The Day of the Heart Attack

I wake up about 2:45 on a Monday morning. The time is greeted with a mental groan. Way too early. Feeling weary, I get out of bed and notice a burning sort of pain in my chest, behind my sternum. “Huh. This must be what heartburn is like.”

I go to the kitchen and get some milk. The milk seems to help a little bit, but the burning sensation is still bothersome, and I lie down on the couch so moving from discomfort won’t bother Grandma.

Worse. Dangit. No way I can go back to sleep feeling like this. I go to the computer to do a little work, but the sensation is too distracting for that. What could be causing it? I reflect. I’d had an unusual amount of green tea, unsweetened, working late, before I went to bed. I’m no food chemist, but maybe it’s acidic burn from the tea? I drink some water, and wow, does the burning get sharper. Back to milk, sip a little bit, and it helps, but not much.

Now I notice that the backs of my arms are starting to feel a little pained and tingling.

Concern sets in. I wake up the poor Wife and tell her I want to go to the emergency room. She stirs and gets up quickly, alarmed, because this is a highly unusual – make that unique – request from me in our marriage. I say it’s probably indigestion or heartburn, but I’d like to be certain. She wonders if I should call the ambulance. I say, no, we’ll be halfway there by the time an ambulance gets here. She suggests I call Steven.

Steven is our neighbor who works as a nurse in the cardiac catheter lab at the local hospital. I say, good idea, and then since I’m not feeling presentable, take a quick shower, which makes me feel so much better, and I consider canceling the whole thing, until I step out of the shower, and the burning pain hits me again. I ponder whether to wake Steven up at 3:15 in the morning, and then think, well, if there’s ever a time to wake up your cardiac-familiar friend at 3:15 a.m., now is the time.

I call him, and he answers by the second ring, his voice alert. I’m impressed. I explain my symptoms to him, and he says they’re classic signs of a possible cardiac event and to call the ambulance. I say, by the time an ambulance gets here, we’ll be halfway to the hospital. Besides, I don’t want to disrupt the neighborhood at this hour.

So I tell Steven we’d drive there, and he tells me to go to Medical Center of the Rockies, where the cardiac doctor who’s on-call currently is. Its cardiac facilities are superior. And he also tells me that he’s on-call himself, he got back a little bit ago, and beware of the state cop sitting in the median on I-25. Had I been focused on what he was really saying, I’d have realized that Steven had already been out that evening.

And just in case, because you can never be sure, I go to my home office and back up my work so people can find it easily. Then I go back the car out of the garage, and the Wife comes out and orders me out of the driver’s seat, like I’m being stupid or something. And okay, I am.

Now it gets a little more grim. The Wife is driving, and I’m directing her because I’ve been to the hospital complex for meetings, and now my chest is hurting ever more, burning and tightening up, the arms are still hurting and tingling, and clamminess is setting in. Steven had told me, and I knew, that clamminess is one of the prime signs of a cardiac issue. I started contemplating the possibility that I might go into coronary failure right there in the car. I’m feeling bad enough that it doesn’t seem too far removed. As we near the hospital, I call the emergency room and tell them I’m a minute away. They know I’m coming; Steven has called them and paved the way. We get to the emergency room, and they’re waiting. They have me sign a form, sit me in a wheelchair, wheel me to a room 20 feet away, and quickly help me onto a bed in there.

I found out that being in extremis is one sure way to get your mind away from self-consciousness. An aide pulls my shirt off me, tosses a blanket over me, pulls off my shoes, socks, grabs my pants and yanks them down, and is reaching for the final item, when I say, “This doesn’t mean we’re engaged or anything.” Polite chuckles. Another guy starts shaving my chest in spots. No biggie. I just say, “Some people pay good money for this.” More polite chuckles. An oxygen tube gets hung in my nostrils. Another guy is saying, “This is going to be cold,” and starts smacking electrodes on my torso, and yes, they are, but it doesn’t bother me at all. A lady says, “This is going to sting,” and starts shoving needles into my arm, and I can feel them, but they don’t matter much.

I’m asked about pain scale. Where am I at, with zero being no pain and 10 being the worst I could possibly imagine? Well, the worst I could imagine would be burned alive, and it’s not that bad. I thought I broke my leg once, and it’s not as that bad, either, although that was a jarring, sharp bolt of pain, and this is ongoing. Fudge factor for one more thing in there, and so I say 7.

They give me baby aspirin to chew, and then a nitroglycerin pill to stick under my tongue. They say it will taste nasty, and maybe it does, but it’s fine. At that point, I would’ve eaten a bowl of live worms if it would make me feel better. But it doesn’t. Two guys are talking about me at the foot of the bed, and I hear one of them say, “He’s pretty stoic.” Um, no. It’s just that all else pales in comparison to this fire consuming my chest and the thought that my heart might just completely fail anytime. They leave the room for just a few seconds and run the quickest X ray I have ever experienced.

I’m self-aware enough at times to concentrate on breathing and relaxing and trying to control the discomfort that way, and I’m trying to crack some humor in the room in response to their comments and actions, just to try to break tension and get a little positive levity going, but I really can’t get away from being acutely conscious of the tightness and ever worsening feeling in my chest and all over.

A guy shows me a readout of ragged peaks and valleys. “See this?” Well, yeah, but it doesn’t help. And really, I’m ready to hear him say, “We’re going to give you a Tums, you big baby.” But he doesn’t. Instead, he says, “You’ve got a blockage. You’re having a heart attack.”

A blockage. My right coronary artery, which feeds blood to heart tissue itself, has areas of plaque on the arterial surface. If you think of an artery as a pipe, then plaque is the equivalent of grease in the sink drain pipe that can collect on the surface areas. But in an artery, there are living cells under that gunky stuff. In my case, those cells got inflamed and infected, built up an area of pus akin to a pimple and, like a pimple, erupted.

That erupted area then brought in my body’s immune response of platelets and white blood cells, and they were just so enthusiastic about covering up that little area of infection that they piled over it, and kept piling over it, like football players on a fumble, until the artery got occluded, or clogged. Since this is the artery that brings nutrients and oxygen to much of the heart, my heart was getting starved, laboring to get its work done, and starting to falter. The myocardium, or heart muscle, was prevented from getting the things that it needed to keep functioning. So we call it a heart attack, but in my case, the readout said “Acute MI,” or acute myocardial infarction.

Back in the ER, they now give me another nitroglycerin pill to stick under my tongue, which doesn’t taste as bad this time. Nitroglycerin is what they call a vasodilator, so it’s supposed to relax blood vessels so the heart doesn’t have to work so hard to get blood through. But it still doesn’t seem to help. Then they start wheeling me through the halls. By now, with my heart struggling, I’m shaking, chilled, and sweating profusely. They replace some big electrodes on my body, because they’re not staying in place, sliding off with the sweat that’s pouring out of my body.

We get to a room, and Steven is there in his scrubs. He helps move me to a table, saying soothing things to me, and telling me that they’re going to run a catheter up my femoral artery. I ask him if he’s okay with being there, since we’re close friends, and he assures me he’s where he wants to be. I can’t get comfortable. The chest discomfort is consuming me. They move some apparatus over me, which I correctly figure to be for fluoroscopy, and tell me they’re going to give me a lidocaine injection for a local. I feel the injection, and then wonder how it’s going to feel when they incise my leg and go into the femoral artery…

… and I fall asleep and dream. Strange, abstract dreams, with weird-shaped and -colored objects around. I’m vaguely aware of where I am and vaguely grateful that I’m asleep and no longer so uncomfortable.

“Grandpa? Grandpa?” I wake up, and Steven is over me, looking down, looking concerned. “Yes,” I say. He asks, “How are you feeling?”

“Better,” I say, and it’s the truth. He says, “You went into fibrillation. We had to shock you twice.”

After making the cut, the cardiac surgeon had run a catheter, about the diameter of an ink tube in a ballpoint pen, with a balloon at the end,  through the arteries, up into the right coronary artery, to the blockage, and inflated the balloon with water pressure. This crunched the blockage down and allowed the blood to rush through and refill the heart’s blood vessels. The shock of the sudden rush of blood sort of stunned the starved heart, and it went into a spasm, or fibrillation, where it wasn’t effectively pushing blood anymore. At that point, Steven had said, “Grandpa, cough!” because coughing will sometimes start regular rhythm again. I’d responded with coughs, but that didn’t do the trick, and a shock was sent through electrodes they had placed on my torso.

You know how guys on TV arch their backs and jerk when they get the paddles? I didn’t do that. I yelled and crunched up. Almost hit the big ol’ metal fluoroscopy unit. Then my heart started beating regularly again.

But the danger hadn’t yet passed. The right coronary artery also supplies the SA, or sinoatrial, node. The SA node is where the pacemaking function of the heart begins. In my case, the SA node, along with much of my cardiac muscle, had been irritated and upset about being denied oxygen and food and then receiving everything in a flood. So after another minute or two, my heart had again protested and gone into fibrillation. They called for another shock, and Steven very considerately moved the overhead fluroscopy unit away.

Then larger shock ripped through me. Larger shock means bigger reaction. I had yelled and crunched up in response, involuntarily, this time my head flying into the space where Steven had just moved the fluoroscopy unit out of. How much do I owe this guy, anyway? And then my heart had returned to normal rhythm, this time for good.

However, all that stuff I just told you about the shocks? I remember none of it. During the procedure, the team ran the drugs Fentanyl and Versed through my IV lines, for their painkilling and sedating effects. The Versed also worked as a short-term amnesiac. The sensations of the catheterization, Steven telling me to cough, and the shocks and my reaction are gone from my memory. I’m sure I felt them. I hope I wasn’t a wuss. Because I have not a hint of memory of that, even after being told about them later. It’s quite strange to have a fairly continuous memory of what went on at that time, only to later discover significant gaps in that continuity.

Back in the room, Steven continues. “We put a stent in your coronary artery.” They could’ve put in the Eiffel Tower for all I cared. The relief was dramatic.

And the relief has stayed since. I had inconsequential superficial results. A few sore spots at the IV ports. Tenderness around the hole where the catheter was run into my femoral artery, and where it had bruised from my crunching up when I got zapped. A somewhat sore burn mark from the defibrillation shock; again, my sweatiness had unfortunately kept one electrode from making great contact on my skin, so it arced a little and created a short-lived first degree burn, or maybe two on top of each other. But all in all, I felt good enough to go home right then, if they’d have let me. But they weren’t inclined to do so just then.

This all had occurred before the sun was up. Through the rest of that day, I had constant monitoring, a frank and informative update by the good doctor and attentive care by the nurses. I was doing great. I believe they were surprised with how good I felt and, after I was allowed to move around, probably a little annoyed with my activity walking around the halls for something to do.

When the good doctor came in the next day to give me The Talk about the pathology of the heart attack, the treatment, and the drugs I’d be placed on at least for the short term, he explained troponin values to me. Troponin is a group of proteins present in skeletal and cardiac muscle fibers. When cardiac tissue is stressed or damaged, the cardiac muscle fibers release certain troponin subtypes, troponin I and T, and the presence of those compounds in the blood indicates to the doctor a level of damage to the heart. I’d had an acute myocardial infarction and a couple shocks. A value of 100 wouldn’t be surprising and would indicate damage that would call for post-treatment therapy. But in my case, the troponin value peaked at 2, or almost no damage. My heart had endured and recovered remarkably and unusually well.

The good doctor also explained the stent in my coronary artery. A stent is a latticed metal tube that’s placed in the blood vessel to prop it open. In my case, he used a “short, fat, unmedicated” stent, and after I asked if he was talking about me or the device, he explained that it was really an optimal configuration to have to use. It would result in the quickest healing and a shorter medication regimen.

So presumably based on my good vitals, the great troponin test results, and the smoothness of the procedure, he finished our discussion with, “Do you want to go home?” “Yes, please.” “Okay, you can,” in his matter-of-fact, good-natured way. And I was out about 24 hours earlier than their customary 48-hour wait-and-observe period.

That’s the story of my brush with death. But here’s what I want you to take away from all this:

This was no walk in the park. This was probably the worst I’ve ever felt in my life, including the measles, mumps, and chicken pox as a child, and activity injuries throughout my life. Trust me, kids: You do not want to go through anything like this, feeling completely horrible and not knowing if you’re even going to live.

I was not a risky candidate for heart disease. There’s no history, to my knowledge, of cardiac disease in my family. I don’t smoke, never have, not a puff. We eat a lot of healthy food – fresh vegetables, whole grains, fish, skinless chicken, ground turkey, fresh vegetables, cook with olive oil. My cholesterol numbers have been fine at times, somewhat elevated others, but never alarming. My friends and family know that I carry some extra weight, but immodestly, I’m a decently well-muscled guy, a grandfather of five, who does pretty good at my age. Some people are higher risk for this than others, but this can happen to anyone.

If you have signs of a heart attack, call for an ambulance. I could have saved myself 15 or 20 minutes if I’d analyzed this correctly. Since the ambulance has EKG equipment, they could’ve made the call on the ambulance as they rushed me in. Instead of going through ER evaluation, I would’ve been rushed straight to treatment. “Time is tissue.” When you’re having a heart attack (or any other emergent event, for that matter), you don’t want to get stupid wasting time, like taking a shower or taking yourself to the hospital. Call for the ambulance and let them take over.

Do the right things. Yes, some people live to be 80, smoking, being sedentary, and eating the wrong things. And then some active, fit, disciplined people die of heart disease in their thirties. Let’s not live by exception. When you eat right, when you exercise right, and when you don’t smoke, you cut down the risk that this is going to happen. I was unlucky, in terms of risk factors, to have this happen. Well, now I realize that I’ve got this whole plaque-and-infection process in my body that happened once, could happen again, could kill me, and you better believe that I’m going to have renewed efforts to not let it.

I have a wonderfully supportive and caring group of family, friends, and colleagues. I posted my status on my Facebook page (again, from the hospital room, amusing and annoying my friends), and the responses were plentiful and sympathetic. A number of friends came to visit me during my short stay in the hospital. The family circle tightened around me in comforting and concerned fashion.

During my short hospitalization, I was asked, of course, “How are you doing?” My standard response was, “I feel good about seeing sunlight stream through the window.” There’s no doubt about it. I’m lucky to be alive. I have Steven, the good doctor, the great people in the ER and cath lab, and our current technology to thank for my being alive today. But also, the pain (and horrible expense) of the experience aside, I’m lucky to have gone through this.

We all live each day with no assurance of there being a tomorrow. I had a peek into how precious each day can be. I know how much life is to be treasured, how much the love of family and friends means, and why we should do the right things to eke out the wondrous value from the time that we have.

I’m lucky to have had that epiphany. Now it’s up to me to make the most of it – as it is for all of us. No, I’m turning all health-nut or evangelical. I’m just here to tell you that life is eminently worth living. Please, kids, please value it so.

— Grandpa

Comments

  1. i remember when i got the news u had a heart attack!!! i think my heart stopped for a second!!! 🙁

  2. Well I hope what I was typing before my Sisi hit the keys on the keyboard did not go through..

    You are so very loved! We all are very pleased with the positive outcome of such a huge life altering experience. This made me cry as much as I did when I received the phone call… Well after I hung up with my dearest friend reassuring her that her daddy was strong and would pull through!

Trackbacks

  1. […] the heart attack chronicled elsewhere in this blog. If you read it, then you’ll remember – well, no, you probably wouldn’t remember, and why […]

  2. […] chronicled in “The Day of the Heart Attack” nearly six years ago, back in May of 2011, I had awakened in the 3:00 a.m. hour of the […]

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