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Cooper Clinic Follow-Up on Cusp of 82nd Birthday

Three Options for Heart Rate Irregularity

The Cooper Clinic is booming in its 50th year. The main clinic building has been leveled and rebuilt from the ground up. With one exception, my overall results are little changed.

Near the end of my follow-up exam, I stepped in the door of the main building and felt lost. I spun around a few times—and finally sat down to wait for a follow-up ultrasound on my carotid arteries and then see cardiologist John Ho. (He has been very generous with his time in the past, showing me that my coronary arteries are very large and wide open.)

This time around, Dr. Ho spend about 30 minutes explaining that my heart rate irregularity is probably genetic and not life threatening. We went over ways to manage it in considerable detail. The first option is to continue monitoring my heart rate on Fitbit. Stay the course for now.

We’ll discuss the other options, after going over my results.

Cardiovascular Results

The follow-up ultrasound on the arteries in my neck showed only minimal change. A repeat test is planned in four years.

My lipid profile without statin therapy continues to be “overall healthy” with a cholesterol/HDL ratio of 3.5, well under the borderline 4.5. My triglycerides are 92, a fraction of the 149 goal level.

My Omega 3 level is 10%, well over the 8% goal.

The concern is that my bad cholesterol (LDL) is far above the goal level. Likely due to genetics and rebound from decades of statin therapy.

Dr. McFarlin recommends that I continue my balanced whole food diet along with a daily fish oil supplement and every-other-day low dose aspirin.

*  *  *

My resting EKG is unchanged, and I show no sign of ischemic heart disease—blood supply to my heart is good at rest and during exercise. I have no chest pain.

A repeat coronary CT angiogram—showing the blood flow in my heart—is planned for 2021.

What I have going for me is a healthy lifestyle: purpose, diet, and a lifetime of exercise.

Other Findings

My kidney function is normal and I show no signs of developing diabetes.

My hsCRP inflammation level is 1.34, a tiny fraction of the reference high of 4.94.

My prostate is normal and my testosterone level is a very healthy 656, more than twice the level of most men my age.

Once again, I exhibited an irregular heart rate during the stress test on the Airdyne.

Supraventricular Tachycardia (SVT) Ablation

“Even though you have not noted a significant decline in exercise tolerance, today’s Airdyne stress test revealed an SVT near maximum exercise intensity and your blood pressure dropped down to 92/56,” Dr. McFarlin wrote in his report. “I anticipate ablation of the SVT arrhythmia will significantly improve your exercise tolerance.

This was a surprise to me. While my Fitbit shows heart rate spikes from time to time, I’ve had no problem during high-intensity exercise. I’ve done HIIT on the Airdyne many times with no problems.

The spikes recorded on my Fitbit are usually during neighborhood walks or foothill hikes; rarely, if ever, during an all-out effort. I don’t feel anything unusual and wouldn’t know about the spikes without Fitbit.

The latest stress test, however, was different. I could feel that something was wrong. I wasn’t short of breath or having pain or pressure in my chest, but I didn’t feel right. I believe psychological stress was an added factor.

The problem coming to a head up at the Cooper Clinic is fortunate and apparently calls for action of some sort. As noted above the first option is to simply be alert to the anomaly. The other options are more invasive.

The second option—medication—has drawbacks. It would probably put a damper on my training and Dr. Ho tells me that drug therapy would likely become less effective with time.

Ablation, the last option, calls to mind a pithy Woody Allen quip: I don't fear dying, I just don’t want to be there when it happens.

*  *  *

The following information on ablation is pieced together from Google and the Mayo Clinic:

Supraventricular tachycardia (SVT) ablation is a non-surgical procedure to create scar tissue within the heart in order to block abnormal electrical signals and restore a normal heart rhythm. It does not require a general anesthetic or stopping the heart.

What you can expect:

SVT ablation is performed in the hospital. You'll receive a sedative that helps you relax.

Once the sedative takes effect, a small area near a vein in your groin or neck is numbed and catheters are inserted into the vein. Your doctor carefully guides the catheters through the vein and into your heart.

Depending on the type of ablation you have, you may or may not be awake during your procedure. If you are awake, you will be asked to report any symptoms, answer questions, or follow instructions given to you by your doctor.

The catheters are equipped with electrodes that are used to record your heart's electrical activity and to send electrical impulses. Your doctor uses this information to determine the best place to apply the SVT ablation treatment. A tip on the ablation catheter will emit high-frequency electrical energy to destroy the abnormal tissue, resulting in a scar.

SVT ablation typically takes three to six hours. Afterward, you'll be taken to a recovery area where your condition will be closely monitored. You'll likely stay overnight in the hospital.

After SVT ablation, most people see an improvement in their quality of life. But there's a chance your fast heartbeat may return. In these cases, you may need to have SVT ablation again or may need other treatment.

Sounds like fun!

*  *  *

Dr. Ho has written a letter of referral, and forwarded my records, to a cardiologist in Albuquerque with a special interest in ablation for athletes and others.

After some back and forth with his staff, an appointment has been scheduled in January.

Carol and I look forward to sitting down with him. Very unlikely that we could have found this doctor on our own, or get in to see him without starting from ground zero. Dr. Ho has once again been a big help.

More later.

November 1, 2019

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 or street address: 528 Chama, N.E., Albuquerque, New Mexico 87108,
 Phone  (505) 266-5858 , e-mail: cncbass@aol.com ,
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