To the concerned, I am bruised but not broken. My heart is ok, but you should see the veins on my left arm. Yesterday’s trip to the ER was humbling but yielded a potentially positive outcome.
It started with a sip of soda; some went down my windpipe and caused me to cough forcefully. This is a bad thing — with me, coughs almost always end in hiccups (after smoking for 9 years, I can’t cough anymore – I have to hack). So, the hiccups inevitably began and I could not silence them soon enough. The unfortunate chain of events ended in tachycardia: the sudden, sustained doubling of my heartrate.
I’ve had this before, too many times. Went to the ER for it on one extremely long case. Usually lasts five to thirty seconds until my heart finally settles down. But yesterday morning, after I tried all my doctor-recommended tricks to end it, I knew it was going to last, so I called to my roomate to take me to the ER.
All the signs, cars, stop lights, people, activity – you notice the absurdity of it all when you’re sitting in a passenger seat and your vehicle is going in slow motion, your pulse is 180bpm and your heart feels like it wants to die. You feel completely unimportant; the world goes on regardless of your emergent health.
Tachycardia is not fatal; there’s a 1% to 3% chance of death from cardiac arrest. It feels like it’s eminent, though; the heart is on a freewheeling feedback where it still pumps blood but does so incredibly inefficiently. When your pulse returns to normal, you almost can’t feel it anymore, but you’re still alive. It’s otherworldly to not feel your own pulse, but you’re glad it’s settled down. You can relax.
I went to the ER hoping that they could get the ECG leads on me before it settled; sadly, my heart once again returned to normal before I could see a triage nurse. For a proper diagnosis, they need to see it happening. I considered trying to induce it, a potentially dangerous proposition, but it’d be the best place to try that kind of thing.
The doctor on staff mentioned that it might be a condition known as WPW, or Wolff-Parkinson-White Syndrome; the cardiologist on call suggested it, and the staff doctor seemed to agree. Basically, the heart has a nerve bundle between the upper and lower chambers which is responsible for transmitting the heartbeat impulse between halves while in the process delaying the beat of the lower chambers.
People with WPW also have a rogue nerve elsewhere between the halves that causes the impulse to be sent too soon and on rare occasion will cause a circular impulse loop, resulting in tachycardia. WPW is treatable with medication and in most cases (I’m assuming) curable with a procedure called radio-frequency ablation where heart surgeons run a catheter to the site of the rogue nerve and burn it with radio energy.
This errant nerve is formed at gestation but its effects are generally not seen until the person is between 11 and 40 years of age. I’ve had this problem for at least since 25. I had always associated it with smoking or too much caffiene; although that exacerbates the situation, it is not the cause.
The ER doctor recommended I see the cardiologist for a follow-up. Gave me his pager and office numbers. Since I have new insurance, I need to check with my provider to ensure I can see this specialist without referral from my primary physician. Politics and money first, health second. As much as I hate using the phone, I will start making some calls tomorrow morning. Even if the ER trip was a wash, this important lead makes it worth the effort.