As you know, I have a pacemaker/defibrillator. It is monitored remotely by a Heart Rhythm Center located about 10 miles from where I live. On Tuesday February 25, my iPhone rang. When I looked on the screen, I saw that it was the number for the Heart Rhythm Center. I usually get a call from the center once a quarter to let me know that a doctor has reviewed the data transmitted by my device, that there are no issues, and that the battery level is still good. But it seemed a bit early for me to be getting this call. Intrigued, I answered the phone.
An employee from the center told me that a doctor had noticed an atrial flutter in the reports. They wanted me to come in for an appointment so they could “interrogate” the device in person. This basically means that a doctor or a physician’s assistant will hold a wand over my heart device, and heart data will appear on their computer screen which they can evaluate in real time.
I set up an appointment to come in on that Thursday. However, I also noted that I had seen a doctor back in the late summer when an “irregular heartbeat” icon appeared on my blood pressure monitor for a number of daily readings. I said that I had worn a holter monitor for two days, and the result was that the doctor confirmed I was having extra heartbeats. However, he also said that they were not at a percentage level that we needed to be concerned about. I asked if perhaps it was this same issue that they were noting in the data. The employee said she did not think so, as the doctor who evaluated the data also had access to all my medical records. He would have been aware of the fact that the other doctor examined me and had provided an opinion on the extra heartbeats. I had no choice but to book the appointment.
I immediately called my sister, and on both ends of the conversation we engaged in spirited googling to find out what atrial flutter is. The first answer I came across made me laugh and I saved it because I knew I would write a blog post one day on this topic. Unfortunately, I can’t remember which website I got it from. But the answer was: "Can you die from an atrial flutter? 2 doctors agreed: No doubt: You can die from drinking too much water but it's unlikely.”
I read this to my sister. But knowing that there is also no doubt that any new heart issue I have needs to be examined closely, we continued to google for some insight into atrial flutter. One of our go-to websites, the Mayo Clinic said:
While it was good to know that my flutter was a disciplined, organized force of nature just like me (or so I’d like to think), whenever your heart starts to do anything that could be considered abnormal, it can be cause for a little concern. My sister and I were glad that I was going to have my medical team check it out soon.
When I arrived at the Heart Rhythm Center, a nurse escorted me back to an examining room to take my vital signs. I had one last college try at explaining that the doctor had previously found that my heart had extra beats. In my non-medical mind, that meant that if there were extra beats than it was probably beating faster, correct? The nurse assured me it was not the same thing and gave me the medical explanation. I am sure my face had a deer in the headlights look. At that moment, I could relate to my clients years and years ago when I tried to explain to them the legal basis for accepting offers in compromise of tax liabilities based on doubt as to liability or doubt as to collectability. When you don’t specialize in the field, it’s all Latin, Greek or Martian to the rest of us.
The nurse finished checking my vital signs. She told me that the physician’s assistant would be in to see me soon. She specializes in electrophysiology issues, which basically means the electrical system of the heart. You might wonder why I wasn’t seeing a doctor. Well I have since learned that the field of electrophysiology is a rather narrow medical specialty. My heart rhythm center uses a team approach to assure that patients are seen in a timely, efficient, and highly qualified fashion. This means that sometimes you are seen by a doctor and sometimes by the physician’s assistant. But you are always seen quickly by someone who is an expert in their field, and the team members stay in touch with each other about your diagnosis and treatment. I think it is a smart and efficient way to assure that me and my co-patients get quality care as soon as it is needed. ‘
The physician’s assistant came in and introduced herself. She put a wand over the heart device to “interrogate” it for relevant data regarding my heart’s rhythm. She could see that some atrial flutter had occurred. However, the burden was less than 1%, and any incident was less than 45 seconds in length. She explained that the concern is that at some point, the flutter could turn into atrial fibrillation which in turn could lead to a blood clot which could cause a stroke. Anticoagulants (also known as a blood thinners) are the treatment of choice if needed for atrial flutter and definitely for atrial fibrillation.
She indicated that the decision as to whether I wanted to go on blood thinners at this point was up to me. I was a little in over my head and needed some more information to help me make a risk versus benefit analysis. So I asked the physician’s assistant what she would do if she were me, and what courses of action were available. We discussed the very low burden of my flutter at that point in time, which means that the risk is not as high as it would be for someone with a much higher burden. She said that I could come back in 6 weeks to look at the data and see if the flutter was better, worse or about the same. In the interim, my bedside monitor would continue to periodically interrogate my device remotely, and I would be watchful for symptoms that the flutter might be increasing. Those symptoms include shortness of breath, fatigue and an increase in my heart rate.
The six weeks went by with no symptoms. But the six weeks also included the emergence of the corona virus in the area, and Federal and state guidance to practice social distancing and to stay indoors as much as possible. This meant no in person appointment for the follow-up. Instead, we modified the appointment so that I could meet online (using the Zoom platform) with a physician’s assistant on April 13. The person I met with in February was not available, but again, anyone I would see at the heart rhythm center has an expertise in electrophysiology.
Prior to the appointment, I received a phone call from a nurse to update my vital signs, medications, etc. Then she asked me if I had interrogated the device that morning. The pause on the phone caused her to ask: “Do you know how to interrogate the device?” My response was “No.” She transferred the call to a technician who was able to walk me through the process.
Once the data was submitted, I met online with the physician’s assistant. He reviewed the data on my heart device for the last 6 weeks. There were still episodes of flutter. In most cases, they were extremely short - less than a minute. However, there was one which occurred on April 1 that lasted 11 minutes. Again, the concern over the flutter turning to A-fib leading to a stroke. He said that any episode lasting more than 6 minutes requires a discussion of the risk posed by the burden of the flutter versus the benefits/risks of treatment with blood thinners.
He said there is a calculator where you can plug in the person's history and see where they fall on a scale of 0 to 9 for the need of treatment with blood thinners. For women, anything that is a 3 or higher normally would fall into the range of needing treatment. My score is 2. Also, the burden of the flutters is still really low - coming in at less than 1 percent. I asked if the length of each episode is factored into the burden calculation and he said yes. So even though I had an 11-minute episode which is longer than most of the little 15 - 45 second blips that were showing up, the burden is still really really low. Additionally, I do take low dose aspirin which he said does result in a 6 to 8% reduction in stroke risks. I also asked if something like stress of the pandemic and having to manage the many restrictions and potential misinformation could impact the heart flutters and he said yes, stress is one of the causes.
Based on this information, we agreed that it was reasonable to do more watchful waiting, with a follow up appointment in about 3 months. He said that this next appointment will be with the doctor who implanted the pacemaker/defibrillator. Additionally, he reinforced that my bedside monitor will provide data that they can see during the next 3 months so that if there is an increase in incidents/length/burden, they will know. Once again, I believe this is an optimal course of action.
Of course, my doctors are interested in, and monitoring the medical causes and physical symptoms of my atrial flutter which is very important. I am lucky that God has brought me such a talented and compassionate medical team to treat not just my heart, but to view me as a patient with feelings. But the faith I have relied on throughout my life, but especially over the last seven years, leads me to believe that there are spiritual causes of my atrial flutter, These causes have an effect of making me even more faithful and more committed to affirming my faith to others.
My theory on the spiritual cause for atrial flutter goes like this: I believe angels are present throughout our lives, especially in challenging times. Hebrews Chapter 1, verse 14 says: “Are not all angels ministering spirits sent to serve those who will inherit salvation?” Maybe the medical people are detecting the flutter of angel wings. Maybe an angel is protecting my heart so that I can do God's work and will. (Although I would respectfully request that my guardian heart angel discontinue the impromptu nighttime flutter dance parties!)
The bottom line is that even in the time of a pandemic when I am in a higher risk category, I am blessed. This is because I believe God gave me terrific doctors and an awesome angel to help me manage a scary medical condition. This angel enables me to witness about the power of faith to overcome daunting challenges. Since I will inherit salvation, I am obliged to relentlessly proclaim my legacy of faith. Just as there are medical mortal forces treating my heart failure and whatever symptoms it creates, I also have a strong celestial force guarding my heart and making it stronger.
Melanie discovered that she had heart failure in 2013. She spent the next 7 years learning how to live with the condition, and how to achieve balance and personal growth. Then in October 2020, she received a heart transplant. This blog is about her journey of the heart.