Category: Heart

Heart problems kill one in four people. I write about my experience of near fatal heart failure and what heart experts did to help me lead a normal life with a super-pacemaker.

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British Heart Foundation – Why I support it

David Roberts
David Roberts

British Heart Foundation – Why I support it

How important is the British Heart foundation? My personal interest in its work I feel profoundly lucky that research and consequent developments in the treatment of heart problems has benefited me. I have a pacemaker/defibrillator in my chest which ensures my heart rate never falls too low and will actually resuscitate me if my heart rate goes dangerously high. That’s the theory, at least!

A quarter of you will die from a heart problem or a related disease such as a stroke or vascular dementia!

So I am not alone in having a heart problem. A quarter of the British population, many millions of people, will experience heart and circulatory disease issues in their lifetime and so many of us will benefit from minor to major heart operations, and drugs like statins, beta blockers and drugs to control blood pressure, which prevent or ameliorate heart problems.

The British heart Foundation has been funding heart research in this country for over fifty years and a great deal of progress in this field is the result of the many millions of pounds they (and others) have invested in research.

You can read more about this on the British Heart Foundation website https://www.bhf.org.uk/what-we-do

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What’s wrong with my heart? A surprising heart problem, my recovery and ICD pacemaker

Anyone who meets me would probably think that I am a very healthy individual. I have felt very well this year and have been very active doing exercise routines most days, swimming in the summer  in the sea and rivers, gardening, painting and decorating, and doing quite a lot of walking etc.

 

Hidden problems

However, I have a couple of hidden health problems. The most serious of these is a heart problem which might have been fatal had it not been for the intervention of the National Health Service. However, thanks to them, I am able to live a normal life.

What the National Health Service has done for my heart

After a series of in hospital investigations (I was in a hospital for a fortnight)  it has implanted under the skin of my chest just under my left collarbone a device called an ICD which is a kind of pacemaker, though, in fact, it’s an unusually sophisticated one. Wires go from it and are inserted into my heart.
The other main thing is that the NHS has put me on two medications. 
After I came out of hospital I was offered a series of cardiac rehab classes and lectures about heart health. I also see a cardiac consultant to check on how I am getting on and every six months I am in touch with the pacemaker clinic which checks that the pacemaker is functioning correctly and that the battery is good for a year or more.

My racing heart – The diagnosis  –   ARVC

All this means is that I have got is a disturbance of the heart rhythm. This is called arrhythmia.

In practical terms what this means is that my heart may, at times, beat irregularly, or too fast, or too slow. If these irregularities take an extreme form then they can be life-threatening. My heart has been recorded at beating at over 200 beats per minute and as low as 26 beats per minute. if these rates had been maintained for a period of time I would have been dead by now. 

When my pulse has been taken in recent years at a doctor’s surgery usually the heart rate has been around 40 to 45 beats per minute. I was always told this was very good and is the speed that a very fit person or an athlete would expect. Apparently the resting heart rate for most people is around 60 beats per minute. 

It seems that what happened in December 2018 and February 2019 was that my heart rate went extremely high and made me feel dizzy. The doctors considered this was dangerous which is why I was taken into hospital for check-ups and monitoring and a remedy.

Cardiomyopathy

So the diagnosis now is ARVC. These letters stand for “arrhythmic right ventricular cardiomyopathy”. The right ventricular bit simply means that the problem is in the lower right chamber of my heart. 

Cardiomyopathy means “disease of the heart muscle” but it is not disease in the  sense of something  attacking it or that it is growing in some exceptional way. Cardiomyopathy normally takes one of two forms, either a thickening of the muscle (wall) of the heart or a thinning of the muscle. In my case it seems that the wall of the right ventricular chamber is thinner and weaker than it should be. The normal effect of this would be that a person experiences breathlessness. I have never experienced this so my conclusion is that any problem there must be fairly slight.

However, the other effect of some sort of abnormality of the  heart such as I have is that vital electrical currents, which cause the heart to beat, don’t flow as well as they should across pathways in my heart. This is what leads to irregularities in my heart rate/pulse.

Cardiomyopathy can lead to sudden, unexpected death.

Medication, a device and follow-up education

  1. I take a drug called Bisoprolol which reduces the amount of adrenaline my body produces and thereby it should steady my heart rate.
  2. If my heart should happen to go much too fast then the muscle of the heart would be unable to pump blood through my lungs to get it oxygenated in the normal way. If the movement of blood slows down for a period of time it can start to thicken up and form a blood clot which could lead to a stroke or death. For this reason I take another tablet called Rivaroxaban which is an anticoagulant which stops my blood from getting thicker.
  3. The third “treatment” that I have is a very specialised kind of pacemaker called an ICD. ICD stands for “implantable cardioverter defibrillator”. This has several functions and can be adjusted electronically.

The functions of my pacemaker

The first is to ensure my heart doesn’t go too slow and currently it is set to prevent my heart from going slower than 50 beats per minute. 

ICD’s built-in accelerometer

It also has a function called an accelerometer. This senses the movement of my chest and decides if I need a boost to the speed of my heart to obtain sufficient oxygen for the activity it has sensed. If it thinks I need more oxygen it will deliver minute electric pulses to my heart to speed it up. 

Defibrillator

The third function is to work as a defibrillator which means that if the speed of my heart goes way out of control or it stops altogether it will deliver a strong electric shock to start a heart again, hopefully with a normal rhythm. 

A final thing is that the ICD stores a record of my heartbeats and understands if something unusual is going on. If it senses a problem it will send a message over the mobile phone network to the pacemaker clinic in the Royal Sussex Hospital in Brighton. The clinic can then take any action it thinks is necessary including alerting the cardiac consultant and my doctor. Every night my pacemaker communicates with a transmitter in my bedroom. It’s like having a spy in my chest.

Monitors heart activity and reports automatically by mobile phone network

It was because this facility functioned in June 2019 that the hospital realised the atrial chamber was malfunctioning and that is why I was put on the anticoagulant. So the pacemaker diagnosed the problem and alerted the doctors. Without it I would not have known that I needed further medication. 

Is the pacemaker working correctly? 

Maybe not. Although I’ve been feeling very well this year my main concern has been that my heart rate sometimes seems to go up very high and for no good reason. The problem occurs if I jog or do any movement which involves my chest going up and down relative to the ground in such exercises as squats or skipping or jogging.  In a few seconds my heart rate can go from 70 beats per minute to 130 beats per minute,  even though I am not the slightest bit out of breath.

When I went to cardiac rehab classes at the Princess Royal Hospital in Haywards Heath shortly after I had the pacemaker inserted I was advised that a safe heart rate for me to exercise at was between 90 and 105 beats per minute.

My own heart rate monitor

I would never have known about this speeding up of my heart rate if I hadn’t bought a high quality heart monitor, the same brand that they use in the hospital cardiac rehab classes. (Polar)

The follow-up to having my my pacemaker insertion has included visits to a cardiac consultant. I told him that I was puzzled about why my heart was suddenly speeding up so much when it didn’t seem to need to do this. He suggested that he reason it may be speeding up might be because of a device within the pacemaker called an accelerometer. He suggested that when I next had an appointment at the pacemaker clinic in Brighton I should ask them if an adjustment might be made.

In fact I went to the pacemaker clinic on the 4th of November and I will write about this experience in due course.

David Roberts

www.davidrobertsblog.com

27 November 2020

British Heart Foundation

For more information and to donate to The British Heart Foundation Click Here 

The cardiomyopathy charity

In the UK one organisation specialises in cardiomyopathy. For more information about cardiomyopathy click here.

NHS cardiomyopathy advice and information

And the NHS website is valuable too. It points out that ” Hypertrophic cardiomyopathy is the most common cause of sudden unexpected death in childhood and in young athletes.” The NHS cardiomyopathy website page. 

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My  unexpected  experience as a heart patient  –  Part Two, the Angiogram

What it’s like having an angiogram   –  actually a very interesting experience

I was moved into a cardiac ward and put onto a bed. I had hardly got onto the bed and looked around me when a message came that I could have an angiogram immediately.

Hospital porters pushed my bed into a small room. A doctor explained the procedure and the risks including a small risk of dying. “But don’t worry about that. You’re not going to die.” So I signed. I was about to see amazing technology and medical wizards at work. It was like being a privileged witness. 

I was wheeled  into a large and quite gloomy room with massive pieces of equipment  looking a bit like grey metallic elephants, plus a number of screens.  Along one side behind some windows was something which seemed to serve as an office and control room. There were a few people there. 

The angiogram process was to view my heart in action by injecting a dye into it so that the action could be observed on a large screen.The elephant like machine had a large box at the end of its jointed  “trunk” about the size of a cabin-baggage suitcase. This was the x-ray camera which was placed very close to my chest and for most of the time obscured my view of the screen. The doctor standing by my bed issued instructions to an unseen operator. It was moved into various positions alongside my chest, down a bit,  across, along the other side, etc.

 A little local anaesthetic was injected into my right wrist and then a very thin tube was inserted into  an artery and was pushed up my arm and into my heart. The only sensation at this stage was a slight tickle in my wrist when the tube was first inserted. The tube carried some dye which enabled the condition of my arteries to be clearly seen on the screen. When I was able to glimpse the screen I could see a very large heart and  what looked like the branching of some very fine  black twigs. There also appeared to be some substantial squirting of fluid into one of the chambers which I took to be blood being pumped.

Seen on an angiogram screen  – arteries made visible with dye

A moment’s panic

Whilst the procedure was progressing I suddenly felt palpitations in my chest. Several; people were standing around the operating table and there was a spontaneous “Whoa!” from them. The surgeon in charge immediately started to call for chemicals to be injected. As I remember it (and I could be wrong, of course) there were calls for so many milligrams of calcium, magnesium and potassium. My heart rhythm quickly returned to normal.

Later, when I was in the cardiac ward one of the nurses told me that my heart rate at this time had gone up to over 200 beats per minute.

As soon as the process  of examination was complete the cardiac surgeon came to put me in the picture. He said that I had very clear arteries, free from cholesterol and the heart was basically in a healthy condition,  but there was a potentially fatal electrical fault in it which would need  further investigation and fixing.

No time for embarrassment

This was all happening about 5 to 5:30 p.m. and no doubt the nurses and technicians and cardiac specialist were all wanting to get home. 

I was moved off the operating table by several nurses. I had to roll to my right side. A board was pushed in as far as it would go. I rolled back onto it then they slid the board across onto my bed/trolley. 

I had a strong cramp like feeling in my stomach. I felt I desperately needed to do a poo. Nurses brought me a bedpan. I’ve never seen one before. It seemed unduly small and shallow. A bit like a dustpan that goes with a brush but the outer wall all round it was about 2 inches high. Inside it had been placed a papier mache dish which fitted the  more or less triangular shape. I didn’t feel very secure on it on the wobbly mattress.

It turned out that I had a lot of wind and needed a pee, but that was all. My bum had got wet and I was handed a bundle of heavy-duty tissues to wipe myself. The bedpan made for a really unpleasant experience. A nurse suggested that the dye that they used sometimes caused stomach ache. 

This is as I remember the experiences prompted by the hospital diary that I kept.

Next time  –  Part Three  –  life in the cardiac ward.

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My  unexpected  experience as a heart patient  –  Part One, a lucky start

I believed I was reasonably fit (February 2019, age 76). After all, for about 10 years I’d been doing a lot of jogging and other exercise.  Typically I ran 6 or 7 miles a week (almost two miles every other day) and on days when I didn’t run I usually lifted weights for about 20 minutes followed by 50 press ups.

Small health problem

However in early February 2019 I had some palpitations in my chest and felt a little bit dizzy on a couple of occasions. There was no pain and I recovered within a few minutes of these episodes which only lasted about 10 to 15 minutes.  I really didn’t think they were serious,  but I have since learnt that any one of the episodes was likely to have been fatal. 

Being puzzled about what had happened I decided to look on the NHS website Apparently chest palpitations are extremely common and normally are of no medical consequence, but if they are accompanied by a feeling of dizziness or fainting then they can be serious, even life-threatening. 

It was a Monday morning and Julie and I were all packed ready to set off for a few days break in The New Forest. Nevertheless, I decided to phone the NHS helpline (111) to ask a few questions about my experiences. To my surprise I was advised to see my doctor immediately.The medical advisor said he would phone my surgery directly to tell them I must have an immediate appointment.

I got an appointment the same morning and following an ECG test and a blood test I received a call in the early evening to say that one of the tests had revealed a matter of serious concern. My troponin level  was 73.3. Write this down now. Then go immediately to Accident and Emergency at the Princess Royal Hospital and give the receptionist the piece of paper with my troponin score on it. ”They will know exactly what to do.”. 

Suddenly in hospital
This seemed to me like an overreaction but at 8:30 pm on Monday the 18th of February I walked into the accident and emergency department of Haywards Heath Princess Royal Hospital and handed in my blood test result. I was soon put on a hospital bed and  into a hospital gown. I had several electrode sensors stuck to my chest to monitor my heart rate and rhythm. My oxygen level was monitored, and my blood pressure taken every 15 to 30 minutes. The heart monitoring carried on continuously for another fortnight but the taking of blood pressure was done at less frequent intervals although it still continued in the middle of the night throughout my stay in hospital. 

My heart rate was running in the low 30s,  whereas my normal heart rate is about 45 beats per minute. While in hospital (for the next 16 days) my heart rate continued mostly to be in the low 30s.

When a doctor came to see me he said that he was concerned about my low heart rate combined with low blood pressure. However, he was not a cardiac specialist and he would phone the cardiac unit in Brighton hospital for advice. He came back after some time to say that the cardiac unit in Brighton said I should be taken down to Brighton straight away. He said he would order an ambulance.

Sent to specialist cardiac unit

A little before 1.30 am two bright, beautiful and smiling faces appeared round the curtain. The blond girl said,”Hello, Mr Roberts. I’m Julia and this is Alex and we are going to take you to Brighton.”  The nurse who had been keeping an eye on me said “Oh! Look at your heart rate now! It’s 50!” Perhaps I just needed more excitement in my life. 

By 1.30 am I was in the ambulance and connected to the ambulance portable monitor with a new set of sticker electrodes on my chest. I was strapped to the trolley. Paramedic Alex stayed with me in the back of the ambulance and Julia drove. It was my first trip in an ambulance and I was going to be delivered to Brighton Accident and Emergency department.It all seemed quite exciting. I had not the slightest thought that I might have a serious health problem. 

I felt very upbeat all this time and spent the journey chatting with Alex,  mainly about her work which she clearly found very rewarding. I mentioned that we had been about to go on holiday that Monday morning to a cottage in the New Forest. Alex said,”  Oh well,  we are taking you down to the seaside.”  I said, “ Yes, and a change is as good as a rest.”

Arrived in Accident and Emergency Department, Brighton

We arrived at 2 a.m. and the accident and emergency reception area was packed  with people on beds and trolleys awaiting attention and with lots of relations and friends around bedsides. Nurses were bustling to and fro. It was a scene of amazing activity considering that it was the middle of the night.  I waited on my Trolley for another half hour with Alex and Julia standing by until someone could be found to take me to  a bay where I could be attached to the Brighton hospital  heart monitor with another set of electrodes stuck on my chest and where a printout could be created of my ECG. (Electro cardiogram –  a print out of the pattern of my heart beats, the rhythm and electrical activity, in fact quite a bit more information tha just the regularity and strength of the heart beat.)

I stayed in that  accident and emergency department for another 14 hours, still being continuously  wired up and monitored. I was clearly just an object waiting to be moved on when a signal was given. No one came to me except when I used a call bell to say I needed to go to the loo. On these occasions they disconnected the heart electrodes and the device that measures oxygen in my blood so that I could take a short walk up the corridor. (I thought nothing of it at the time, but perhaps it wasn’t really the correct and safe procedure.) It took quite a while for a nurse to attend to my calls so, after two or three occasions, I decided, having observed the process,  to do the disconnection myself, go to the loo and return and reconnect myself.  

When I had been put into the ambulance Julie (my wife) had been advised to go home and get some rest. She turned up at the A&E department in the afternoon so was able to go with me when I was at last moved to a cardiac ward in the hospital about 5 pm.

Next part: the Angiogram

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Can too much exercise kill? – How I nearly did too much

I’m now 76 (August 2019). For the last ten years or so I’ve run a little under two miles every other day, and on my off days I’ve enjoyed exercising with weights, nothing massive. About 7 kg in each hand: 10 lifts above my head from shoulder height, ten lifts from floor to above my head, 30 diagonal lifts (one at a time) from waist height to by my opposite side ear; then 30 press-ups.

Encouraged to do more by TV Doctors

In the autumn 2018 I watched a tv programme about fitness presented by the van Tulleken twins, Chris and Xand van Tulleken. One of them suggested that the more exercise the better and, I think, two sessions of 50 minutes vigorous exercise a week was what we all ought to be doing. “The only mistake you can make with exercise is not doing it.” They were supervising pensioner-age, overweight men running round a race track for quite a while and doing two or more sessions a week for 6 or 8 weeks. No suggestion of risk of heart attack or anything like that. At the end of the period the men declared themselves to be feeling much fitter and happier.

The message I took from this was that perhaps I ought to be doing more, so I tried to increase the speed of my jogging, the number of lifts I did with weights, increased the weights from 7kg to 9kg, and increased my press-ups from 30 per session to 50. The press-ups were becoming quite a struggle and I needed a number of pauses to get up to 50.

Dangerous episodes

I felt very well, but then a couple of brief events happened which I thought were very minor but which I later learned could have been fatal.

A couple of weeks before Christmas, as I walked into Marks and Spencer’s in Brighton with my wife to do some Christmas shopping I felt my heart racing and I felt a bit dizzy. I didn’t want to alarm Julie so I simply said “I feel a bit dizzy”. I think I’ll just wait for you here by the door for a little while. I couldn’t see a chair anywhere to sit down on.

A few minutes passed and Julie suggested that I went up to the next floor where she knew there were some chairs. So I went upstairs and sat down for about ten minutes. After this I felt better. The palpitations stopped. I resumed normal life, although I think that after Christmas I noticed that jogging seemed a bit more of an effort.

One Friday morning in mid February 2019 I came back from a jog one morning and started to do some stretches (my normal routine after a run) when I felt a bit dizzy and my heart was beating very heavily, really thudding. I decided to lie down on the lounge floor. (Julie was out swimming at this time.) For a moment it felt as if my heart was throwing itself from one side to another. It quickly calmed down. After a few minutes I felt OK, got up and went to have a shower as usual. I carried on with my normal day.

During the following Sunday night I got up to go to the loo and felt a little dizzy and I was conscious of my heart beating rapidly. I went back to bed and instantly fell asleep. I felt perfectly normal when I got up.

After breakfast I decided I ought to phone the National Health Service advice line and ask if my experiences were serious. They said I should see a doctor urgently and they would phone my surgery to ensure that I had an urgent appointment. I was given an appointment at 10.30, had an ECG and a blood test.

What happened next?

At 7.30 that evening I had a phone call from the doctor covering the practice out of hours. He said I should go immediately to A&E at our nearest hospital, The Princess Royal in Haywards Heath. At 1.30 am I was in an ambulance on my way to the cardiac unit in Brighton Hospital where I stayed for two weeks. I now have a very high-tech pacemaker which will re-start my heart if it becomes too fast or erratic. I’ll write more about the follow-up experiences shortly. (August 2020)

David Roberts reposted from my Tumblr blog of 6 August 2019.

 

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Disturbed heart rhythm – risk of sudden cardiac death

If you are in tip-top physical condition and exercising a lot you may be in greater danger than you realise. I thought I was super-fit but one day, at the age of 76, I unexpectedly felt faint and had a fast heart beat. I was later told that this “episode” could have proved fatal. It may have been caused by too much exercise. There is such a thing as “over-doing it”. There is a lot of evidence for this but it is not widely publicised.

This is a quote from an article in the Daily Telegraph. In spite of some risk I am sure it remains true that plenty of regular exercise is good for you.

From The Daily Telegraph, “ Abnormal heart rhythms. A long but gentle session on the treadmill can’t hurt, right? Wrong. Those who regularly engage in endurance sports are at risk of causing permanent structural changes to heart muscles which scientists describe as ‘cardiotoxic’.Such changes are believed to predispose athletes to arrhythmia (abnormal heart rhythms), making them more prone to sudden cardiac death.

For years, a handful of clean-living sports nuts have sat smug in the knowledge that tobacco, caffeine and recreational drugs are the main causes of an irregular heart beat. But studies released by the European Heart Journal in 2013 suggest that – especially for those with a family history of irregular heartbeats – overdoing the fat-burning workout can also contribute to poor cardio health.The study, which measured the heart rhythms of over 52,000 cross-country skiiers during a ten year period, found that the risk of arrhythmia is increased with every race completed, and was up to 30pc higher for those who competed year-on-year for a period of five years. Exercise intensity also affected results: those who finished fastest were at higher risk for arrhythmia.”