Category Archives: My Running

Almost Ablation Time

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In just over a week I’ll be going in for a “simple” procedure called a cardiac ablation.   A few weeks ago I wrote that I finally had a diagnosis for what I was feeling in my chest while running sometimes (first reported here).  It seems that I’ve been suffering from episodes of Atrial Fibrillation for well over a year.  I can say the Metoprolol doesn’t seem to be working very well for me.  I’ve also been on the blood thinner Eliquis for about a month now, after found out the http://sideeffectsofxarelto.org/current-xarelto-lawsuits/, although was going to take that one.  This is used to prepare for the procedure and reduce the risk of a stroke.

As I noted previously I’m a good candidate for cardiac ablation and will undergo the procedure on December 22. This catheter procedure will take anywhere from 3-8 hours while under a general anesthesia.  As a result it does require an overnight stay at the hospital, but only 1 week of recovery time.  The recovery time is mostly to ensure that the 3 incisions heal well as they are in the femoral and carotid arteries.

From the Mayo:

Ablation usually uses long, flexible tubes (catheters) inserted through a vein in your groin and threaded to your heart to correct structural problems in your heart that cause an arrhythmia.

Cardiac ablation works by scarring or destroying tissue in your heart that triggers an abnormal heart rhythm. In some cases, ablation prevents abnormal electrical signals from traveling through your heart and, thus, stops the arrhythmia.

Illustration showing cardiac catheter ablation

 

Though it is described as a simple procedure there are quite a few risks, though we won’t worry about those! The procedure is 75-80% effective – that’s what we want to focus on.  It would be dishonest to say that I’m not a little worried, but that is normal!

 

 

A Diagnosis: Atrial Fibrilation

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Finally a diagnosis and next steps! While the Stress Test was inconclusive, wearing an event monitor for one day provided conclusive evidence and a diagnosis of Atrial Fibrillation.

Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body.

During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart. Atrial fibrillation symptoms often include heart palpitations, shortness of breath and weakness.

Episodes of atrial fibrillation can come and go.

I had 2 episodes in less than 12 hours of wearing the monitor.  The monitor is a 3-lead EKG monitor that has 3G technology and functions in two ways.  First, when you feel an event you trigger the monitor which then sends a segment of data back to the manufacturer which then reviews the data and forwards it to the doctor.  The second function is that the monitor itself watches your heart rhythms and sends data back to the company if it detects anything abnormal.

I had 97 episodes during the entire time I wore the monitor and only one of them did I submit.  The first one, was while sitting on the couch at home watching TV!  I didn’t get the opportunity to review all of the the episodes, which would be interesting to see when they were happening and if there was a pattern that correlates to my activity or behaviors.

So now that I have a diagnosis, what’s next?

The first step is medication – Metoprolol  a beta-blocker, blood pressure medicine.  And an Aspirin daily, even though my stroke risk is a 0, they still wanted me to take an Aspirin as strokes are a risk of AFib.

If Metoprolol doesn’t work, there are other medicines that could be used.  Given my age and overall health I am also a candidate for cardiac ablation – a catheter procedure to change the heart structure to prevent future Atrial Fibrillations from occurring.

Exercise Stress Echo Report

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20150916_152611I think I’ve written before about how much I dislike treadmill running… Well taking a treadmill stress test is much worse! Not a casual walk in the park during the test you are essentially hooked up to a EKG monitor the whole time running on a treadmill and not being allowed to take your hands off the rail except to have your blood pressure and pulse oxygen taken every 3 minutes.  Try running all out uphill with one hand being held by a technician. And they are trying to get you to talk to them!
During the setup time she told me that the maximum length the test would go for is 21 minutes.  Using the Bruce protocol at 21 minutes you are running at a 22% grade at 6 mph pace.  The pace isn’t super intense but the hill is brutal.  I thought to myself that I’d like to hit the time limit, but didn’t make it.  I ran for 16 minutes which put me at 20% grade and 5.5 mph pace.  I think if I hadn’t done 5×5 squats that morning I could have lasted a little bit longer!
20150916_154148Oh yea, one last hard thing – the second the test is over you have to turn around and lay down in the exact right location to get an ultrasound of your heart. While panting and out of breath, they ask you to hold your breath to get a quality image.
All of that and I didn’t have any “episodes” during the test, though there were some minor things but nothing that the cardiologist on duty was concerned about.  My pulse did hit 190+ for at least 4 minutes which is pretty high.

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EXERCISE STRESS ECHO REPORT
——————————————————————————–
Patient Name:   NICHOLAS H CROSS Date of Exam:   9/16/2015
Type of Study: STRESS ECHO 2D Echo/Doppler/Color Doppler.
Indications: Exertional palpitations
 ___________________________________________________________________
Summary:
 1. Normal stress echocardiogram with no inducible wall motion abnormalities at stress.
 2. LV function is normal. The visually estimated ejection fraction is 60% at rest.
 3. Mildly elevated pulmonary pressure estimated at 25.6 mmHg plus right atrial pressure.
 4. PSVT in recovery at about 140-150 spontaneously resolved.
 5. No anginal symptoms with exercise.
 6. Dyspnea with exercise.
 7. Target heart rate achieved.
 8. Normal exercise capacity.
____________________________________________________________________
History: Patient with a history of No cardiovascular risk factors. Special Considerations: Lung CTA and No Murmur. Multivitamin daily.
Exam Protocol: Bruce stress protocol. Predicted maximum heart rate is 186. 85% percent target heart rate is 158.
Patient Performance: The patient exercised for 15 minutes and 35 seconds to stage VI of a Bruce protocol, achieving 15 METS. The patient developed dyspnea and leg fatigue during the test. The resting heart rate was 88 beats per minute. The resting blood pressure was 102/78 mmHg. The peak heart rate achieved was 192 bpm, which was 103% of the predicted target heart rate. The peak blood pressure during stress was 158/70 mmHg. The double product achieved was 30336. The stress test was terminated due to target Heart rate achieved and leg fatigue. O2 saturation at rest is 99% on room air. O2 saturation with stress is 92% on room air.

EKG: Resting EKG showed sinus rhythm and freq premature atrial contractions at a rate of 88 beats per minute. The patient developed no ecg changes and PSVT > 6 beats during exercise.

REST ECHO:
Left Ventricle: The left ventricular size is normal. LV function is normal. The visually estimated ejection fraction is 60% at rest.
Valve Findings: Mild aortic valve sclerosis. The aortic valve is trileaflet. Trace aortic valve regurgitation. No evidence of significant mitral valve regurgitation. Trace tricuspid regurgitation.
Right Ventricular Systolic Pressure Estimate: The estimated pulmonary artery systolic pressure is mildly elevated at 25.6 mmHg plus right atrial pressure.
Exercise Data:
+————-+—+——+———————————————+——-+
:Stage        :HR :BP    :Comments                                     :Initial:
+————-+—+——+———————————————+——-+
:Supine       :88 :102/78:Stiff muscle in left shoulder and upper back :GD     :
:             :   :      :at rest, frequent to bigeminal PAC’s,        :       :
:             :   :      :occasional PVC’s at rest                     :       :
+————-+—+——+———————————————+——-+
:I            :106:122/70:no symptoms and O2 sat 98%                   :       :
+————-+—+——+———————————————+——-+
:II           :124:136/70:no symptoms and O2 sat 98%                   :       :
+————-+—+——+———————————————+——-+
:III          :145:144/72:no symptoms and O2 sat 99%                   :       :
+————-+—+——+———————————————+——-+
:IV           :174:148/70:Slight leg fatigue, O2 sat 95%.              :       :
+————-+—+——+———————————————+——-+
:V            :192:158/70:Mild shortness of breath, O2 sat 92%, rare   :       :
:             :   :      :PVC and leg fatique.                         :       :
+————-+—+——+———————————————+——-+
:VI           :192:-     :Mild shortness of breath, leg fatique and    :       :
:             :   :      :rare PVC.                                    :       :
+————-+—+——+———————————————+——-+
:Post 1 min   :145:-     :Mild shortness of breath and rare PVC’s.     :       :
+————-+—+——+———————————————+——-+
:Post 3 min   :114:130/70:O2 sat 98%, 2-3 beat bursts atrial tach-no   :       :
:             :   :      :symptoms.                                    :       :
+————-+—+——+———————————————+——-+
:Post 5 min   :111:120/60:No symptoms and 2-3 beat bursts atrial tach, :       :
:             :   :      :frequent PAC’s.                              :       :
+————-+—+——+———————————————+——-+
:Post 7 min   :108:112/70:Rarre PAC’s, waiting on heart rate to        :       :
:             :   :      :decrease and no symptoms.                    :       :
+————-+—+——+———————————————+——-+
:Post 9 min   :102:-     :No ectopy and no symptoms.                   :       :
+————-+—+——+———————————————+——-+
:Post 9:39 min:99 :-     :Rare PAC and no symptoms.                    :GD     :
+————-+—+——+———————————————+——-+