Angie & Jim

Never a Dull Momentby Jim

Just a few minutes after my last post, the fire alarm went off. The policy at the hospital is to shelter in place unless otherwise directed. Everyone in the waiting area was very relieved when the alarm finally stopped ringing. It’s a digital tone, but it is definitely loud enough to get your attention. A few minutes later, the nurse came to bring me to recovery to see Angela. She’s smiling and in good spirits. The doctor that did the cardioversion wanted to keep her sedated as short as possible because the longer you’re in sedation, the harder it is on your body and the longer it takes to wake up. That’s why they only did one zap. Fortunately, that means that Angie is awake and feeling well, all things considered. I’ll post again when we have word from the doctors about the next few days’ plan.

Cautiously Optimisticby Jim

Well, I have some good news. The cardioversion was successful and she’s back in regular rhythm (and in only one shock). They pumped 360 joules through her (yes, the geeky engineer in me just had to ask) and it was enough to fix things. They only wanted to zap her once, so they didn’t ramp up with little shocks like they usually do. She just got the big one first. She was sedated, so she didn’t feel a thing. She’ll be in recovery soon and I’ll be able to go see her. Now, we’ll see if the amiodarone will be enough to keep her out. I don’t know how long they’ll want to observe her, but when the doctors come and talk to us after Angie wakes up, I’m sure they’ll tell us.

Cardioversionby Jim

They just took her back to the OR where they’ll be doing the procedure. They will do a transesophageal echocardiogram to check for blood clots before doing the cardioversion (that’s standard procedure before shocking you out of arrhythmia). If they don’t find anything, they’ll move forward and see if they can stop the arrhythmias. The whole process shouldn’t take very long, so I should be able to post again soon with any update.

We’re hoping and praying that this cardioversion will be enough to get her out and that the amiodarone will be enough to keep her out of arrhythmias. If that’s the case, we should be able to go home tonight. If they can’t get her out, they plan to transition her back to her previous anti-arrhythmia drug. That transition has to be done under observation over 48-72 hours. I don’t know if they can start that immediately, or if they have to wait for the amiodarone to get out of her system.

A Trip in the Emergency Roomby Jim

Well, using her pacemaker to get her out of arrhythmia didn’t work, so they’re going to do the cardioversion tomorrow. We saw both Dr. Dubin and Dr. Lui and they are concerned about the recent developments. Angie’s heart function has decreased even more since her visit last week, which worries them. They didn’t have a bed available on the cardiovascular floor, but they wanted to observe her for the night, so they asked that we head to the emergency room and “check-in” that way. They have a brand new emergency room in the new building and I guess we came at just the right time because there was practically no wait. Fastest emergency room admission ever.

The plan now is that they will observe her tonight and do the cardioversion tomorrow. There is concern that the amiodarone (her new supposedly more powerful anti-arrhythmia drug) isn’t enough to keep her out of arrhythmia after they cardiovert her. The problem is they have no way to know. She’s gotten stuck in bad rhythms like this before on other medications and had to cardiovert out, so the amiodarone may still be good enough, but the initial signs don’t look promising. If she goes back into arrhythmia after the cardioversion, they’ll need to transition her back to her previous medicine (dofetilide), which means she’ll have to wait for a few days for the amiodarone to clear out of her system before putting her back on dofetilide. Once the dofetilide is in her system (it takes a few days: it has a longer half-life than amiodarone), they’ll do another cardioversion to get her out of arrhythmia and keep her out. So that’s our plan for the week.

Awaiting a Cardioversionby Jim

We’re here at Stanford waiting to see the cardiologist and electrophysiologist. We had to schedule these appointments only a week ago, so they had to squeeze us in and so we’ve got to do a lot of waiting. So far this morning they’ve done an EKG and a device check. Angie is still in arrhythmia, which means the plan is to do a cardioversion, but the latest word is that they’ll do it tomorrow morning. Expected recovery is pretty quick, so we shouldn’t need to stay long. Dr. Lui did say, “bring a bag,” when we were talking about it last week, so I expect we’ll be spending at least one night after the procedure for them to observe her. I’ll post again in a few hours after we have heard from the doctors.

The Ol’ College Tryby Jim

Well, we had our post-op follow-up appointment today to do a device check and speak with Angie’s cardiologist, and I’m afraid there isn’t good news. The device check revealed that Angie has been in arrhythmia since January 9, the day of the ablation. Getting into the arrhythmia isn’t surprising, because they had her stop her anti-arrhythmia medications before the procedure to induce arrhythmia so that they could find the rogue circuits while they were mapping out her heart. The unfortunate thing is that the new medication they put her on hasn’t been enough to get her out of arrhythmia since the 9th. That wasn’t really what we wanted to hear.

So, currently the plan is to increase the dosage for another week to make sure we give the new drug “the ol’ college try” before giving up on it. Dr. Lui asked that we come back in a week and if she’s still not in sinus rhythm (or regular heat rhythm), they’ll need to intervene. They’ll try first with her pacemaker and if that doesn’t work, they’ll have to cardiovert (shock) her. We’ve done a couple cardioversions before, but they aren’t fun. Dr. Lui mentioned the possibility of going back to a former anti-arrhythmia medication if this one just can’t cut it. We’re definitely hoping that the increased dosage is all it takes and we don’t have to be admitted to the hospital next week.