The Cardiac Chronicles

And were gonna find out with bubbles

Life is full of questions:

“What is my IP address?”

“How do I screenshot on Mac?”

“Where in the world is Carmen San Diego?”

Right now, my big one is: “Why did I have a heart attack? “

Google doesn’t have the answers to all the questions.

The Labs

At the University of Utah Farmington Clinic, located just inside the east entrance, are the walk in labs. Here, one can get samples collected for testing — no appointment needed. Right after my appointment with sports cardiology1, Emily and I found ourselves in that very spot.

After checking in, we sat down to wait. The day of my appointment was also the third day of the Cocodonda 250 and the leaders were closing in on the finish line. We entertained ourselves by refreshing the runner tracker and discussing whether Rachel Entrekin might snag a podium spot. After 10 minutes or so they called me into the lab, placed an IV in my left arm, and started taking blood. After they took 12 or 13 vials I started wondering if they might be running a vampire food bank.

Later that night, the results started to come in. The quickest were things like settling time, and clotting metrics. Next were lipoprotein concentrations and inflammation markers, then HIV, then I lost track2. Everything seemed to be coming back normal. When you’re chasing the cause of an abnormal event, normal results can be frustrating.

About 5 days after the appointment the last results came in. A couple hours later I get a notification that my “care team” had sent me a message.

Dr. Jacobsen has already taken the time to go over my results. He confirms, the blood markers, all normal. That rules out clotting disorders and blood diseases. He had also already taken my angiogram to his interventional cardiologist friend who confirmed his suspicions about the lack of plaque. This puts the “embolic clot + hole” theory at the top right now.

A blood clot that breaks away from its original location is called an embolic clot. In a pulmonary embol-ism a blood clot travels to the lungs, causing issues. You can also have an embolic stroke if it goes to your brain. Embolic clots don’t typically cause heart attacks because there shouldn’t be a direct connection between your left heart chamber and heart arteries.

A crash course in the circulatory system

In humans, deoxygenated (used) blood enters the heart chambers on left side. From there, it is pumped into the lungs. After picking up some oxygen, the blood flows into the right side of the heart and is pumped out to the rest of the body (including into the left anterior descending artery).

If a clot gets loose somewhere in your body and ends up in the left heart chamber it usually goes straight to the lungs, causing a pulmonary embolism.

This is why the hole is a critical piece to our theory. Come to find out, everyone starts out with a hole in their heart (called a patent foramen ovale). When you’re in the womb, as a baby, you don’t really need your lungs. Mom does all the breathing for you. You get oxygenated blood from her lungs so, as I understand it, there’s a hole in your heart that allows your little baby body to bypass your lungs and pump blood directly to the rest of your body. When you are born, this hole is supposed to close up. In reality, that only happens for about 75% of people, for most of the other 25% it’s never a problem. For me, it might be…

It’s possible, somewhere in the far reaches of my body, maybe from the stresses of training, or a cut, a previous surgery (deviated septum, wisdom teeth), or something else entirely, a blood clot formed inside a blood vein, broke off, and traveled up to my heart. There, instead of getting pumped through my lungs, it got pumped through a hole into my left anterior descending artery, where it got stuck.

Bam! Blood flow to the heart muscle is blocked and I’m having a heart attack.

The first time this theory surfaced was at Mckay Dee. The operating doctor mentioned embolic clots and heart holes but embolic type stuff is supposedly more common after an activity, not during. He gave the example of people doing Ironman triathlons. Often these athletes travel a faraway place to compete, then have a heart attack or pulmonary embolism on the plane ride home.

We’re getting used to being abnormal at this point aren’t we.

Now we’ve got a well formulated theory, (even though it might have some holes) it’s time to test it out.

What do we do?

An echocardiogram, with bubbles!

Sounds like a cheap upsell, like a combo meal, or personalized engraving.

From what I gather, an echocardiogram with bubble study is similar to finding the hole in a punctured bike tube. First you’re stuck with an IV. Then two syringes are connected to the IV port. One syringe is full of saline. The stopper on the other syringe has been pulled back to fill it with air. Pumping the two stoppers back and forth makes the saline froth up. After it’s fully carbonated, the saline gets pumped into your veins. On the ultrasound, your heart pumps and the bubbles are visible as they pass through any holes in your heart.

Pretty neat eh?

I always thought bubbles in your blood were bad; I guess these are special. In theory, the bubbles should make their way through my circulatory system to be breathed out in my lungs. This is much better than what happens when I get bubbles in my digestive system.

It’ll be a couple weeks before I go in for my echo with bubble study. For now I’ll focus on answering other ungooglable questions like: “what are we gonna eat for dinner?”, and “where are my car keys?”

A blog with bubbles? maybe someday