I could hear the birds softly chiming in the new morning but my attention reverted to throbbing pain in my neck and head. Just another morning dominated by flagrant nerve responses to deteriorating discs. I eased myself from bed, first legs and feet, then pushed up with hands until I was upright. To the bathroom cabinet for a last pain pill though it was 50% effective, if that.
Want to get this under control before the nuclear stress test in a few hours. Hope I can get more sleep.
But my heart must have heard that thought, as its earlier steady rhythm began a rapid increase on the way back to bed. I lay down a few moments; it rushed onward. I pressed the carotid artery on the left side of my neck to verify what I already knew.
Tachycardia…not now! Quiet, heart, keep things running well so I can rest another two hours.
I resurrected meditation breathing, those slow, metered breaths in and out that can (somewhat) help control a rapid heart rate. After what seemed a long while, the heart rate calmed a bit, fell from around 130 beats per minute to around 90. I turned over, relieved. I thought it must have been the sudden movement from bed to bathroom to bed, as sometimes–not for a couple years, however–the motion from happy repose to ambulatory action can set my heart roaring. Temporarily, mostly. I plumped up my pillow and smoothed the pillowcase.
Rest. I need to be ready in a few hours for that test.
I had had unusual chest pain three weeks prior. A nuclear stress test had been scheduled after an emergency room doctor determined it would be wise. Since I’ve lived with coronary artery disease for well over a decade, I don’t wait too long to get help but neither do I believe all arrhythmias (irregular heart rhythm) need to elicit panic. All had turned out well enough that day but the attending doctor decided it would be helpful to obtain more complex images of my heart’s inner workings. We would see what the arteries were up to fourteen years after two stent implants.
I hadn’t been thrilled about the upcoming procedure. I couldn’t explain why. I have had plenty of stress tests involving treadmills and ultrasound but not a nuclear test. There is always some risk. I had been in the hospital at least a dozen times over the years. Yet a feeling of unease about this time hovered in my consciousness.
Was I just anxious, was that the issue? Be calmer, I told myself.
The anvil of pain in my head didn’t help. But it failed to keep my attention as my heart began once more to race, the heartbeats to gather more speed each second. Then decreased. It was an internal equivalent of a siren becoming very loud and then becoming quieter, up and then down, over and over. It was getting tiring. I was breathless and dizzy.
What irony! A heart stress test in a few hours and I am having unpleasant heart stress right now…It has to be not taking my beta blocker for over 30 hours in preparation for the test, right? So I have a galloping horse of a heart now…what now? My life is always in Your hands, Lord.
I reached for my phone as the heart rate cranked up once more. Dialed 911.
The fire engine came, then the ambulance with EMTs and they hooked me up for an EKG as they encouraged me to go to the hospital. But I hesitated. Did I really want to go to emergency again? I had a big bill from last time. My heart was settling down. They stood in my living room with arms dangling, patience their strength as much as medical skills. I knew this: they wouldn’t advise otherwise, especially when you are a heart patient. We headed out to the hospital where my cardiologist practices.
On the way to the emergency room I glanced out the back windows at a man driving an SUV. He looked at me, I, at him. What is that man thinking about? Being late for work? An important dinner date later? Is he wondering what I am doing in the back of this ambulance, grateful it isn’t him? I was wondering why I was there, too, as my heart rate was getting closer to livability again.
At the emergency room, I insisted, “It has to be the absence of the beta blocker, I had to discontinue it about thirty-two hours ago for a nuclear stress test appointment later this morning. It was intense. But I’m not sure why I’m here now.”
It bothered me, the time it was taking, the money it was costing, my heart seeming less imperiled. I worried about missing the nuclear stress test across the street at my cardiology clinic.
The energetic nurse with short blonde hair positioned more adhesive patches and wires to me chest and legs.
“Those beta blockers are powerful, so could be, but you never know for sure until we can check you out. We’ll get you fixed up here. Better to be here than in trouble at home.”
My beta blocker medicine ordinarily has this wonderful power–it slows and steadies heart action so I can live a life that is as close to normal as I can likely get. I had not been off it for fourteen years until this occasion.
Things did not get better just because I was in the emergency room. It was overcrowded as they were remodelling. The patient next to me had severe abdominal and stomach pain with nausea. Strangers poked their heads in and out. There were needles that finally found my veins. The heart monitor showed every little variance and I tried in vain not to watch.
I did not want another procedure; I wanted to get up and leave. My chest was alright so far, high blood pressure was coming down and heart rate was no longer threatening to take me under. Further, I wanted my head and neck pain to stop but there it was, the one constant in the background.
But it was determined I would have the nuclear stress test in the hospital. I would be admitted, likely.
“I want to get up and just walk over to my cardiologist’s office now,” I insisted. “I can have my test there. They’re expecting me. I’ll have to cancel it if I don’t go now.”
“I cannot advise your leaving the hospital; you have had significant tachycardia; you have heart disease. But you can choose to leave as an adult, of course,” a pressured, kindly doctor stated.
My sister arrived. After some discussion it was decided I would stay. I was already there, and more answers were needed to evaluate the state of my heart health. I cancelled my appointment with apologies which the receptionist seemed to find odd. Maybe I was operating from an altered state; things did feel a bit askew. Adrenalin, maybe.
My spouse was on a business trip in Mexico and it seemed he was in another galaxy. I texted him and he said he’d get a flight as soon as possible and he was praying for me. I was notified of the stress test since my heart rate had stabilized.
A nuclear stress test is generally deemed safe but has potential, if rare, complications including, per Mayo Clinic info: allergic reaction to the small amount of radioactive dye given intravenously for imaging; abnormal heart rhythms; heart attack; flushing sensation in upper body and head and/or chest pain. A substance called an arterial vasodilator is administered to patients when unable to use a treadmill; this chemically increases stress on the heart for data gathering. It dilates arteries to allow more blood to flow to and from the heart, which also allows for good images of the heart muscle as well as arteries.
The first part was simple and easy. I was injected with radioactive dye; it seemed strange that something we associate with deadliness was not even noticed. The amount was no more than when one has an X-ray. Images were taken for twenty minutes without any heart stress. Th stress part came second, when my heart was to be agitated by medicine in a way that exercise might. More images were then to be taken.
And then, as the vasodilator medicine was infused into my arm, I developed sudden, intense tachycardia, a thunderous, chest-pounding very rapid beat that was so fast it nearly took my breath away. In a few more seconds I felt as if I was starting to detach from my body.
This is what I was afraid of, I realized, and that I might have a heart attack and die.
“I am having trouble breathing. My chest hurts,” I told the attending cardiologist who was not, unhappily, my own. She was studying the EKG monitor.
“It will peak and fade in a minute or so, the heat and discomfort you are feeling is normal,” the technician reassured me.
“I don’t think so,” I said. It was getting harder to breathe, my chest feeling heavier, the ache deepening, spreading. “The pain is worse.”
Lord. Help. Breathe. Lord.
“Reverse vasodilator now!” the doctor commanded. “This tachycardia isn’t relenting, EKG shows …other signs. Cancel the last imaging set for now.”
She instructed another drug be injected. And in less than a minute the “reversing” medicine was spreading throughout and my heart rate quickly slowed. The pain receded, leaving a tender feeling. My head hurt more. It was as if I had been pounced on by a giant, ravenous cougar, my adrenalin wiped out in less than a couple of minutes, and then that cougar melted into the sun streaks that filled the room. It was as if a dream. But I felt unable to move, despite reassurances. I had seen terror again and it had left traces behind even though my heart rate magically returned to normal and the chest pain finally was erased.
I felt as if I had been having a heart attack all over, like that afternoon when I had been hiking in the forest, climbing up ancient railroad ties that led to another pristine waterfall, each step suddenly impossibly hard as I climbed, my chest crushed by an enormous, formless weight, mind numbed, spirit overtaken. The agony of it. I closed my eyes.
It’s over, Lord. I’m okay for now.
“Even without the rest of the nuclear stress test I would admit you to hospital. I need to find out more after that,” the cardiologist informed me and then left.
I rested for an hour, then returned to have the second set of images taken, as my heart was still stressed, so more could be documented.
The hospital admittance was for the next-day angiogram, which requires cardiologists to enter a femoral artery with a tiny camera to look for any blockages or other anomalies. The doctor wanted to see if there was anything further to be addressed, due to the response I had during the stress and the earlier tachycardia. I had had six of these before; I was not worried about this test, but I could not sleep. The headache was by now a familar, like a shadow of myself. I was given more pain medication which did nothing. But with relief I resumed beta blocker medicine to help my shaken heart pump steadily.
I wasn’t hungry. I waited through the night between doses of light sleep, wondering what the new day would bring. Prayed. “The Lord is my Shepherd, I shall not want…” Lay on cool white sheets listening to the music of my heart, thinking of my husband far away in a land I didn’t know at all. Thinking of my children and grandchildren, the shapes of their faces, the designs of their lives. My heart stayed tranquil, as if telling me it had already endured this long and rather much; it could endure longer, more.
The angiogram felt like old home week. I relaxed and chatted with the nurses, feeling the haze of an anesthesia that left me conscious yet with little memory when done. I floated while they worked.
Someone said. “No new stents today…lack of beta blocker likely provoked tachycardia….extreme response to vasodilator…”
When I awakened fully I wondered if what I had heard was right. I was hesitant to to hope all went well.
“Yes, that’s what the report says,” a chipper, brunette nurse confirmed. “I think you’ll be home by evening.”
She read me the rest of the report but I had no interest. I could go home again after two days of confusion and fear and relief. My son came to get me. I looked terrible, wan and dishevelled and exhausted but he hugged me and told me he loved me and we left.
When my husband arrived at midnight from his trip, I was half asleep on the easy chair but his smile and hug all but dismissed ongoing aches and utter weariness. In the morning we lay in bed for hours, often silent but our arms about each other, noting blue sky through the blinds and the chatty robins, sharing stories and dozing. I hadn’t felt so safe and joyous in a long while and I praised God for it.
It has been four days since this latest heart adventure. I’ve pondered it, replayed how it unfolded, what might have been done better by myself or the staff.
Then, yesterday, I had a follow-up with my own cardiologist, Dr. P. It seems I am one of a fairly small number who have such a reaction–“rebound tachycardia”–to stopping a beta blocker that long. I am also one of “approximately five to seven percent” who are noted as having an extreme reaction to a vasodilator. Well, it was no real surprise, I responded. I have had many adverse reactions to medicines, including those for the heart. And I had had a feeling it might not go well.
“But I feel foolish for calling 911. I should have waited it out since I suspected what was wrong.”
“No. Too many people wait to get help too long, ignore the symptoms or are in denial that worse could happen. They’re the ones who are found dead in their homes when everyone thought things were just fine. You even waited until the next day to get medical help when you had a heart attack in the forest, remember? You never should regret calling 911 when your heart is acting up. Give yourself some grace on that one, alright?”
“Alright, I get it.”
“You know, all this told us that your stents are still holding well after fourteen years, that your arteries are clear with no new blockages, and that your heart itself is strong. You are doing so well, still a star patient of mine! It’s all because you’ve taken my advice and done what you needed to do. You exercise daily, you eat healthily, take care of your stress levels.” He paused and leaned forward. ” So what’s wrong?”
I stared at bruised skin on my arms where needles delivered medicines that both hurt and helped me. I didn’t want to cry, not then. “My sister passed from congestive heart failure, had a heart attack just a month ago. It has been unsettling.”
I almost added: How is it that I can live while she does not? And when will I have to pass on?
“Oh, I’m sorry. That’s hard, more so right now.”
“I loved her so much; she was vibrant, talented, so good.” I looked at his tired hazel eyes. “Do I show any sign of congestive heart failure?”
“She died from multiple heart attacks…she was only 78….and my brother has arrythmias that worry me but insists on travelling all over the world…My parents had heart disease, too, as oyu know. It’s everywhere.”
“It’d not just genetics, but many factors including general health and stresses. And it’s how we can help heal ourselves.” He leaned back.” I know mortality gets close and personal when you lose someone and could lose others.. Nut remember, Cynthia, we’ll all die from our hearts stopping. That is the organ we must keep well if at all possible. It is the one that gives up the very last when all other organs are giving out. It fights. It keeps on beating till it cannot, anymore.”
I am silent, in awe once more of this remarkable reality, this heart we all have that propels us through life.
“And I would say that you have many more years of life ahead, as your heart is glad of the work you do to keep it beating strong.”
“Okay.” I smiled and sighed, let go of the last ounce of weightiness. “Wahoo!”
He laughed. “Right–wahoo is right!”
“So I can try river rafting, more strenuous hiking, salsa dancing and whatever else I want to do.”
“Go for it, sounds good,” he said and pressed my hand, “and keep on taking such good care. Call me if you need help, though.”
Then he left, on to the next patient. I thought how he had also aged since I first met him, and how many people he would not have good news for that day. He would tend to them each with compassion and straight talk. I have been blessed to have such a heart doctor.
I had thanked God many times since getting out of the hospital. Yet I still had wondered, why did I have to undergo the trials of the last few days? And then it turned out that the tests showed nothing remarkable. It would cost me more money, as well.
But the fact that I got the message that my heart is working well is certainly something to celebrate. Despite the coronary artery disease diagnosis that seemed an early death sentence in 2001–per doctors then–I am thriving thus far. I have become stronger and healthier because I still had too much to do, have so wanted to live it with vigor and enthusiasm. I have a stubborn streak, and it has guided me well in this. I am on intimate terms with my heart as well as my soul and will not back down from hard work to ensure saving both. I have followed recovery instructions. But God has been right here through the messiness, the times of doubt and error, eluding death’s pursuit, finding new ways to care for myself and others. Resetting my compass. Just going on.
I had a dream last night. Three people came to me in good cheer who have passed one: my mother, my sister and my ex-husband, the father of two of my adored children.
“You’re watching over me, aren’t you?” I whispered as I came up from sleep, to a light-imbued room. And they smiled, then drifted off and my heart, it was at peace.
Postscript: I am not a professional health care provider and can only attest to my own experiences. I am familiar with tests, procedures and medications noted as well as my own heart conditions. You may have greater knowledge or different experiences. But if you have troubling heart symptoms, please do not delay in seeking proper medical care and prepare yourself with your own knowledge. Women often exhibit different symptoms of heart attack than men.