Sometimes the medical clinic seems to have a theme for a time with several of our patients coming in with similar things.
Here recently one of the themes seems to be cardiac. (See blog Stomach, Lungs, or Heart for another one of these patients.)
Last week, we had a visit from a patient that we had last seen about a year ago when he was diagnosed with late-stage heart failure. At that time, the x-ray showed that his heart was enlarged to the point of almost filling his whole chest, limiting his lung capacity. He came last week with a sore on his leg that was not healing. Though we provided wound care we explained that with his poor circulation due to his dying heart it would likely not close. His only hope was a heart transplant which is, as far as we know, non-existent in this country.
The nurse tending him could tell that he not far from death and sat down to talk with him. This friend had believed on Jesus as God’s Son and His savior over a year or more ago. The nurse frankly told him that he was close to death and discussed what that would mean for him. The man acknowledged that this was so, he knew it, and he was ready for it to come. Ready to be done struggling with weakness and ready to see Jesus in person. We saw him helped/carried home by another friend for the last time. We were told that he had died just 2 days later. How sweet to know that though we couldn’t fix his illness it is now cured forever and he is seeing Jesus face-to-face!
Then this week, we saw another man, an ex-pat who has lived in this country for 22 years. He, a healthy middle-aged man, had been having increasing shortness of breath. In his health history, there was no cause to be concerned. All vital signs were normal. Limited alcohol use. Non-smoker. Regular exercise. Held a full-time job and had just returned two weeks ago from Sydney, Australia. No hypertension (high blood pressure). No diabetes. No lung diseases. No recent illnesses. And though he had a family history with extensive heart issues, he had never had any problems. His exam was also completely normal until the doctor had him move from laying on the exam table to sitting up. When he went to place his stethoscope to listen to his heart and lungs, the doctor saw the irregular beat in the jugular vein and surmised that he might be in arrhythmia (irregular heart beat).
Chest x-ray showed a moderately enlarged heart. EKG showed atrial-fibrillation/flutter. This is when the upper chambers of the heart are out of sync with the lower part of the heart and receiving extra signals to beat, thus beating too fast and not allowing appropriate time for blood to fill the chambers and get pumped to the lower parts of the heart and to the lungs. This was causing his shortness of breath.
Lab work came back normal except for a very mildly decreased total protein level and mildly elevated CRP.
With the absence of normal causes for A-fib/flutter it is surmised that he potential had a viral infection at some point that attacked his heart. This reaction caused the heart to enlarge as it tried to compensate for the failure and this growth stretched and potentially separated the nerve fibers in the heart that transmit the signal to beat. This stretching and separating left gaps in the transmission and opened the line for other areas to give additional signals to the upper chambers to beat, leading to a rapid, irregular beat in the atria.
This was hard news to relate to an otherwise very healthy man–his heart is dying. He will be on light-duty for the rest of his life (likely retiring early and moving out of PNG), no strenuous activity (even the tennis and diving he has always enjoyed), and no lifting anything over 10kg unless okayed by his cardiologist. He was not shown to be at risk for clots so no anticoagulation was recommended but we did put him on aspirin just in case. We also started a very low dose beta-blocker just to help slow and rest his heart a little without dropping his blood pressure. He will be returning to Sydney to see a cardiologist who will be assuming his care. I’m sure he’d appreciate your prayers for this big transition for him! Unfortunately, I doubt I will ever be able to give you “the rest of the story”, as Paul Harvey used to say.
We do thank God for great doctors and that he brings things to their minds at just the time it is needed! And that he has given us the equipment and abilities to perform testing on-site and make accurate diagnoses so that we can better recommend appropriate care! “His mercies are new every morning!” (Lam.3:23)