HAC – Diagnostics and Catheterization

My heart attack education continued the day after the I checked into the hospital. I was to learn all about the joy of the stress test. Given my condition, however, they weren’t going to make me run on a treadmill. Instead I was to undergo a chemically induced stress test with a nuclear component for imaging. This is about as much fun as it sounds.

They wheeled me down to the lab areas and hooked me up to an EKG. This, of course, involved the removal of old leads and the attachment of new leads, along with the associated hair loss. I was then taken to a room where I was put on a bed, arms reaching straight past my head, and positioned over a giant, rotating camera. This camera would take pictures of my heart at rest and would only take 24 minutes or so. My arms were over my head because the camera has to be close to get the proper imaging and the arms get in the way. This would be a bad position for me normally, but I was still mildly wrecked from the check-in and the drugs so it didn’t really hurt much. I believe an imaging drug was injected into my IV, then the camera started its circuit. I actually dozed off several times during this procedure, which help speed the time along, though it fogs my recollection.

After the pictures were finished, I was wheeled into another room for my stress test. Here I was still hooked up to an EKG and I was administered some adenosine to simulate exercise conditions on my heart. Here’s the first, but not the last, time that I experienced the same symptoms that I felt during the first couple of nights of my heart attack. The teeth aching sensation came back as well as the shortness of breath and burning sensations. An imaging drug was injected after a bit and later I was wheeled back into the camera room. Another series of pictures was taken of my heart under stress. The two series of pictures would be compared to determine where the problem areas were and the extent of ischemia (reduced blood flow). All I know is that I managed to fall asleep again during the second round of pictures and actually woke myself up by snoring a couple of times.

I’m not really sure how long this process took all told, what with the constant naps and the fact that I didn’t have access to any timekeeping devices, but I imagine it was a couple of hours at the least. Regardless, it was completed and I was wheeled back to my room to rest. Thankfully I had family and friends to come by and visit me, plus the endless parade of nurses, doctors and residents.

Eventually, the doctor stopped by with the results from the stress test. The heart attack had occurred in the lower right portion of my heart and blood flow still wasn’t good. I needed to get to the cath lab for a catheterization procedure to determine the best course of action to reopen the clogged artery. I was scheduled for the next day.

I was wheeled down to the cath lab in the morning and placed in a curtained off stall in a large room. The room was full of nurses bustling about, patients in the many other stalls and the occasional group of doctors. The ceilings of the stalls each had a different nature scene backlit by a fluorescent light, presumably to calm the patient who had little else to look at, given their prone position. I was given a “light” anesthetic, but I was to be awake for the procedure. My assumption is that I was given too much of this anesthetic, because I was pretty well out of it for most of the catheterization. Basically the doctors made an incision in my femoral artery, right in the groinal-area, and threaded a plastic tube up through the artery and into my heart. Once in the suspect arteries, they injected some dye so get a good look on the camera and then they dumped some more adenosine in me. This brought on the symptoms of yet another heart attack, but they were watching my heart to see exactly what was happening to the organ under stress. It was during this procedure that they could see the artery feeding the right part of my heart was 99% blocked. At this point the decision was made to put in a drug-coated stent.

A stent is a tube of metal, kind of like chickenwire, put on the balloon portion of a traditional angioplasty in a collapsed state. It’s inserted into the artery and the balloon is inflated. The stent pushes the blockage to the walls of the artery and holds it there, providing a better opening than angioplasty alone. The drug works to combat re-clogging of the artery. As part of having a drug-coated stent, I’m required to stay on anti-clotting meds, in this case Plavix, in order to prevent possible issues with clots forming around the stent. As I understand it, I’ll be on Plavix for at least two years, which is fine by me if it means avoiding a clot and another, possibly fatal, heart attack.

Again, my memory of the first visit to the cath lab is fuzzy. I remember the room, the symptoms returning and somebody yelling at me to “breathe”, which I think might not have been a very good sign. The last thing I remember is waking up to someone telling me not to move my right leg, which of course I immediately did. This led to a problem with suturing up the incision in the femoral artery, which is a bad thing as the femoral artery is one of the big ones that will cause a person to bleed out in a short amount of time if its lacerated. I believe the doctor cursed when I moved, and I spent the next 6 to 8 hours or so with a plastic contraption pressing on my groin to keep pressure on the wound. Not fun. Or comfortable. I also have a nice knot of scar tissue there now.

I don’t remember too much about the rest of the day, except spending it in my bed. I had family and friends visiting and hanging out, which was great. Nurses were in and out on a regular schedule to check out the groin area for bleeding. I was still having bits of pain though, despite all the work done. I slept fine that night and the next morning followed up with the Cardiologist. I told him that I was still having some pain and he decided that I needed another visit to the cath lab. While I had one artery that was 99% blocked, I also had another artery that was 60-70% blocked. He wanted to get more information on this artery to see if it was the cause of my continued pain. As I understand it, a second visit to the cath lab is unusual.

But I was scheduled for a visit the next day, and away I went. The scene was pretty much identical to what I described above. As the team of doctors wheeled me into the cath lab, I mentioned that I was definitely NOT going to move my leg this time. This caused some laughter and one of them said, “Oh I remember you! You better not move your leg again!” I promised I wouldn’t. I wasn’t nearly as heavily sedated this time, so I had a better recollection of the procedure. This time I ended up with a bare metal stent in the other blocked artery. Turns out it was closing down under stress. This second stent resolved the pain issue and now I was just in the hospital for recovery and observation. Oh, and I didn’t move my leg which means that I didn’t have a big plastic contraption clamped onto my groin and several hours of bleeding. Upgrade!

So now I have two bits of chickenwire in my chest. At my mother’s suggestion, I decided they needed names. I chose Jake and Elwood in honor of the Blues Brothers and their foray into country. Remember the chickenwire?

I spent the next couple of days moving around more and more, visiting with my family, friends and coworkers who stopped by, and generally recovering from the entire ordeal. I was given initial overviews of recommended diet plans, changes to my drinking, introduced to the idea of cardiac rehab and even spent some time just hanging out with the Cardiologist who watched a half-inning of a Red Sox game with me. I was given prescriptions for all the drugs I would be taking, and am continuing to take, as well as a bottle of nitroglycerin for emergencies. I transferred these to a small, metal container I bought from CVS specifically for this purpose and now carry them on my keychain. A friend of my father’s and I compared our nitro containers one night not too long after I got out of the hospital…I did not realize I had joined a fraternity or sorts. Several follow-up appointments were scheduled for me and I was given the lowdown about how long I would be out of work. The doctor really kind of left it up to me so I kept myself out for the month of October. Come to find out, most people take a lot longer than that to get back to work, especially since work-stress is often a big cause of heart attacks. Oh well, I don’t like to be a slacker on someone else’s dime (I was on short-term disability leave at this point).

On the first Saturday after checking in, I was released. My brother came down from Vermont and drove my stinky ass (no showers, only sponging myself off) back to my apartment so I could pick up some necessities, which was very cool of him to do. Then he drove me down to my parent’s house where I would stay while continuing my recovery. This insured that I wasn’t alone in case of an emergency and, since I wasn’t allowed to drive until the doctor gave me permission, I had to mooch rides off my folks to get my prescriptions and to get to my appointments. They’re patient and selfless folks, those parents of mine.

So ended my stay in the hospital and the beginning of all the changes I would make to try and prevent another heart attack from hitting.

This entry was posted on Wednesday, June 25th, 2008 at 11:09pm and is filed under Heart Attack. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the end and leave a response. Pinging is currently not allowed.