Sunday, October 21, 2007

What the cardiologist said

I had an appointment with a new cardiologist last Friday (the 12th). Why a new one? Because the old one is in Cape Town, and plane tickets aren't covered by my medical aid. It was a bit strange, the procedure was completely different to what I'm used to. I was first asked to get undressed and put on some boxers that were supplied.

Then I sat in a second waiting room, for the semi dressed people. When the ECG lady was ready for me she asked me to stand on a scale, 75kg. Then she asked me to stand in front of her while she stuck conductive electrodes all over my chest. Once she had wired me up to the ECG machine she asked me to sit, instead of lie on the bed, which is what usually happens. It showed my heart rate as 57bpm, which is lower than I expected.

Having removed mercifully little chest hair, I was sent back to the waiting room to wait for the doctor. He then asked me the usual questions: Do you smoke? Drink? Family history of heart conditions? When were you first diagnosed... blah blah blah. I'm not sure I gave him the full picture as I'm so over all that, and he didn't seem to ask all the correct leading questions, hopefully he requests my file from my previous doc.

Once he had got enough history he asked me to lie on a bed while he recorded what he remembered me saying with a dictaphone, presumably for later typing by a secretary. He then listened to my heart, took my BP, checked my ankles for swelling and then listened to my lungs. We then went to the echo machine and he did an echocardiogram. Checking the size of my left ventricle and my ejection fraction.

The good news is that there are marginal improvements in both these measures of cardiac function. That could be due to measurement error, or an actual improvement in my cardiac function. I have some recollection that the last time I went to my Cape Town cardiologist, he said the same thing, that there was a marginal improvement but it is difficult to say whether it is a real improvement because it is such a small change. It's unfortunate that my appointments are so far apart and that I have no personal records. But if my recollection is correct then 2 small improvements make 1 bigger improvement, so maybe I am seeing some real improvements in my condition. My ejection fraction is currently 36%.

The doctor also asked for me to have some blood tests to check some chemical markers that are indicators of heart failure. What they are exactly I'm not sure. I also got myself sorted again for monitoring my INR, that's the thickness of my blood. I have had a pretty constant dosage and have been really lazy about having blood tests lately. Not because I don't like having them, but because, firstly there are no fixed dates for the tests, and secondly because the nurses at the clinic where I last had a blood test seemed really disagreeable.

The problem, which I am very aware of, but have been shoving to the back of my mind, is two fold. If my blood is too thick then a clot could possibly form, getting stuck anywhere in my body, including my brain, which could cause a stroke. So it's a good thing that I'm having it monitored correctly once more. It does mean that there are numerous regular blood tests that I need to have in the near future.

I asked what the doctor thought of me running regularly. He said as long as I wasn't racing it should all be good. As soon as you start competing with people you stop listening to your body and can do some serious damage.

He also said that I may need to consider having an ICD installed. ICD - Internal Cardioverter Defibrillator. I will write an article about what that is soon. He says that they are indicated (that means suggested or necessary) for patients with ejection fractions under 35% so I am very much on the cusp. Because it is invasive and visible, and because I am young, he said we will avoid it for as long as possible. Personally I don't think I need one, but perhaps as time goes on I will.

All said the news and prognosis is good and I should live healthily at least until my next appointment in 6 months time.


Marli said...

wow... that's quite the mouth ful. But I'm glad you'll be around for at least another 6 months...!

Pharmy said...

Wow Mark! I had no idea that your EF was 36%. Take it easy when you train! But if there's already improvement on your medication, let's hope those ventricular muscles improve even more!

Love Pharm