The heart’s resilience and fixability is striking.  That is, compared to the frailty of other components of the birthday-ravaged body.  We cardiologists are advantaged by the attention heart disease garners in the minds of patients.  We get priority over the polyp, or the bulging disc.

But should we?

He is an older man living a simple happy life with his cane. There were other medical issues resulting in life on a fine line.  Healthiness for the older is like a narrow exposed trail, with danger lurking on either side, and just the smallest bobble creates a potential disaster.

He had the dreaded ventricular tachycardia (VT) for years. Even though it only raised the heart rate to 120 beats per minute, it scared everyone because of its name–like the friendly old black lab with the loud deep bark. Atrial fibrillation, atrial flutter or other benign SVTs go faster, but VT always elicits more fright.    

The rapid heart rate traversed through tiny channels of living heart tissue inside a scar from a distant heart attack.  It caused him symptoms that were troublesome, but even worse were the side effects from the ineffective rhythm medicines.

Assess and decide: it was time.  It was fun searching out those serpentine-like channels, which created a mosaic of electrical squiggles.  “Wow, that was an amazing electrogram.”  High watts were passed through the saline-irrigated catheter tip.  The tachycardia vanished immediately.  Huge grin!

However.  But.  Not so fast.  This triumph was months ago. The arrhythmia is gone, and the toxic medicines are no longer needed.  Unfortunately, there have been four unrelated hospitalizations since:  pneumonia, urinary tract infection, exacerbation of kidney failure, and then fluid excess.  He is arrhythmia free, but miserable in his wheelchair.  “I am so weak.  I am trying so hard.”

“You heart is good,” I add.

“I know, but I am so weak.”

Chapter 2:

He has intermittent atrial fibrillation.  He is older, also with a cane and a life on that same narrow trail.  His generic four dollar per month rhythm medicines work.  The heart is resilient.  Ah, but that dreaded little colon polyp that could not be snipped with the scope.  Surgery.  It could be cancer.

The surgeon is one of our cities best.  The anesthesia, or all the other factors–bed-rest, immobility, pain, pain-meds, ileus, atrial fib from withholding oral meds, or a combination of all the above–results in weeks in the hospital.  Finally the discharge.  The urinary catheter was pulled and urine will not come.  Sadness ensued.  The heart was rhythmic again as he is back on his generic medicine–that works.

Now a urinary catheter was in place for weeks.  A bag was taped to the leg. That little baby colon polyp.  More urologic surgery is needed.  Office based “procedures” done with rigid catheters through the aged urethra were required.  A little tear drops out from his eye as he tells me of the wide awake urologic procedure.  The heart is good. That dreaded polyp. It was benign.

The heart ticks on, sometimes almost infinitely.  The singular focus required to eliminate pathologic squiggles from the heart sometimes blinds us to the other stories of the aging human body.

Heart disease frightens the most, but often proves easiest to fix.

JMM