MY HEART STORY by SCOTT POPJES
As I made my way from the kitchen back into the den my heart suddenly started to race, and a sudden tightness in my chest and shortness of breath, quickly followed. I had grown accustomed over the years to the palpitations associated with PVC’s (Pre-Ventricular Contractions), but unlike PVC’s, which were usually isolated to one or two beats, this racing rhythm kept going. It wasn’t long before I became lightheaded and my vision started to tunnel, like I was looking at the world through a paper towel roll. I leaned up against the wall in nervous anticipation of what would happen next.
My heart “story” didn’t start at that moment. It started about 24 years earlier when, during a high school basketball physical, a heart murmur was detected. After seeing multiple doctors and having multiple echocardiograms (ECHO) I was diagnosed with mitral valve prolapse (MVP). This discovery ended my high school athletic pursuits, but at the time no other limitations were placed on my activity. I continued with an active lifestyle – weight training, racquetball, pickup basketball games, softball, flag football.
Reflecting back now I can remember having a random fluttering feeling in my chest, a sensation similar to what I imagine butterflies would feel like flying around inside my chest. But it happened infrequently and I didn’t think much of it and didn’t say anything about it. For more than 5 years life went on.
When I was 22 my dad was diagnosed with Hypertrophic Cardiomyopathy (HCM), a genetic heart disorder that affects 1 in every 500 people. Once my dad was diagnosed, it was recommended that I stop my strenuous activity and get screened as soon as possible. So off to the doctor I went, and sure enough, since that initial diagnosis of mitral valve prolapse in high school my septum had thickened and I was diagnosed with HCM.
Even though I experienced no noticeable symptoms associated with HCM my lifestyle changed. It had to or I would run the risk of a symptom of the disease: sudden cardiac death. So no more burst activity. No more competitive sports. Shortly after the diagnosis, my cardiologist recommended I enroll in a research study for HCM that was underway at the National Institutes of Health (NIH) in Bethesda, MD. And for a number of years I made an annual trek to Bethesda to be examined – Electrocardiogram (ECG), Chest X-ray, ECHO – and given medication. At the time there was never any mention of me needing an Implantable Cardioverter Defibrillator ICD.
I remained asymptomatic and lived a reasonably active lifestyle for the next 3 or 4 years. I moved to California for career pursuits and everything seemed stable. Then, while driving home from the gym with a friend, my heart started to race, I became short of breath and my vision started to tunnel. I immediately pulled over and my friend summoned an ambulance. They took me to the hospital and after a few hours of monitoring and observation I was released. California was a very long way from the NIH in Bethesda so I immediately contacted a cardiologist / electrophysiologist who had been recommended to me. The doctor arranged for a holter monitor for a few days. As a result of the monitor it was determined that I had Supraventricular Tachycardia (SVT) and Atrial Flutter, rhythm abnormalities, but not the dreaded ventricular tachycardia.
For a few months I tried medication to control the SVT and atrial flutter. But it didn’t fully suppress the irregular rhythm. The next step was a radiofrequency ablation for Atrial Fibrillation (A-Fib). That procedure was a success and everything went back to normal… for a while.
About 9 months later I started to have more palpitations and a racing heart beat. Once again, I was put on a holter monitor. This time the results were different. It showed episodes of ventricular tachycardia (V-Tach), a much more serious concern. At that time I was given two options, medication or an ICD. Due to my family history and risk stratification I was a candidate for an ICD. But the thought of having the device implanted in my chest was a bit frightening. The only other option was a potent anti-arrhythmia drug called Amiodarone. So after some discussion my doctor and I agreed to try the Amiodarone.
While the Amiodarone was effective in keeping my heart stable, it’s potentially toxic side effects gnawed at the back of my mind. Over time the drug can build up in a patient’s system and start affecting the liver, the eyes, the thyroid. I was still young and realized I’d have to be on this drug for the rest of my life. I couldn’t help but wonder what that kind of exposure could end up doing to me. Would the side effects over time be too great? I also couldn’t help but think about having an errant rhythm that the drug couldn’t control. If that ever happened there was no other “safety net” that could prevent sudden cardiac arrest. I was beginning to think that this drug was not the ideal long-term treatment plan for my situation.
By late 1999 I became more comfortable with the thought of getting an ICD. More and more, it seemed like the best long-term choice for me. The decision was made and in December 1999 I had my ICD implanted. And almost 8 years later, on that Friday evening in 2007 I was happy I did.
As I slid down the wall to the floor with my heart racing and my vision tunneling, I called out to my wife and braced myself for the ICD shock I was certain was about to hit me. But it didn’t come. Instead, smaller “pulses” known as ATP delivered pacing therapy to my heart as the first level of defense against a dangerous rhythm. Within seconds my heart rate returned to normal and the symptoms disappeared. My wife was already on the phone with my doctor’s office, and shortly thereafter I transmitted the data from my ICD using my Medtronic Carelink remote monitor. The episode was confirmed as V-Tach at a rate in excess of 200 beats per minute and that it was terminated by the ATP therapy. That day I was thankful that I had the ICD implanted in my chest, because without it the outcome may have been very different.
It’s now 2013 and I have had an ICD implanted in my chest for almost 14 years. I live with the peace of mind of knowing that if my heart ever does go into a dangerous, irregular rhythm that my ICD will do its best to correct it and keep me alive.
Screening through echocardiogram detected the HCM and made me aware of my heart disease. Careful monitoring detected the potentially life-threatening rhythms and led to me having an ICD that has since intervened and probably saved my life. While the journey hasn’t always been the easiest (open heart surgery, inappropriate ICD shocks) it’s nothing compared to the consequences of having a heart condition and not knowing about it until it’s too late.
Get screened. It’s easy, it doesn’t hurt, and it only takes a few minutes of your time. And who knows, it may end up saving your life.
EARLY DETECTION SAVES LIVES FROM SUDDEN CARDIAC ARREST (SCA)
HEARTFELT CARDIAC PROJECTS
PROVIDES AFFORDABLE HEART SCREENINGS TO THE PUBLIC
Heart Murmur: http://www.nhlbi.nih.gov/health/health-topics/topics/heartmurmur/
Hypertrophic Cardiomyopathy (HCM): http://hcmny.org/whatis/
Echocardiogram (ECHO): http://www.nlm.nih.gov/medlineplus/ency/article/003869.htm
Electrocardiogram (EKG): http://www.nlm.nih.gov/medlineplus/ency/article/003868.htm
Mitral Valve Prolapse (MVP): http://www.mayoclinic.com/health/mitral-valve-prolapse/DS00504
Supraventricular Tachycardia (SVT): http://www.emedicinehealth.com/supraventricular_tachycardia/article_em.htm
Radiofrequency Ablation for Atrial Fibrillation (A-Fib): http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=348
Implantable Cardioverter Defibrillator (ICD): http://www.nhlbi.nih.gov/health/health-topics/topics/icd/
Amiodarone (Drug): http://www.drugs.com/amiodarone.html