Wednesday, November 21, 2007

Supraventricular Tachycardia: An Unedited Stream of Consciousness

One minute you’re reading a bedtime story to your kids. The next minute an EMT is intentionally stopping your heart.

You’ve just said goodnight to your kids (another chapter in the latest “Harry Potter” book) and you’re sitting down in front of the computer to look for images of sheep to use in the preschool puppet show this week when you notice your heartbeat suddenly kick into high gear. You sit back and try to relax for a minute. Maybe this is just a temporary thing – stress-related or something, but it doesn’t go away. So you carefully stand up and walk down the hallway to let your spouse know that something’s not right. Mainly she’s annoyed that you’re disturbing her, but she eventually figures out that something a bit more serious might be going on.

The heartbeat is incredibly strong. You can see it pounding through your t-shirt. You lie down on the bed to try to relax, and it only seems to get worse. It starts to hurt a little in your neck.

This has happened before. The last time was at work and it really freaked you out. You thought you were going to die. When it didn’t stop that time, you had the office manager call 911. But it stopped before the EMTs got there. There was no evidence that it had ever happened. They took you to the hospital anyway, but there was nothing to be done other than a standard battery of tests. The longest lasting side effect was a badly shaved chest that bled profusely and turned into a set of nasty-looking circular welts like crop circles on your stubbly abdomen. The PA told you that this whole episode was nothing to worry about. That if it happened again, you could probably stop if by coughing or performing Veigle maneuvers or putting your face into a bowl of ice-cold water. In any case, it would stop by itself in about 10 minutes. It may never happen again, but if it does it’s certainly not an excuse to get a ride in an ambulance. You’ve dismissed the whole series of events and are a bit embarrassed to have put others through such a messy ordeal. And you’re tired of the “how are you feeling” questions at work. And you’re no longer polite when people ask.

So here you are, 3 months later, and it’s happening again. So you try coughing, but that just hurts and your heart keeps up the tempo. You get your spouse to bring up a bowl of ice and you pour it into the sink with water and you force your face into the cold. You emerge, sputtering and cold, and realize that the pain is a bit lessened, but the beat goes on. You’re starting to feel dizzy, but you’re not sure if that’s a result of the heartbeat or of the rising panic that you’re desperately trying to rationalize away. You try coughing again and try the water torture again. The water’s colder this time, but still no effects outside of clammy skin. And that may have been there before.

You lie down and try to relax. And you decide that maybe another call to 911 is justified. You take a aspirin – they always tell you to take one – and it doesn’t seem to help the pain much. You’re starting to feel really bad. You’re neck and chest are really starting to hurt and your stomach is in knots and you’re not sure if you’re going to pass out or thrown up or both simultaneously.

Then you realize that your son is in the bed next to you. You open your eyes, and he’s kneeling there next to you with his eyes closed and his head bowed and his hands pressed together in front of his face. He’s quiet for a long time. Then he says “God, please help my Daddy to feel better soon. Amen.” And you close your eyes again so he doesn’t see the tears. You take a deep breath – as deep as you can manage – and you reach out and touch him and tell him that everything’s going to be ok. And you smile a genuine smile and try to laugh so he doesn’t see what you’re really feeling.

Your spouse tries to get you to take deep breaths. She’s read this on some on-line article unrelated to what’s going on, but close enough to make her feel that this is the correct behavior. You try to explain that deep breaths aren’t an option here. Deep breaths hurt. A lot. More than you can believe that they should. And that adds to the panic and now you’re really starting to feel bad.

The EMTs are on the way, so you move downstairs to the couch so that they don’t have to climb the stairs. No need to make them carry you down on the inevitable gurney. No need to wake up your daughter, who’s sleeping soundly through the entire ordeal. You start worrying that maybe they won’t show up in time to take a reading of this episode and it’ll all be another waste of time for the EMTs, the doctors, and the insurance processors who will have to sort it all out once more.

But this time your heart’s still pounding when they get there on their big, flashy fire engine. They hook up the monitor and make the type of raised-eyebrow faces that don’t translate to “not a big deal”. One of them is a rookie who asks “Is that really a heart rate?” You’re at 190 beats per minute, plus or minus. Mostly plus. And the EMTs call for “a bed”.

You’re poked and prodded. They insert an IV and hook up the EKG. This time there’s going to be a nice printout as evidence for the doctors. And then the one in charge pulls out a needle and fills it with a clear liquid.

“This will convert you,” he says, “but you’ll probably feel woozy for a minute or two.”

Thanks for the warning. He pumps the drugs into your IV port, and you don’t feel woozy. You feel like you’re dying. But it works, and the heart rate monitor drops to the 90s – a reasonable number for someone in your situation.

“I didn’t want to tell you before,” says the head EMT, “but what that just did was stop your heart for a minute. I don’t like to tell people that beforehand, because it scares them.”

And then your heartrate jumps back up to 190 and he has to do it again. And this time you know what to expect, except that this time they double the dose. As it enters your bloodstream, you can’t breathe. You gasp for air, but nothing happens. You feel worse than you’ve ever felt in your life and you believe that this must be what a heart-attack victim experiences in the last moments of their life and you panic and you pray and you fight for life as you’ve never had to before. And it’s all over in a second or two, but it seems like it was much longer. Your heartrate’s back into the 90s and you feel better.

Then you start shaking. Maybe it’s the cold from the front door that the EMTs left open, or maybe it’s some chemical reaction inside your body from the drugs or the panic or the near-death experience. The shaking gets worse. Your legs are jumping off of the couch on their own. Your hands are so violently shaking that you’re afraid the IV will pull out. Your teeth are chattering. And you feel very, very bad. Not like you’re going to die, but bad enough that you’re convinced something else has broken loose inside.

Then you notice that the EMTs aren’t panicking, and that helps. They are professionals, bringing in the gurney, watching your vitals, and doing what needs to be done to get you into the ambulance. They’ve moved your coffee table – for some reason that seems important. They help you into the gurney and strap you down. At some point they’ve hooked up oxygen, and it’s pulling on your ears. They put the tank between your legs and it’s cold and you’re wishing you were wearing more than a t-shirt to go out into the cold. But you’re feeling better.

Your neighbors have arrived. You realize how lucky you are to have moved into a neighborhood filled with so many remarkable people. They are here to watch your kids for you, to offer assistance in any way that you might need them. It’s after 10pm on a Saturday night, and they’re out there in whatever they threw on and they’re willing to do whatever you need. And you realize that you’re wearing a t-shirt that says “God’s Helping Hands” and you know that you’re seeing them all around you. You’re loaded into the ambulance and your spouse gets into her car to follow, and you’re on your way to the hospital.

The ambulance driver won’t turn on the lights or siren, though, even when you ask. Those are reserved for the real emergencies. It’s nice to know that you’re not a “real emergency”. You’re starting to even believe it. You watch out of the back of the ambulance as the EMTs call in your vitals and ask personal questions like “Have you ever taken Viagra” and “Do you smoke” and enter the results into their laptop computers. This is your second time in an ambulance and you’d really like not to ever do it again.

At the hospital, you’re handed off to another group of professionals who continue to make you feel comfortable and confident that this isn’t your last days among the living. They put on new monitors and remove old ones, removing patches of hair as they go, but you really don’t notice that pain very much. It’s a relief to be noticing anything other than your heartbeat.

This time, you get a chance to talk to a doctor, which turns out to be the most beneficial conversation of the entire experience. The MD explains that what you experienced is SVT. It’s an electrical problem, not a blood-flow problem and it has nothing to do with the kind of heart attacks that killed your grandparents. It’s not life threatening. There’s an extra electrical feedback path in your heart that isn’t supposed to be there, and sometimes it gets activated. The signal starts running up and down your heart, causing the rapid heartbeat. It’s treatable, although it’s probably a good idea to confirm this with a cardiologist. And he gives you a name of a cardiologist to call and set up an appointment. And he explains that it may never happen again … or it may happen again 15 minutes after you leave. And he discharges you from the hospital with nothing more than paperwork to take home with you.

You call home to let your neighbor know that you’re on the way and she asks if she should send your son to bed now. It’s 11pm, and he was supposed to be in bed 2 hours ago. He’s told her that “on Saturday nights I get to stay up until 10:30,” and he’s been so convincing that she’s believed him. Her daughter has been over and they’ve been playing and watching television. (The next day, the only thing that your son will tell your daughter about the evening was that he had a play date all night with the neighbors.) You tell her to send him on to bed, and by the time you get home he’s already asleep.

You go to bed and wake up at 3am and you’ve sweated completely through your shirt and your heart is racing and you’re convinced that it’s all starting again and you get up and go to the bathroom to throw up and realize that you’re heart’s not quite beating so fast and maybe this is just panic setting in. And even though that’s true, it’s not a much better feeling. You wash your face, change shirts, and climb back into bed and try to think about anything other than heartbeats, blood flow, electrical paths, doctors, hospitals, or ambulances.

Eventually it works and you fall asleep.

On Monday, you call to set up an appointment with the cardiologist. Because of the holidays, it’ll be 2 weeks. Meanwhile, the panic is getting a little better, but every time you start to do anything requiring exertion and your heart starts beating a little faster, you stop and rest a bit.

Just in case.

2 comments:

Nurse Practitioners Save Lives said...

You described your experience so eloquently. Sorry that you had it to begin with. Health care providers shouldn't dismiss your fears regarding that kind of situation. It's your life in the balance.
I popped in to ask how you implement the expandable link list into the old blogger template? Thanks for any info!

Scott said...

NPSL,

Thanks for the comment. I hope not to experience it again, either.

As for the link list, I've posted the template and links at http://www.wilkinsons.com/Bananna/2006/08/howd-you-do-that-banana-stew-template.html. Let me know if that's what you need.

Good luck,
Scott