The murmur was so loud I could hear it without a stethoscope. I was surprised I hadn’t noticed it before. With my head on his chest it sounded like a washing machine churning, and with the assistance of my stethoscope I could hear it radiating throughout his entire thorax, including when listening to his back.
The physician in me was obviously concerned and planning out which cardiologist I would refer him to. The human in me was alarmed at the thought that my husband might need a major surgery.
He hadn’t been having any chest pain, in fact we had just gone for a 4 mile run that day. Over the past few months he had been feeling a little more winded with heavy exercise than usual, but he thought it was just lack of conditioning as he hadn’t been cycling as much lately.
Two weeks later during his transesophageal echocardiogram the cardiologist put his arm around my shoulder and said, “He’s going to be okay, but he’s going to need surgery. Soon.” When he woke up from the sedation he could tell from the look in my eyes that it wasn’t good news. His mitral valve was “completely shot.” The anterior and posterior leaflets of the valve, instead of being tethered to the heart muscle, had ripped free and the valve was wide open. With each beat of his heart the blood was backwashing into the left atrium, and the left side of his heart was starting to enlarge due to the increased pressure. It wasn’t an emergency, but something needed to be done sooner rather than later as over time he could develop congestive heart failure if not treated.
We had a plan. We found the best surgeon to repair the valve (who could do the surgery with the most minimally invasive approach possible), and even though we would have to travel, we didn’t mind.
I asked him about his medical history. About five years before we met he had several episodes of a rapid heart rate. He was seen at a medical institution 2000 miles from where we currently live. He said he had a stress test and an echocardiogram back then, and though he didn’t have a copy of the reports, the doctors back then told him his heart was fine, “nothing to worry about.” I was skeptical.
We flew out of state to meet his surgeon for the preoperative assessment. As part of the planning for surgery he underwent a CT angiogram which helps the surgeon to map out the blood vessels in preparation for the minimally invasive valve surgery. He went through with the scan, and we were waiting patiently for the surgeon to finish in the operating room with another case. His fellow was keeping us company, shooting the breeze. As soon as the surgeon walked into the exam room he looked his fellow in the eye and said, “Did you tell them about the stenosis yet?”
No he had not told us.
“What stenosis?” I asked.
“He has a 90% blockage of his proximal LAD. It’s a totally unexpected finding. We can’t do a minimally invasive approach because he will need coronary artery bypass in addition to the valve repair.”
My husband looked pale. He had a hard time following exactly what we were talking about, but he knew it couldn’t be good.
I explained to him that in addition to the valve problem he had a 90% blockage of the main artery that supplies the heart with blood – this puts him at risk for sudden death if the remaining 10% of the artery suddenly closes off. (In the medical community we call the LAD “the widow-maker.”) He would have to have open heart surgery to fix the problem, so the minimally invasive approach for repairing his valve was off the table. Thank god for the heart murmur. If he hadn’t had the murmur, the blockage would have gone unnoticed because we never would have thought to pursue any testing. He wasn’t having chest pain or other symptoms of heart attack, and he was young, healthy, and fit. Even the cardiac surgeon was shocked by the finding. What started off being a chronic issue that needed repair suddenly was overshadowed by a much more immediately life-threatening problem.
I was just grateful that we found the blockage before it was too late. He could have gone out for a bicycle ride one day and never come home…
Months after the surgery we received his medical records in the mail from years before. As I reviewed the reports I noticed something odd. The cardiac stress test from years before was actually positive – a sign that even back then he had evidence of the LAD blockage. The report even was marked “abnormal” under the interpretation. However, upon reading the cardiologist’s note, the cardiologist cited a “normal” cardiac stress test. A huge oversight, and one that could have cost my husband his life.
As a physician I understand the pressure we are all under to see more and more patients in shorter and shorter time frames. Not to mention, there is an overwhelming amount of data that we are expected to review and synthesize as part of our duty to provide excellent care. No one is perfect all the time. It is human to occasionally make a mistake, so I do not blame the cardiologist who missed this critical element of my husband’s health situation. However, if we had access to review this report long before I heard the murmur, I would have known something wasn’t right and could have taken action. Even my husband, not having a medical education, would have read the word “abnormal” on a stress test and would have known to ask for an explanation.
Thankfully by the grace of god we caught the abnormality before it was too late. His surgery was successful (both the bypass and the valve repair), though he had quite a long road to recovery. There is no question that having instant access to those reports from several years ago could have been lifesaving. Chance was on our side this time.