So I mentioned last week that I had an echo and everything looked "normal." As it turns out that is not the case. Bill has a friend who is a very smart pediatric cardiologist, the kind of doctor who actually thinks which is unfortunately rare. After the echo, Bill and I were confuse. If the echo is normal why do I feel so badly and why has my heart rate increased so much over the past several months. That along with some other symptoms and occurances -- the severity of the embolism episode, a history of fainting spells, and the fact that I can breathe more easily when I squat -- made us wonder if I had a common congenital defect that no one had picked up on a previous study. The defect is called a patent foramen ovale (PFO) and about 25% of the population has one to no ill effect.
So today I was the oldest patient at the Duke Children's Hospital. All those health services researchers out there using claims data, not all those "out of range" values on your data are errors! I had another echocardiogram done but this time they injected "agitated saline." They watched the bubbles on the echo to see if they pass from the right atrium to the left atrium. I had some pass and they passed late so the idea of a PFO is less likely. The cardiologist did say he is still suspicious that it is there but the amount of shunting from right to left, if it is there, was small.
But the echo was not normal. In fact there are several changes from the last two echos that suggests that there is an actual cardiac problem rather than my heart compensating for my crappy lungs. My heart rate has increased a great deal, the electrical rhythm of the heart has changed and there is evidence that my heart is not able to fill adequately. It is unclear whether the sac around the heart has tightened and needs to be removed or if their is a problem with the heart elasticity. I must say it was impressive to listen to the cardiologist think aloud. It's rare that I meet a really smart doctor, one who knocks my socks off, but this one did just that.
I don't know whether to be happy or scared. I'm going to need another cardiac catheterization, but this time it's the full deal left and right sides of the heart. Depending on what that shows, I may also need an MRI before we can figure all this out. So I am back in panic mode.