My Big Heart

August 23, 2012

Wowzers!  What a week or 72 hrs it has been.  I am sure most of you have heard our news this week, but I decided I needed to record this life event on the blog too.  I apologize if this sounds very clinical and cold.  As you know I am a stoic internalizer of stress.  Most of the people closest to me are concerned about me not processing this with emotion.  I am.  I have had cracks in my firm disposition.  Thank you to those of you who have made me open up even if just momentarily.  

Ok.  Background.  When I was 19 and cheering for our fabulous TN Titans, I came down with pleurisy.  Since Mom is an ultrasonographer she wanted my heart looked at just to make sure.  With her connections, one of the local cardiologists took a look with an echocardiogram or ultrasound of my chest.  He told me that my heart was fine.  I just had a small congenital anomaly of an atrial septal defect or ASD.  He said it was tiny and that only 1 or 2 red blood cells could fit through at a time.  He said since I was healthy and athletic with no symptoms not to worry about it.  We discussed that I had always had an innocent murmur and that was to be expected.  No worries.  I recovered from the pleurisy and returned to cheering and life.  Then I got married, moved to Lynchburg, graduated from Liberty's Nursing program, moved back, started my nursing career at HMC, had two beautiful babies, and never considered my ASD again.  

Until last Friday.  I have been battling bronchitis with a cough since the middle of July.  Since we were going on like the forth week of the cough with antibiotics, inhalers, and steroids my PCP ordered a chest X-ray.  I had that done and called the nurse for results.  She told me it was normal with no pneumonia, but I had an enlarged heart.  This quickly brought up the memories from twelve years ago,but I didn't think much of it over the weekend.

On Monday the office called and wanted me to have an echocardiogram.  I agreed and thought that was a good idea since I had never officially had my heart worked up anyways.  Being at work, I acted like a nurse and talked to our ultrasound department and got it scheduled for that day.  They got me in and it was completed.  As I got ready to leave for the day I passed one of the cardiologists and his nurse in the hall.  I asked if he had read the echos from the day. He said "They're all done. In the reading room." I knew I couldn't look, so thankfully he returned a few moments later to talk me through my scans.  He told me to sit down and look and he pointed to the screen.  He showed me how my right side was very enlarged and that I had a large hole in the septum between my atria.  My non-medical buddies:  Your heart has four chambers divided by walls and valves.  My middle that is suppose to be  a solid wall has a 1 inch hole between the top chambers.  This atrial septum defect causes blood to mix back and forth between the left and right sides.  So as my heart tries to pump blood from my right atria to my right ventricle (bottom chamber) and then to my lungs for oxygen it looses blood across the hole to the left side atria.  The left side atria recollects blood from the lungs to send it to the left ventricle and then out the aorta to the body.  So when blood swishes through the hole it causes pressure equalization problems in the heart.  The right side builds up do to working so hard against the hole just like an muscle when you are working out.  Thus, my right side is twice the size it should be due to it trying to compensate for the hole.  Also, this rushing across to the wrong side causes blood that hasn't been to my lungs yet for oxygen pickup to be sent back out into the body. Got it non-med buds?  Well, the cardiologist and I chatted for a while.  Then another cardiologist from the group stepped in the office and talked too.  It was definitely mind boggling to have both of them looking at you and your pictures.  I should be having all types of symptoms like swelling, shortness of breath, exercise intolerance, etc.  I do not present with any of these things.  Actually Jay and I just ran a 5K obstacle mud run on Saturday.  They were also blown away that my pregnancies didn't cause any cardiac issues with me.  I had no problems.  Crazy huh?  The cardiologist called a surgeon downtown and they started talking and planning.  He told me to go home and share the info with Jay.  Then he gave me some orders and said to come to his office on Wednesday.

Tuesday I worked as I was scheduled.  It was a busy day and I struggled to keep it together.  I had my blood work done and began to share my upcoming journey with my co-workers.  We also started going through a mental list of who we needed to talk this through with.   So by Tuesday night both our families and a few friends knew the scenario and what we were dealing with comprehending.

Wednesday morning Jay and I met with my new buddy of a cardiologist.  Everyone in the office was intrigued by no signs and symptoms for such a large defect.  My cardiologist explained that I would be seeing the cardiologist surgeons on Thursday for some more testing.  He felt that it was better for the actual surgeons to get the diagnostics they needed rather than rely on my cardiologist to get them.  So we scheduled the tests and tried to mentally prepare for all the information and decisions.

Thursday morning he headed down to Centennial for a transesophageal echocardiogram or TEE.  During this procedure I was put to sleep by anesthesia while it was being performed.  One cardiologist surgeon performed the TEE while the other one was at bedside.  This exam involved putting a scope down my throat to get more precise pictures and measurements.  These calculations help to make a decision on what type of surgery with fix the hole.  We hoped that one of these cardiologist were going to be able to fix the hole with a percutaneous approach.  This would have involved going into my groin with a catheter and up to my heart.  It is minimally invasive as they place a closure device like a mesh in the hole.  After they visualized the hole, they quickly knew it was too big to be corrected in that manner.  The hole measures to be just under 3cm or about a inch.  Being so big the defect doesn't give the cardiologists a good anchor area of tissue for the device.  They thought the device would place pressure on my aorta and eventually erode it.  Since I am only 31yrs old, this is not an ideal situation.  With that option eliminated we moved on up the ladder to other options.  These options include incisions on the chest.  The open heart surgery will be done with  incisions on my sternum, under my left breast, or my left side through my ribs.  They will also probably use exsisting tissue around my heart to plug the hole instead of a device.  Before those decisions can be made I needed another exam.  I went for a Cardiac MRI also today.  This scan was a curve ball we didn't see coming.  The MRI was done to check for other abnormalities that are associated with ASD.  Like one of the docs said today, "Open heart is a one time thing.  We have to get it all fixed this go round.  You don't want problems later in life that lead to another surgery."  Amen.  I couldn't agree more, let's fix it all now.  We don't know any results from the MRI, but since it took so long I didn't get to me the next surgeon today.  I have an appointment with him on Wednesday.  That sounds really far away to me since I have gotten all this done in a 72 hr period.  As a dear friend reminded me, "It will be done in God's timing."  I know this and am trying to be at peace with it.  I will continue to update as I know more.  At this point we just need to remember that "our God is bigger than the boogie man" and an ASD.  Jay and I just request your prayers during this time.  We will update as we know new information.