tomandhisheart.com
Tom And His Heart
Introduction and Motivation
I do not write this story looking for sympathy or sorrow. Instead, as corny as this sounds, I hope to maybe save the life of one of my friends.
On October 15, 2023, I underwent open chest double bypass surgery. The following summarizes how I ended up with a bypass (and in future blog entries, the days in the hospital that followed, and much more!)
Much more importantly, I discuss my good fortune to have detected my blocked Left Atrial Descending heart artery (also known as the Widowmaker) without noticing any symptoms. I want to share how I detected this dangerous blockage so that you can share with your friends and loved ones, in the event one of them has a time bomb in their heart like I had!
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First, A Shout Out!
I will never be able to express the amount of appreciation I have for the nursing staff at the UNC Rex Heart and Vascular hospital. I wish I could list their first names here, but have decided not to for privacy reasons.
How Does One Know To Go To A Cardiologist?
At age 50, colonoscopies are recommended, and for good reason! Colon cancer is SO AVOIDABLE with regular colonoscopies.
Unfortunately the medical community does not have analogous protocol to flush out cardiac heart disease (CHD). They rely on you having chest pains or extreme fatigue, neither of which I had. In other words, the ball is in your court regarding detection.
My recent experience has shown there are a few non-invasive tests that can be performed to give a reasonable idea of your heart health. I discuss them in the next section.
How Did I know To Go To A Cardiologist?
This is probably the information folks are wanting to know. Before I was diagnosed with CHD, I considered myself to be in pretty good shape for a 61-year old. I am a non-smoker, averaged only one or two servings of alcohol a week, worked out three times a week, ran once or twice a week, would regularly walk 18 holes of golf, and was constantly on my feet doing chores around the house. Given no symptoms of heart issues, I was rather confident I was in good health.
Now to the good fortune that I have no doubt saved me from a likely fatal heart attack. The following is the most important thing to take away from this as far as how I detected my coronary heart disease!
In September 2020, I purchased a KardiaMobile 6L because of its incredible capabilities of providing a six lead ECG (a.k.a. EKG) along with heart rate reporting. This device analyzes the data recorded and lets you know if you’re in Normal Sinus Rhythm or have some issue with your heart.
I had discussed this device with my friend Phil, and we both concluded this device was cheap insurance against undetected CHD. After every workout and run, I would use my KardiaMobile 6L to check my heart rate and EKG. From September 2020 until early July of 2023, “Normal Sinus Rhythm” was always reported (except after some of my runs where my heart rate was >120, in which case the expected “Tachycardia” was reported).
However, a couple of readings in July 2023 that reported “Possible Afib” kicked off the data gathering phase with a series of tests to determine what was going on with my heart.
You can purchase a KardiaMobile 6L by clicking the link below (I strongly recommend you spend the extra money to get the six-lead version!):
TWS: Affiliate Link Here
Timeline
In an attempt to help with understanding the sequence of events that occurred, this timeline is provided for reference if needed.
| Date | Event |
| 7/10/23 | First “Possible AFib” detected by KardiaMobile 6L |
| Second “Possible AFib” detected by KardiaMobile 6L | |
| Third “Possible AFib” detected by KardiaMobile 6L | |
| First visit to general practitioner | |
| Second visit to general practitioner | |
Assessing The Situation
After three “Possible AFib” readings from the KardiaMobile 6L, I went to my general practitioner (GP) to kick off the investigation. He recorded an EKG, but no AFib was detected. Since I had immediately re-tested with the device and received “Normal Sinus Rhythm”, we concluded the device had mistakenly returned “Possible AFib.” (I later theorized that the KardiaMobile app on my phone had been updated, and a more conservative assessment of possible afib was introduced to ensure a peculiar reading was investigated.)
In early August, I had a couple of days where my heart felt “fluttery.” However, the KardiaMobile 6L had returned “Normal Sinus Rhythm.” I still decided to go see the GP a second time.
Thankfully, without me asking, my GP immediately referred me to a cardiologist at WakeMed. Despite the urgency conveyed by my GP, I had to wait about three weeks before the initial appointment.
A couple of days after my second GP visit, I requested an appointment with a cardiologist at UNC UNC Rex who basically saved my father-in-law‘s life and is well liked and highly respected by my wife and in-laws. (After a couple of visits, I would conclude that he is most likely the best doctor I have ever had.)
Because I was a new patient at UNC Rex for a high-demand cardiologist, getting an appointment took over seven weeks to schedule. (Tip: if you know a good cardiologist, you may want to make an appointment so that you become an existing patient, and thus get higher priority if time is critical.)
WakeMed Cardiologist Visits
Before my initial trip to the WakeMed cardiologist, my friend Ken recommended a couple of non-invasive tests to me to facilitate data gathering:
- CT Cardiac Calcium Scoring to evaluate the amount of calcified (hard) plaque in your heart vessels, basically looking for hardening of the arteries.
- Lipoprotein (a) test measures the level of lipoprotein (a) in your blood. A high level may mean you are at risk for heart disease.
In my initial WakeMed appointment, I requested that those two tests be performed. (Frankly I’m not sure if the cardiologist would have even suggested these, but that’s just speculation).
The cardiologist had those scheduled, along with the following:
- A 7 Day Heart Monitor Patch to see if I was indeed having sporadic AFib.
- Stress Echocardiogram to check for the presence of blockages in the coronary arteries.
My WakeMed Test Results
As you will soon see, my test results were cause of great concern to me.
CT Cardiac Calcium Scoring
Overview
CT cardiac calcium scoring is a non-invasive imaging technique that uses a CT scanner to assess the amount of calcified plaque in the coronary arteries. Note that calcification of the arteries is exactly the same as hardening of the arteries.
Currently, insurance companies do not pay for this test. I ended up (gladly) paying $250 for this test. However, I later found out in Raleigh that these tests are $99 at Cardinal Points Imaging. Shop around!
The following table summarizes the calcification level and risk of coronary artery disease based on the cardiac calcium score:
| Score | Calcification Level | Risk Of Coronary Artery Disease |
| 0 | None detected | Lower |
| 1-10 | Minimal Calcification | Low |
| 11-100 | Mild Calcification | Low to moderate |
| 101-400 | Moderate Calcification | Moderate |
| Over 400 | Extensive Calcification | High |
CT Cardiac Calcium Scoring Summary
My Cardiac Calcium Score
Needless to say, I was quite frightened when my cardiac calcium score came back as 1342.5! Here is a breakdown of each of my arteries that were evaluated:
| Artery | Cardiac Calcium Score |
| Left Main | 0 |
| Left Anterior Descending | 555 |
| Left Circumflex | 155.8 |
| Right Coronary Artery | 631.7 |
| Posterior Descending Artery | 0 |
My Cardiac Calcium Score Breakdown
Lipoprotein (a) Level
Overview
The Lipoprotein (a) (a.k.a. Lp(a)) levels are determined via a blood test. Note that Lp(a) is not tested in a standard lipid panel where cholesterol levels are determined, and an explicit request for Lp(a) is required.
The following table summarizes Lp(a) levels and associated risk of coronary artery disease:
| Lipoprotein (a) Range | Risk Of Coronary Artery Disease |
| <14 mg/dL (less than 140 nmol/L) | Lower |
| 14-50 mg/dL (140-500 nmol/L) | Increased |
| > 50 mg/dL (greater than 500 nmol/L | Elevated |
Lipprotein (a) Summary
My Lipoprotein(a) Level
My Lp(a) level was determined to be 166 nmol/L. Not nearly as concerning at my cardiac calcium score, but still, more elevated than desirable.
Stress Electrocardiogram
Overview
A stress electrocardiogram (ECG or EKG) is a diagnostic test that measures the activity of the heart during physical stress. This test is also known as an exercise ECG or treadmill test. The purpose of a stress ECG is to evaluate how well the heart responds to increased demands for blood and oxygen when the body is under stress, typically induced by exercise.
Here is the sequence of events with a stress echocardiogram:
- The patient arrives wearing comfortable clothing and athletic shoes.
- An ECG is recorded and ultrasound images of the heart are captured to recorda baseline readings of the patient’s heart at rest.
- The patient gets on a treadmill that is gradually elevated in order to increase the patient’s heart rate.
- Once the maximum heart rate is reached, the patient immediately gets their ECG recorded and ultrasound images captured of the patient’s heart at stress.
- The cardiologist analyzes the results and provides guidance to the patient on suggested course of action.
There are numerous metrics recorded with a stress echocardiogram, too many to discuss here. However, there are two metrics that are relevant for discussion here:
- Ejection Fraction (EF) – a measure of the percentage of blood pumped out of the heart with each contraction.
- Horizontal ST Depression – a value of > 0.5 mm indicates possible myocardial ischemia, which is when blood flow is obstructed by blockage of some degree in a coronary artery.
The following table summarizes the different degrees of EF:
| EF Percentage | Level of Reduction |
| 50-70% | Normal |
| 40-50% | Mildly reduced |
| 30-40% | Moderately reduced |
| <30% | Severely reduced |
EF Percentage Overview
Some of the key implications of a severely reduced ejection fraction include:
- Heart Failure: A severely reduced ejection fraction is often associated with heart failure. Heart failure occurs when the heart is unable to pump blood effectively to meet the body’s needs. It can lead to symptoms such as shortness of breath, fatigue, fluid retention (edema), and exercise intolerance.
- Increased Mortality Risk: A low ejection fraction is a strong predictor of adverse cardiovascular events and mortality. Individuals with severely reduced ejection fraction have a higher risk of sudden cardiac death and other complications.
- Impaired Exercise Capacity: Reduced ejection fraction can result in decreased cardiac output, limiting the ability of the heart to supply oxygen-rich blood to the body during physical activity. This can lead to exercise intolerance and reduced quality of life.
- Arrhythmias: Severe reductions in ejection fraction can disrupt the normal electrical activity of the heart, increasing the risk of arrhythmias (irregular heart rhythms). This can further contribute to the risk of sudden cardiac death.
- Complications of Heart Failure: Chronic heart failure can lead to complications such as kidney dysfunction, liver congestion, and pulmonary edema. It can also exacerbate other health conditions.
- Impaired Pumping Function: The heart’s pumping function is compromised when the ejection fraction is severely reduced, affecting the ability of the heart to efficiently circulate blood and maintain adequate perfusion to vital organs.
My Stress ECG Results
For my age, the test was configured such that the target heart rate would be 135 beats per minute (BPM) and the maximum of 152. During the test, my heart rate got to 142 before the technician had me stop. At that point I was really huffing and puffing!
Immediately after I got off the treadmill, the ECG and ultrasound data was gathered.
Fortunately, my EF was 60-65%, which is falls in the normal range.
However, my horizontal ST depression was 1.5mm, which is higher than the acceptable < 5mm.
Heart Rate Monitor Interpretation
Overview
There are many types of heart monitors, but I was given a Zio XT monitor to wear for seven days. This monitor is simply a data logger, and has no means to transmit data or alert anyone if an anomaly is found.
However, the device has a button that can be pressed if the person wearing the monitor experiences an unusual feeling or pain in the heart. A log book is provided so that the person reporting the condition can “bookmark” when the event occurred, and can write down what physical activity was occurring in the time that led up to the event.
My Heart Rate Monitor Results
After seven days, I removed the patch and mailed the patch to an address in Illinois for analysis (e.g. to look for AFib).
Fortunately and thankfully, the data recorded by the heart monitor showed that my heart exhibited no AFib over the course of those seven days. (Although a few premature atrial contractions were detected, the longest of which was six beats. I will leave that as an exercise for the reader to research what those contractions are.) Later I will discuss a potential reason why my KardiaMobile 6L reported “Possible AFib.”
WakeMed Cardiologist’s Conclusions
TWS:
A few days before an upcoming 5K, I mentioned to the WakeMed cardiologist that I was going to run/walk a 5K on the upcoming Sunday. He said that was fine, but suggested I hold off getting the heart rate monitor until the Monday after the 5K, right after my stress echocardiogram.
I later mentioned this sequencing to the UNC Rex cardiologist. He was surprised and said that the monitor should have been attached before the 5K, in order to measure the heart under stress. This is an example of the value of getting multiple opinions.
TWS: calcium, family history, stress test-> stent
TWS See hardcopy markups!! After this was interpreted by the WakeMed cardiologist, he called me on the golf course and told me what he found was a low risk issue; however given my high Lipoprotein (a), horrible CT cardiac calcium score, and family history, he recommended that a stent be inserted. Needless to say, the last 6 holes that day were a blur.
Interestingly enough, between my initial consultation and the stress test, the cardiologist said I was okay to run in the Carolina Hurricanes 5K on September 19. I didn’t push myself and walked every now and then, but I completed the 5K and definitely got my heart rate up.
So the day after that, I got the stress test and the next day in the golf course the doctor called me and said well it’s a low risk based on your genetics and calcium score. I believe we should put in a stent scheduler will be calling you
UNC Rex Cardiologist Visit
Right at this time, the UNC Rex cardiology appointment was came up and so I pushed off the scheduler from WakeMed. He recommended a CT angiogram that where they inject die and can tell how much better understanding of blockages in the heart. At this point, I dropped a WakeMed doctor since wake me at cannot do the CT angiogram. I never really mentioned it.
CT Coronary Angiogram
Overview
So the CT angiogram is done and it turned out that my Widowmaker artery was more than 70% blocked. 70% is where they will do something like a stent versus just trying to control the cholesterol statins and perhaps diet.
Tom: Apparently stress can cause high blood choleterol
So that point he scheduled a cardiac catheterization on (of course) Friday the 13th of October. Last stroke of luck. Both of the boys were in town for us to go on a boom trip unfortunately had to cancel that trip but at least they were there to help Andrea navigate this situation.
So the CT angiogram is done and it turned out that my Widowmaker artery was more than 70% blocked. 70% is where they will do something like a stent versus just trying to control the cholesterol statins and perhaps diet.
Tom: Apparently stress can cause high blood choleterol
UNC Rex Cardiologist’s Conclusions
TWS: Due to >70% blockkage, time for cardiac cath. note we don’t recall him ever saying stent vs bypass.
Time For Cardiac Catheterization
Overview
With the cardiac catheterization a.k.a. cardiac cath, the cardiologist (at least in my case) puts a catheter in your groin and goes up in your heart and look around (a “look see” as the UNC Rex cardiologist described it). If the cardiologist confirms a blockage(s) > 70%, a cardiac surgeon would insert the stent(s).
If a stent(s) would not adequately rectify the blockage, a bypass would be required. Note that the room where the cardiac cath is performed is not a sterile surgical room, so a bypass would have to be scheduled.
My Cardiac Cath Results
So I went into the room and the cop. The cardiologist is there next to me and he put in the catheter which actually hurt a lot and then I could feel the contrast dye inside my body and then I woke up. It turned out that I had “coded on the table and they had to defibrillate me that’s pretty crazy at that.
Andrea met the cardiologist. He said, “Well we had a surprise. I don’t member the last time this happened.” and then he mentioned about me coding. It turns out that my left main artery is really narrow and the left main feeds two of the four main arteries in the heart, so because of this bypass was needed.
The Bypass Consultation
So Saturday the I was in the room and waiting for status update in the cardiac surgeon PA came in. She said that well you know it’s the weekend and I usually don’t do stuff on the weekends. Your vital signs are stable so because we have Buck schedule during the week. Maybe it’s a Tuesday or Wednesday you’ll get the surgery done.
Less than an hour later, the cardiac surgeon came in and said “I don’t like what I saw in those images. You might live this Christmas, but you will not lift next Christmas. How would you like to proceed quote parentheses I think he loves using that line parentheses. He actually scheduled the surgery for early Sunday so clear that showed the urgency of the situation.
To wrap up this conversation, the cardiac surgeon said, “Well, I’ll see you naked tomorrow morning on the operating table.” This clearly shows how confident the surgeon was, and that he had a bit of a sense of humor.
TWS: wrap up blog entry #0 here
Surgery Prep
Needless to say, that was an eye-opener for us. So 4 o’clock in the morning Sunday morning I had to take a shower and then two female nurses shave my body so much for dignity then I was glad off the surgery and of course you go on a certain operating room. You see all the shiny stainless steel in the bright lights, and then I will send you were in the postop waking up feeling like crap.
Early Days of Post Op
So I woke up there’s some two IVs hanging out of my neck there’s three tubes going into a box coming out of my stomach for a drainage and how convenient the catheter for urine.
Tom, here mention the hallucinations.
Fortunately, I was in good enough shape or I could get up out of bed pretty early in the process San Jose able to get up to go to the bathroom by myself although I don’t need to for the first few days obviously unless I could get up to my car and legs are in good shape which I am thankful for this is what I had planned for.
I was quite fortunate that I didn’t lose my appetite. My mom and a good friend of mine had heart attacks and after the surgery everything tasted like metal and they had no appetite at all. I was frustrated at the time with my mom and she couldn’t eat, but now I feel kind of bad about that.
So on Tuesday while someone was visiting me, my heart went into a fib, and my pulse rate went really high just kicked off another battle. I was put on an IV of amiodarone and to hopefully change my heart to get back to normal sinus rhythm.
Latter Days of Post Op
So on Wednesday, they hooked up the box and on the walker, and I took my first steps after the surgery. It was quite painful to get up with those three tubes in my stomach. Everyone kept saying things would be much better once those tubes came out, and they were correct, thankfully.
Tom here put how awesome and it was
So Friday or so they put me on oral version of amiodarone two get my keep my heart out of a fib in Normal Sinus Rhythm. So we went home Saturday afternoon and.
Home Again! (Spoiler Alert: Not For Long)
Because of the fact that they cut my chest wide-open I had to I have to sleep on my back until like eight weeks so that the bone heals. When I got home Saturday night, I tried to sleep on the bed but we couldn’t get the pillows comfortable enough, so I ended up going in the recliner in the bonus room.
So about 115 or so. In the morning I woke up. My heart was really beating really badly or hard whatever and much Danny Dries Shukri and I went downstairs and got my KardiaMobile device and also took my blood pressure and everything was OK. Early that early in the morning Andrea came by and put her I watch on me and it turned out that I was in a fib my pulse is in the one teens.
I went downstairs and got my KardiaMobile device and it also noted possible a fib which validated the Cardia mobile device in my mind. I called the doctor hotline and they sell out and Sunday go to the emergency room and they will they will take care of you and hopefully get into the heart and vascular Hospital.\
So they kept me on amiodarone IV for a few days and then move me to an oral tablet. On Saturday they sent me home with a tapered load of amiodarone right now. I am at one pill for the next week and a half or two weeks.So they kept me on amiodarone IV for a few days and then move me to an oral tablet. On Saturday they sent me home with a tapered load of amiodarone right now. I am at one pill for the next week and a half or two weeks.
So they kept me on amiodarone IV for a few days and then move me to an oral tablet. On Saturday they sent me home with a tapered load of amiodarone right now. I am at one pill for the next week and a half or two weeks.
Emergency Room Fun
The weekly drive, but this point my blood pressure oh sorry my BPM was in the 130s every now and then that was getting kind of scary so I went to the hospital ER and saw those sick people in emergency room waiting room. Luckily Rexis as a chest separate chest area and they said go sit in that chair and very quickly I was on the table getting an EKG done
So I was led to the little cubby in the ER and talk to some other doctors and nurse doctor nurse there at that point he really wanted the heart doctor to take over but the protocol is the ER doctor owns everything so after about noon they put me on an IV of amiodarone and six hours later at 3 PM. Luckily a room opened up at the six floor where I was earlier I was in room HP 6018 this time versus a three 6024.
They are we met an awesome nurse named Helene that Andrea ended up printing on the Facebook. At 5:44 PM on that Sunday the 22nd, my heart went back into normal sinus rhythm.
Second Stint On The Sixth Floor
Should I Have Known Much Earlier?
Looking back, I was experiencing issues that would indicate heart disease, specifically a lack of stamina. I have run off and on for several years, including numerous 5Ks and three half marathons. The last few years I have been battling foot issues, but have managed to run a couple of miles every five days or so.
I noticed that my runs were more of a struggle, and I had reverted to a run/walk approach. I simply rationalized it as, “well, I haven’t run a lot lately. I just need to build up my cardio.” I now believe this was a missed clue on my heart issue. I never had chest pains worthy of concern.
Another things I should have considered is the fact that both my father and mother had heart attacks at the age of 71. Sadly, my father collapsed and died from a heart attack March 21 of 2000, and my mother had a heart attack (and really miraculous to have survived) in July 2000.
The medical community did not consider 71 as a young age to have a heart attack, and thus did not put me in a higher risk for CHD. I in fact had a stress test in 2001 or so (out of my own paranoia that some light-headedness was a sign of something going on with my heart), but nothing was found. I had also tweaked my diet for a while, but eventually reverted back to my not-so-healthy diet.
What’s Ahead
Now I am eating a heart healthy diet, walking a couple of times a day, and trying to drink a lot of water. I am looking forward to cardiac rehab starting in late December!
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My goal is to continue describing my experience in the hospital and what to expect, educate folks on cardiac health, and perhaps motivate people to adjust their lifestyles to avoid going through what I am going through.
Stay tuned for updates! Did I mention to subscribe? 
Future Content: Describe a heart-healthy diet, give example of protein bars instead of hot dogs backfiring, fake meat being unhealthy
The USDA recommended daily allowance is 20 g of saturated fat. However, a heart-healthy diet limits the intake to 15 g. For both diets, sodium intake is recommended to be 2300 mg, which is roughly a teaspoon full of salt.
Hospital Highlights (future blog?)
- As I mentioned earlier, the nursing staff was just incredible
- My cardiac surgeon was “quite confident,” which left me and my wife feeling as comfortable as could be expected for such unchartered territory.
- The food was better than expected.
- My wife had a surprisingly comfortable bed (conversion from couch) to sleep in so that she could help me out.
- The nursing staff didn’t really make a big deal if there more than the limit of two guests. (Except in post-surgical ICU)
- A personal note, but the hospital was only a 13 minute drive from our house, the parking was easy and my wife always felt safe.
- The rooms were quite large and comfortable.
Hospital Lowlights
- Post-surgery, I was getting my finger pricked 3-4 times a day to check my glucose. Apparently insulin given to me during surgery is the reason.
Tom mentioned the horrendous rash earlier
- Grinding pumps make annoying sound
- Can I cross feet? Thought
- Thoughts of cardiaversion not working and life on meds
- Thoughts of me being hypocrite when talking about mom and no appetite
- Bumping button
- Drop glasses
- IV
- Light in bathroom
- Tall nurse raised bed, bed locked. Could not raise or lower back of bed
- Iv under wheels
- Air bubbles in line a couple times
- Bag emptied quicker than nurse thought it would, causing tubing to be flushed
- Realized appetite gone during the night and probably gone for months
- Someone came in and ddint re close curtains
- Surprise X-ray
- Nurse tech gave me water during npo
- Constant movement of sheets over leg to regulate comfort
- Probably slept no more than 15 minutes in any setting. Maybe 4-5 total
- Pillow partially came out of pillowcase that I was using to block bathroom light, which hit face and annoyance that needed to fixing in
- Realized there were so many opportunities for me to pick up on this
What Should You Do NOW?
FAQ
- Did I see a light when I coded during the cardiac cath? Answer: At first I was saying no. However, I recalled that during the procedure I was under “Conscious Sedation.” In this state, I could respond to requests during the procedure, but at the end of the procedure I would have no recollection of the procedure. So in theory I could have seen light, but due to the nature of the sedation I was under, I’ll never know!
- What is the official name of the surgery I had? Answer: Coronary artery bypass graft surgery, or CABG. Pronounced “Cabbage.”
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