Angiograms are well-covered by a Google search, but try these for starters.
The WebMD link below has a short animation, which I highly recommend viewing.
- Calcium scoring CT scan. Two nice explanations about this test.
- Stents and the insertion procedure
- Pre-operative sedation, a little more information about the types and role of drugs used before a surgical procedure