The human heart weighs between 200 and 425 grams and its size is commonly described as being slightly larger than your fist. The heart beats an average of 100,000 times per day and pumps about 7.5 liters of blood in 24 hours. It is responsible for getting blood to the other organs, tissues and cells throughout the body which provide the much needed oxygen and nutrients these parts need to perform their functions. Composed of four chambers, four types of valves and an intricate electrical system that makes it all work through contractions, the heart is a complex muscular organ and the diagnosis of any malfunction can be complex as well.
Approximately five years ago while in her 30s, Traci Turner began to experience symptoms of palpitations which she initially attributed to stress. But when her symptoms worsened, she saw her primary care physician. He had Traci wear a holter monitor (a machine worn by a patient 24-48 hours that continuously records the heart’s rhythm) and found some abnormalities in her heart beat.
This working mother of two who was used to being active had begun experiencing shortness of breath and sharp shooting chest pains in addition to palpitations. Her symptoms, which came to include headache and dizziness, were noted to worsen with exertion or with attempts to work out. She had previously enjoyed walking and jogging but noticed that her endurance level had declined, so she had to rest sooner and more often. Bike riding became easier for her than jogging.
About this time, Traci was going through a painful divorce, so quite understandably her physician felt some of the palpitations and panic-like attacks were due to some anxiety from the emotional turmoil in her life. But during her visit after wearing a holter monitor, her doctor noted a rapid heart rate above 200 beats per minute. Though he treated her for some anxiety, he also treated her for her tachycardia (increased heart rate) with a medicine called Tenormin, which lowers the heart rate. He made a timely referral to a cardiologist (a doctor trained in treating diseases of the heart and blood vessels) who diagnosed Traci with atrioventricular nodal reentry tachycardia (AVNRT), an abnormal rhythm of the heart caused by an abnormality in the atrioventricular (AV) node which carries impulses from the top part of the heart to the bottom part of the heart. He also diagnosed her with atrial fibrillation which is an abnormal rhythm originating in the top part of the heart.
The cardiologist referred Traci to an electrophysiologist, a cardiologist with special training in electrophysiology (a test that records the electrical activity and the electrical pathways of your heart). This physician was able to determine where the abnormality was occurring in her heart and then performed a procedure called a cardiac ablation. An ablation procedure involves use of a catheter with special electrodes, which is inserted through a vein in the groin and threaded to the heart. Ablation works by scarring the tissue in the heart that triggers an abnormal rhythm.
After undergoing two ablation procedures her arrhythmias were controlled, but Traci noted shortly after the second procedure that she was even more short of breath. Further testing revealed that she had developed a pulmonary embolus (blood clot to the lung). She required a six-month treatment with Coumadin, a blood thinner, and was under the care of a pulmonologist, a lung doctor.
Traci Turner’s physicians had warned her that if the ablation procedure had not worked, a pacemaker would have been the next consideration. Various medications, including beta-blockers and calcium channel blockers, had been tried between procedures to decrease her heart rate, but these caused significant drops in her blood pressure that she was unable to tolerate.
Traci decided, in consultation with her physicians, to forego medications since the side effects interfered with her work and the energy needed to take care of two children. Her doctors feel she now has no life-threatening arrhythmias but they are continuing close monitoring of her condition.
Diagnosing cardiac problems can sometimes be complicated, as shown in Traci’s case, and can require more than one specialist working together to make the diagnosis and provide the appropriate treatment. But you, the patient, should never underestimate the importance of your role in the teamwork that will lead to optimum care of the problem. Traci sought timely medical care and kept her physicians abreast of her symptoms. She was compliant in follow-up of the plan of treatment and made final decisions about her options based on careful consideration of her physicians’ recommendations.
Though Traci continues with some endurance issues, she manages to keep pretty busy. She works full time as a physical therapy assistant at Conway Regional Rehabilitation Hospital and even plays on the hospital’s kickball and softball teams. She does attempt some walking, rides her bike and recently rejoined the gym. In addition to friends and family, Traci credits her faith with getting her through what was a difficult, and at times, frightening period in her life.