December 30, 2011, is a day I’ll never forget. After a long week of work, I was home on Friday evening, enjoying a favorite after-dinner treat of vanilla ice cream topped with frozen blueberries. It had been a stressful work-week, with more hours required than usual, and I was looking forward to a quiet relaxing evening with a sci-fi novel. I was also pondering the upcoming wedding of a friend that my wife and I would be attending New Year’s Eve. I had eaten six spoonsful of dessert when it happened; my pulse rate took off like a racehorse, hammering fast and erratically. I immediately laid down on the couch to wait for my wife to return from a baby shower so she could drive me to the hospital. I couldn’t believe this was happening given how fanatical I was about taking care of my health.
I’m a clinical exercise physiologist by profession and have managed cardiac and pulmonary rehab programs for the last nineteen years. I’ve taken care of thousands of clients with various heart conditions, including many with heart arrhythmias like the one I was now feeling. Based on my clinical knowledge, I concluded that I was either experiencing Supraventricular Tachycardia or fast atrial fibrillation and hoped desperately for the former. After laying on the couch for ten minutes with no change, I decided to try something called vagal maneuver to see if that would stop the arrhythmia. I held my breath and bore down like having a bowel movement, but nothing changed. I also knew that having ice water thrown in a persons’ face was sometimes effective in converting the pulse rate back to normal. I considered taking a cold shower but was so dizzy by that time I was afraid I would pass out if I tried. I was also beginning to have mild chest pressure along with a constricting feeling in my throat and was apprehensive about getting off the couch. I considered calling my wife’s cell phone but didn’t want to alarm her, so decided to just “ride it out” until she got home. She arrived twenty minutes later to find me standing in her garage stall. I quickly climbed in the passenger’s seat of her car and told her she needed to take me to the hospital.
On the way to the hospital, my clinical training overrode my common sense. I made a split-second decision to have my wife take me to my office first. We had a telemetry monitor in our department that I could attach myself to so I could see what was going on. The department was also easy walking distance from the hospital emergency room – for someone not having heart issues! I hooked up and saw a pulse rate of 180s, too fast for me to tell if it was Supraventricular Tachycardia or fast atrial fibrillation. I quickly printed out some of the readings to take along to the ER. My symptoms were unabated since starting, and I had already decided I was not fooling around with an extended wait in Admitting! I walked gingerly with my wife to the ER and presented my printouts, my name badge, and my insurance card to the attendant, making sure she was crystal clear regarding my symptoms. Inside of five minutes, a triage nurse came out, took my information, and admitted me to an ER bed. After I was hooked up to the telemetry monitor, and my nurse started an IV, the ER doctor came in and reviewed my heart rhythm readings. He confirmed my fears; it was fast atrial fibrillation. Having had the opportunity to work in cardiac rehabilitation programs in three states, I’d had many clients share their experiences of atrial fibrillation with me. Recalling those stories with clarity, and being well versed in standard treatments for atrial fibrillation, I knew what was coming next.
Fast, symptomatic atrial fibrillation treatment starts with the administration of an IV calcium channel blocker medication. I was given Cardizem; it felt like ice water running through my veins. Cardizem produced no change, so it was on to drug #2 – IV Adenosine. I knew from my Advanced Cardiac Life Support training that Adenosine was used to “reset” the heart back into a normal rhythm, and had to create a ‘pause” of the heart for this to occur. The nurse quickly dispensed it, and time frighteningly stood still for a couple of seconds… then my heart decided it preferred atrial fibrillation. Two drugs down and no results – time for IV Amiodarone, an anti-arrhythmic. Once this was started, the cardiologist on call stopped by to check in and tell me I was being admitted to intensive care. I would be kept overnight to see if Amiodarone running continuously all night would kick my heart back into its normal rhythm. If not, I would be scheduled for cardioversion (electrical shock) first thing in the morning. Fortunately, at 5:15 AM that next morning after a sleepless night with much prayer, my heart slipped back into a normal rhythm. I was discharged shortly after with orders to begin taking a full aspirin once daily.
I wish I could say that everything has been great since then. Unfortunately, I’ve had several more episodes. In four instances, I chose not to go to the hospital, and just stayed in bed until the occurrence passed. One of those happened while vacationing with my wife in Costa Rica. I had been having a relaxing soak in a mineral hot spring for about three hours when my “friend’ decided to pay me a visit. I climbed out of the pool, cautiously walked back to my room, dried off and climbed into bed. There was no way I was going to test out the Costa Rican health care system with my “Spanglish”! With four other episodes, I did go to the hospital, receiving the previously mentioned treatment coupled with cardioversion. Twice the cardioversion worked, twice it failed. Another handful of episodes lasted two hours or less, resolving on their own. After the most recent episode in 2015, I opted to follow my cardiologist’s recommendations and have a radio-frequency ablation. The procedure was successful, but I experienced a recurrence a few days later requiring re-hospitalization, which happens in some cases. It took four months to completely recover from the surgery, which I hadn’t anticipated. I experienced foggy thinking for several months, but that has finally subsided.
Over the last five years, I’ve learned a great deal more about atrial fibrillation on a personal level than I ever knew from a professional perspective. Experience has taught me that exposure to hot showers, hot tubs, and eating and drinking cold things like frozen treats and iced drinks are no-nos. Even though I’ve had the ablation, it’s very possible that the atrial fibrillation could return. My body seems to have an internal timer; regardless of whether I have drugs, cardioversion, or do nothing, the atrial fibrillation converts back into a normal rhythm after 8-10 hours. I like to work out intensely, but haven’t until about two months ago, due to fear of triggering another episode. I can feel when one is about to start – I have several “extra” beats at one time. I have a few extra, and a few skipped beats daily; each time they happen, I’m reminded that I’m probably not out of the woods, and suffer some momentary anxiety. I’ve been afraid to watch some of my favorite sports teams play, for fear my excitement will trigger another event. My condition’s in the back of my mind often. It’s hard to accept that regardless of how closely I monitor my exercise, diet, and exposure to hot water and cold foods/drinks, I’m not in control. Prayer has helped, as well as talking to other sufferers about their experiences on Reachout. I believe my situation has made me a better clinician, now having a personal connection to individuals with this disease. I’ve developed a deeper understanding of what they’ve gone through and greater compassion for how it’s affected each of them. Some days I ask “why me,” but those are growing fewer as I hear about more friends and family being diagnosed with this condition.
Atrial Fibrillation is scary because it’s so unpredictable. More and more people are being diagnosed and are having to learn to live and cope with the disease. I feel fortunate that my condition is currently well-controlled. Having a cardiologist that I can “partner” has been a big plus. It also helps to have support from a close friend and a parent who both know what it’s like to live with atrial fibrillation. I hope, given my personal experience and professional background that I can be a resource for those who have questions and fears about atrial fibrillation.