My Heart Surgery Story 2: The Real Angiography

This is the continuing story of my heart surgery. To summarize, in My Heart Surgery Story 1: The Almost Angiography, I was short of breath, which turned out to be iron deficiency anemia. The story goes on…

My iron levels returned to normal and I no longer had shortness of breath. Things were going along fine.

But my cardiologist did say to return in 6 months for a follow-up visit. Well, 6 months was during the Thanksgiving season, so I put it off. In December, it was the Christmas season but I did call for an appointment. The office offered a January appointment, so I scheduled it for the end of the month. After all, I had lost 20 pounds, my blood pressure was down and all felt well. Why look for trouble?

The Return to My Cardiologist

In early January, my wife and I joined the local YMCA so we could take a swimercise class.  It was fun being in the water 3 days a week in the middle of winter.  Well, California winter, anyway.

But something began to happen after about the third week of swimercise class.  Toward the end of the 45-minute session, we did an exercise to get our heart rate up – a reward for all that stretching and walking in the pool.  Well, when my heart rate began to hit 120 (Pulse of 20 for 10 seconds – so 20 X 6 = 120) I began to get a knot in my chest.  Not pain, not pressure – it just felt like a knot in my chest.

So I did less of the “get your heart rate up” exercise.  But even when my heart rate was hitting 100, I felt the knot again.  I’m thinking, “If this were a heart attack, I’d be feeling pain, or heavy pressure in my chest, or my right arm would have referred pain.”  Since I didn’t have any of those, I’m thinking “Well, maybe it’s heartburn.”  Except that we didn’t’ eat until after swimercise class.

The last week in January I went to see my cardiologist.  She listened to my heart and told me my heart murmur was worse.  I told her about the knot in my chest.  She said the swimercise problem was as good as a stress test for telling her I needed to move to the next step – angiography.

Angiography

Two weeks later, I am again in my gown with an IV in my arm waiting for the angio. For angiography, a small tube is inserted in a blood vessel in the groin area (actually, the upper end of your thigh). The tube is moved up to your heart and a special fluid is injected. X-ray pictures, called angiograms, are then taken of the fluid. The pictures let the doctor measure the size of the arteries, veins, and valves in your heart. The nurse shaves my groin area and at 8 am I am rolled into the operating room.

I was not asleep when they did the angio. On the other hand, I was not really awake. They put a nice anesthetic into the IV that put me in a dream like state. I could see the images which showed some dark line against my backbone. At least that’s what I thought I saw. I don’t remember seeing my heart. But then I don’t remember much of the 90 minute procedure. I certainly felt no pain.

I remember coming into consciousness when it was all over. I was still on the operating table. The cardiologist was telling me my aortic valve was smaller than last time and I would need to see a heart doctor and have heart surgery. Why she told me this when I was still half asleep I don’t know – maybe to soften the blow. Because what she was saying was that I needed to have my chest cracked open and my heart repaired.

I went home that day and rested. My groin was black and blue where they went in and I had a nick where the nurse had been a little too zealous in his shaving. I had not wrapped my brain around the heart surgery yet.

The Heart Surgeon

The next referral, to the heart surgeon was approved pretty quickly.  Once I had his name, it was on to Google to check this guy out.  Fortunately, he came out looking good.

More importantly, my wife’s manicurist checked his name out with her high-end customers and they gave his heart group high marks.  In LA that means his group had worked on movie stars, lawyers, and politicians.  I was sold.

Meeting a heart surgeon is like a blind date – one hopes for the best.  It’s not like you don’t know what he’s going to say – so it’s all in how he tells you.  You want to be inspired by his confidence since he’s literally going to have your heart in his hands.  You want desperately to feel safe.  My doctor did inspire confidence.  Frankly, I think that’s the kind of people who become heart surgeons.

He told me I needed an aortic valve replacement, or AVR as it is known to the “in” crowd.  Then he added, “And while we’re in there, we’ll also do a triple bypass.”  Say what!  Technically, that’s a Coronary Artery Bypass Graft, or CABG to the “in” crowd.  Actually, a CABG can be a single, double, triple, or quadruple bypass.  For me, he was advising “just” a triple.  Well, this was news to me.  (For more about CABG, see my other hub about CAD and Heart Bypass Surgery.

In the world of heart surgery, they figure that since your chest is open anyway, why not take care of all potential problems?  What they don’t want is for the patient to go home from a successful AVR surgery, only to have a heart attack from bad arteries a week later.  That would reflect badly on the heart surgeon – and would not inspire confidence from future patients.

So it was back to the referral business. (Remember, this is HMO medicine – everything must be approved beforehand.)  Soon it was approval for a pre-op EKG, checking my carotid artery, and “mapping” the veins in my legs.  Why?  Because that graft in my heart is going to be using the good, round, juicy veins from my leg.  Oh, yeah.  Did I mention that when you get a triple bypass you also get a “free” leg surgery so they can take those leg veins and use them for the heart graft?  As I said, once they’ve got you on the table, they do it all.

The Waiting is the Hardest Part

With all the tests done, it was finally time to schedule the heart surgery.  Unlike a sudden heart attack, a scheduled date gives you plenty of time to think about a surgery in which your heart will be stopped for about an hour while your blood flows through a heart-lung machine.  For a geezer like myself, that means plenty of time for reflection.

My heart surgery will take place in a few days.  I will report on what that was like after the surgery and after the drugs wear off, which I’m hoping will be about two to three weeks.  There are about a half million heart surgeries done a year and a large percentage work out fine.  So I’ve put myself in the “all things will work out fine” category.

Looking forward...

Addendum

The heart surgery was cancelled because pre-op testing found I had iron deficiency -- the same thing that happened in Part 1. So Part 3, the actual heart surgery, will have to wait.

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