Tim Samoff // Weblog (old)

July 08, 2004

A little bump in the ol' Troponin...

Or… What would a guy do for a new Blog entry?

Question: What’s worse than having a urinary catheter put in?

Answer: Having it done twice!

(I could do with a rim shot here, but I know you’re a good audience and your laughing hysterically right now.)

But, I guess this isn’t really a laughing matter. You see, after Tuesday morning, my status as a human being changed somewhat. I am now a 32-year old heart attack survivor.

Yeah, I can hardly believe it myself.

It happened rather subtly. I had arrived at work and was quietly typing away on my computer. First it was my fingertips. They just…hurt a little. It wasn’t too bad. In fact, it was probably another half an hour before I really took notice. By this time, my fingertips, hands, my left arm, and between my shoulder blades were aching pretty badly and I was very uncomfortable. In fact, for some reason, I felt like taking my wedding ring and my watch off even though I wasn’t swelling up or anything — they just felt like they hurt and I needed them off. All the while, pressure in my chest was building and my breath was getting shorter. Nothing was excruciating, mind you, just…uncomfortable. The strangest thing was that, while nothing seemed too wrong, something inside of me was telling me that all of this was more than just aches and pains. After calling my wife (who works in cardiology), I was convinced that I should go to the hospital. My boss drove me to the hospital and I checked into the E.R.

At this point, I still didn’t think that I had a heart attack. Neither did the E.R. doctor. I mean, I’m young, I’m healthy, I was cracking jokes and generally seemed to have a good attitude… These just aren’t things that apply to the usual heart attack victims that come into the E.R. I was a mystery.

The first thing they did was draw some blood. One way to see if someone has had a heart attack is to check the level of Troponin in their blood stream. Troponin is a protein enzyme that resides in the muscle of everyone’s heart. When a heart attack occurs, this enzyme is released. Normally, a person has less than 0.7 milligrams per milliliter in their blood. Mine was up to 1.8 mg/ml. Now, this is still low, but it assured the doctors that some sort of heart trauma had occurred.

Two hours later, my Troponin levels were up to 14 (the levels that you would usually find in your average 70-year old heart attack victim). This was strange, though, because usually, Troponin levels drop drastically after a heart attack takes place. The mystery was getting even better and I was labeled as a future “Interesting Case Study.” (I must include that my EKG showed a normal, stable heart rhythm all the while.) When they found that my Troponin levels had increased, they had me admitted to the hospital and scheduled for a Cardiac Cath.

The Cardiac Cath only created more mystery. My heart was completely clear (as you can see in the photos of my arteries). They came up with one possible cause of my attack, but they were pretty much still stumped. The attack may have happened because two of my arteries are crossed (the circled area in that first photo there — click to enlarge). Possibly, one of those arteries became swollen for some reason and, in doing so, crimped the other artery. Another factor in all of this may be some “narrowing of the arteries” which can also be found in the first photo. This is very bad if there were to actually be build-up in my arteries, but, as you can see, there is none. The second photo shows good, clear arteries, although the largest artery appears to be a bit mishapen.

Anyway, the Cardiac Cath went smoothly. When the nurses asked me what kind of music I wanted to listen to, I said NPR... They wouldn’t comply. In reality, the drug that they gave me for the procedure worked well enough that I don’t even remember what happened.

I had a number of visitors after my procedure was done. It was very nice. I am so thankful for my friends and family. The food isn’t so bad at hospitals either — well, not at this hospital anyway. All of the nurses are very nice as well.

My night wasn’t as pleasant as my evening, though. Hospitals just aren’t very easy to sleep in. To begin with, the mixture of noises and lights don’t make sleep very easy. I asked for a bunch of drugs (Morphine, Valium, Restoril, etc.), but nothing seemed to do the trick. This was all on top of the fact that, because of my procedure, I was not supposed to move. At 8:00 pm, I was to have my “sheath” removed (see picture — click to enlarge). The sheath is the entry tube into my artery so that the dye for the Cardiac Cath could be injected. Once this was removed, I couldn’t move until 3:00 am. Another thing that happened was that, sometime in the middle of the night, my urinary catheter became dislodged — which resulted in my peeing all over myself. So, I had to have that put back in (hence, the introductory joke at the beginning of story). Last, during the night, I developed a fever. This had me shivering and asking for more blankets now and then. It wasn’t fun. This all being said, sleep wasn’t easy. At 3:00 am, I was able to move to my side and sleep for a couple of hours. My fever didn’t break until around 10:00 am.

Wednesday wasn’t very fun either. While I felt fine, I wouldn’t know anything until my cardiologist talked to me. So, Julianna and I waited until we heard. I had a few more visitors. We watched a little TV. I slept a little. It was pretty boring.

At around 1:00 pm, my cardiologist finally came in to let me know what was happening. My Troponin levels were still high, at 6.8, but since they were dropping, the hospital was going to release me. Also, since I was still a bit of a mystery to everyone, I was to be placed on Coronary Artery Disease status (someone with clogged arteries) as a precaution.

So, now, I’m at home — they told me not to go back to work until Friday. I have a couple of new medications to take every day. I even have a prescription for Nitro Glycerin… You know, that pill that old people in movies always yell for when they grab their heart? Yeah, that’s funny. I’m going to have to go back to the hospital for a couple more check-ups too.

There are now two possible diagnoses for what happened to me. The first is that I had a Coronary Artery Spasm (because of the crossed arteries). The other is that I developed a blood clot on the plane the other day and by the time I had my Cardiac Cath done, the clot had already dissolved because of the medication they had given me. But none of these are final diagnosis yet.

Thankfully, this seems to be a fluke that won’t ever happen again. Thankfully, my heart is clear and I am healthy. I do wish I knew what exactly it was that happened, but I am content to know that I am safe for now.

The incision where the sheath was is fairly painful at this point. And bruised. But I can live with that — as well as a few unsightly bald spots from where they had to shave me. I’m a little tired too. I am also a ball of emotions today, not having had the chance to process everything that has happened to me.

Thanks to all of those who prayed for me. I do appreciate it. I wish I could have gotten a post up about this when it was all happening, but computers aren’t something that they give admitted patients. Go figure.

Tim Samoff: a 32-year old heart attack survivor.

That’s me!

Posted at 2:55 pm

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