Since my doctor was not in, I went to the walk in clinic. Six months previously, I went to this same clinic for a swollen right leg on a Friday, and the next night, when I was attending Carmen at the Detroit Opera Theatre, they called me to rush to the emergency room for a possible blood clot based on a mildly elevated D-dimer blood test, see https://en.wikipedia.org/wiki/D-dimer (which I did not do). Back to the present, they took my history, did a short exam, ordered an EKG, and then all hell broke loose.
The EKG indicated:
ST elevation, consider inferolateral injury or acute infarct
** ** ACUTE MI / STEMI ** **
I did not think I was having a heart attack. I had no symptoms. The rib pain was from my mattress, at least in my mind, although I don't think anyone believed me. But it also had none of the characteristics of heart attack pain (it was dull and constant, exercise did not make it worse, etc.). Other than being 59 and male, I had no risk factors for coronary artery disease. I am thin (BMI 21-22), a bicyclist (100-150 miles per week in season), vegan, with a low blood pressure (usually 105/65), good LDL (83), good HDL (54), no diabetes, no smoking, no alcohol. I told them I did not want a cardiac cath. The first blood test for heart damage (troponin) was negative, which made me more confident. They did a bedside chest Xray which showed bilateral pleural effusions (fluid at the base of both lungs) and an enlarged heart shadow (abnormal, cause unclear). The D-dimer blood test done today was more elevated than the last time, so they were worried about a pulmonary embolism (blood clot), although I had no blood clots elsewhere in the body. A second troponin test was also negative.
A chest CT gave the diagnosis of a pericardial effusion, fluid surrounding the heart due to an inflamed pericardium (acute pericarditis), which is the membrane lining the heart. This is usually due to a virus, but as in my case, the cause usually cannot be determined. The virus causes inflammation, which causes fluid to accumulate. The danger is that the fluid can press on the heart, and prevent it from beating normally, a condition called cardiac tamponade. At that point, it was clear that a cardiac cath was not indicated, and I was transferred to the ICU for monitoring, which happened Thursday morning at about 12:30 am.
In the ICU, I was hooked up. An IV is mandatory (two is preferable but I had "bad veins"). There was also a "pulse ox" (a monitor attached to a finger tip to measure the amount of oxygen in the blood), a blood pressure cuff that inflated automatically, and a cable attached to electrodes taped to my chest, to monitor my heart. Then it was time to sleep! At this hospital, every room, even the ICU, is private, and has its own bathroom and shower. They allowed me to use the bathroom and not a bedpan. I just had to disconnect the 3 cables, and bring the IV pole (which had wheels) with me.
On Thursday morning at about 9am, I had my first echocardiogram, an ultrasound of the heart. The cardiologist said I had a large amount of fluid surrounding the heart, although the heart wall and the values themselves were fine, with no evidence of any damage. However, the amount of fluid appeared to be mildly affecting the function of the heart, so it would have to be tapped, which could be done today or tomorrow. Tapping means sticking a needle in the chest next to the heart, to drain the fluid. The risk was low (~ 1% complication rate), particularly because there was so much fluid. Today or tomorrow: I chose tomorrow. They would monitor me until then. Since I am not great at sitting around doing nothing, I changed into my street clothes, set up an "office" and did some work. Then I walked around the ICU with my IV pole, and one of the male nurses had a hissy fit: "This is so inappropriate - you should not be in the unit", he started to rant. I ignored him. Later that day, Rachel and Sam visited and brought food. Others visited too, which lifted my spirits, although hospital visits are quite tiring. I ordered off the hospital menu - the food was pretty good. For the pericarditis, I was given high dose aspirin (2 regular aspirins every 6 hours) plus colchicine, an anti-inflammation drug used for gout. I went to sleep thinking about tomorrow's tap.
On Friday morning, I had my second echocardiogram. The fluid had lessened, and the cardiologist indicated the tap could wait. I would be monitored over the weekend, and could be transferred to a less intense unit The IV was kept in, but was disconnected from the IV pole. The pulse ox and the automatic blood pressure monitor were discontinued. That afternoon, I walked with a staff to the telemetry unit, which had a similar room, but a smaller nurse to patient ratio. I was seen by cardiology Saturday and Sunday morning. On Sunday morning, I had a third echocardiogram, which showed continued reduction in fluid, and they agreed to discharge me. I had gained an additional 9 pounds in the hospital (confirmed on my doctor's scale at home). At about 12:30 pm, I stepped outside, waiting for Leah to pick me up. Then I "lost it" for a few minutes.
I am now taking aspirin (only 325 mg every 6 hours) and colchicine, with a repeat echocardiogram and cardiology visit in 2 weeks. I was told to "take it easy", which to me means no bicycling (except short easy rides), no fast walking and no weights at the gym.
I am no longer "shaky" due to the experience, but it's hard to believe a week ago I was in the ICU.
There are probably some life lessons from this experience. Here is what I have compiled to date:
1. Exercise, eat healthy, stay thin, and follow your doctor's advice (when rational), and be in the best health you can be. It may not prevent all problems, such as I had, but will probably limit the damage when they occur.
2. Replace your bad mattresses.
3. Make sure you have a working digital thermometer, and your over the counter medications are not expired.
4. Being in the ICU, or perhaps being sick in general, is when you most need (want) a significant other. I am not sure what to do about this - for me, dating is quite miserable.
5. Make an extra effort to stay on good terms with your family members and friends.
6. My personal philosophy is to delay procedures if at all reasonable. I avoided two procedures that turned out to be unnecessary. Perhaps they would have gone well, but you never know.
7. If you are rational in crisis situations, use your brain and ask questions. In general, medicine should make sense. If you are not rational (or are always right, or know everything), listen to your doctors and hope for the best.
8. Pack a "personal bag" for emergencies, with toiletries and clothes for a day, for someone to pick up for you if needed.
9. Count your blessings - you never know when things will get much more difficult.
- Nat
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