Monday, March 14, 2011

Heart Monitor, ECG/EKG readings of erratics and patient pictures from the Hospital ER

Here I am, relaxed but hooked up to the machine which tells you breathing per minute (white), upper heart, lower heart, (green) blood pressure and all sorts of fun stuff. My one side of my face is red, due to being overheated and my arm is red as my body is putting blood to the surface to try and cool down. Good luck on that! And here, with a close up of the screen, are nine heart beats with two big erratics in them, you can see my breath sucked in as I felt the erratics, as it is that spike in the white line for oxygen.

An electrocardiogram tells the Doctors and Nurses what is occurring in the heart. For example your pacemaker, or AV node tells the chambers when to fire, so heart is pushed around, if it doesn’t that is called IVR (the bottom empties faster than the top fills). Follow along by clicking HERE, then click on the different terms to explain the strip (some are for the upper chambers, like Sinus Tach, some are for the lower chambers, like IVR. IVR (which I had, along with about a dozen others) doesn’t provide enough blood moving, normally. Vfib, is when the bottom strip, the ventricles, are not creating enough electricity for a beat, which leads to heart failure, or Agonal rythym, which is seen right before asystole, otherwise known as ‘flatline’.

Each of the little boxes is .2 of a second, so literally only four or five seconds of your heart is often taken, unless, like me, you are hooked up to a continuous monitor and feed. Much of the early, later, and post medicine paper feeds off the EKG were taken for my chart, as I left once regular rhythm and/or Sinus Tach was established. We took some of the roll from the section after assessment and during treatment. The last time I came in, there were very small bumps, the kind you see here 10-14 times between heartbeats, or small extra beats, very small. (click to enlarge and read the ECG strip) Because I was in sense with my body, those hurt, so I went in. That was two years ago, they said.

Since then, I have heart pills, and I have high levels of pain control and yet, the pain got so bad I did not have control over my limbs or the ability to see clearly. Instead of regular waves or Sinus Tach with small extra beats thrown in, there is almost random chaos, as while the heart does beat, there is a fluttering of the valve, those little bumps, you can see, up to eight times a second
going on for sometimes several seconds. When this happens, the blood comes into the heart but nothing happens, it doesn't move on, or blood backflows. This is extremely painful and my teeth are exposed in a grimace as my back arches off the bed.

Also, sometimes the heartbeat simply stops, or goes into agonal rythym. Looking at strips like this, I wonder why I was let out of the hospital, or why I'm not dead. Sometimes the upper and lower chambers all fire at once, or the four parts of the beat are missing, just a burst of electricity, seen as a spike before going into asystole (flatline, which you can see starting), then into erratic upper heart chambers which take over the whole heart making it unstable, and blood not flowing. For humans, this is usually a very bad sign. Like a 'you are dead or soon will be' sign. For me, is it normal? But every time they took the strip, every 6 second strip or four seconds there wasn’t 1 or 2 errors but dozens. To give you an example, a holter monitor, if you have an EXTRA AV node, giving you a heart condition called PAT, might have 47 or 69 irregular heart beats, or extra beats in a 24 hour holter monitor test. Here I had more irregular beats in two minutes than I did four years ago in 24 hours. I guess it is clear now how my disease (AAN or MSA varient) is a degeneration of the central autonomic system (the heart, lungs, blood pressure, vascular constriction, etc).

Sometimes the heart will keep pumping in the upper chambers while the lower chambers do not empty, which is both very, very painful, but also cuts off blood flow to the brain and body. The readings are not supposed to go beyond the edge of the strip, but depending on how strong the electricity, or ‘pulse’, and erratic…, same with when they stop.

At least I give lots of variation for them to read, right? The machine would put out the errors, the recommendations, and the heart rate as well as other vitals. Sometimes that would simply be a ‘?’ which means, ‘unable to capture’ – which happened often on the heart beat, as if I am so erratic, it can’t count a reliable heart beat.

Here I am being hit with a series of erratics, you can see my eyes are shut due to the pain, which wrinkles my brow as I arc my back and tense up as if getting hit by a baseball bat in the chest (as that is what it felt like). The monitor shows 11 heart beats, which have five erratics in the upper heart chamber and well, a BUNCH in the lower chamber including the big spike up and down on the left (which is probably the pain I felt, causing me to clench and arc), and the erratic breathing to match the pain levels.

Plus there was an automatic heart rate and BP monitor attached to me, and if it couldn’t get a good reading it would tighten again and again, so I have bruises all along with that was. So this is a reading of what occurs to me for from 30 minutes to several hours every day, this was just in the midst of the fourth straight bad day.


SharonMV said...

Dear Beth,
Thank you for the pictures from you ER visit. seeing you in such pain is hard. and your heart readings really illustrate how erratic your heart is. I can recognize the difference over time too.
I read your previous blog about your trip to the ER. I'm amazed that you were so aware & remember so much. You (and Linda) have to fight for the care you need at the ER. I'm so glad the good Dr Cool came & helped. First, bravo for giving you adequate pain relief so that you could communicate. And for listening to you and trying the meds. I'm so glad they worked.

I don't like the ER. I've had nurses not listen, nurses & docs lying or just wrong in the records, just being mean & yelling at me. I wasn't fighting for my life! Now, with all my dxs, maybe they'd treat me better. I'm not convinced. Dennis just said the other day, that if I had to go to the ER, he's afraid he wouldn't be able to remember all my conditions & what I need. So I really need to write it all up for him.

Hope you are doing OK. Kudos for going to Boxing after the ER.


Baba Yaga said...

Those are really very dramatic readings. Sometimes the visual really does help the understanding.

Bits of the understanding, anyway.

It's not entirely surprising that Dr. Gung-ho was rather worried, but ... you'd think that at that point the patient's knowledge might be really useful to draw on, wouldn't you?

Aviatrix said...

Wow, thank you for going to the trouble to collect and explain such detailed information.

Kate J said...

Seriously scary stuff... I don't understand the medical details, but I know you were in serious pain and in danger. Glad you're still here, dear Beth.
And thank you too for the card and bird pictures I just received... beautiful!
Love & peace

JaneB said...

Thanks for continuing to report. I don't know what to say that's any use, but, I'm here and reading. And definitely going boxing was impressive! And getting to work with a partner - does that mean this substitute coach is less of an ass than the last one??

Noisyworld said...

I really want to type some rude words here because that looked excruciating. I too am glad you're still here and are sharing your gift of writing until the end, much love.

wendryn said...

That's a whole lot of erratics. I'm sorry to see you in so much pain. Thank you for writing and helping me/us understand what you are going through.


tinarussell said...

Wow, thank you for posting these. I think I’d be too prideful to share something like my ECG readouts, or what I look like on a hospital bed, those moments of weakness, especially when you’re staring at the readouts and wondering why you’re not dead.

In any case, I’m soooo glad you’re not dead. (tight hugs) Each new word from you is a gift.

And, you still manage to look pretty while lying on a hospital bed with tubes in you, damn it!

Vanessa and Gang said...

Okay firstly, holy crap at those readings! Even when I did nursing work I've never seen a strip come out that bad. XP Seeing that makes me want to cry because I've had eratics before (because I have a heart murmur) but nothing like that and I can't even imagine the pain that you go through each time those hit. Baseball bat? Probably more like a train to the rest of us.

Secondly I'm shocked and angry that they let you go so soon afterward. I mean, really, how long did they have you stable? 15 minutes? With that kind of damage to the heart and chest wall (because it does rip the muscles) you shouldn't even ride in a vehicle for 24 hours. OMG I LOATHE doctors. XP

rachelcreative said...

Ouch is really not going to be a strong enough word. I cannot imagine that pain. Or that pain combined with the doctor with an attitude like a tornado.

While I remember I got a lovely card and gift from you. Thank you so much. I'm always so happy to hear from you and I know what you put into getting that card and gift to me so thank you my friend.

Candy said...

Does the heart problems you are experiencing have anything to do with having marfan's?

Elizabeth McClung said...

Candy: No, though the previous Holter test which showed 47 erratics were PAT's, which was due to Marfans, and I expect some of the valve flutter is increased due to Marfan shaping, as I had backflow before, but not heart valve open flutter. The autonomic failure is electrical failure causing everything from surges to little blips of electrical energy which don't seem to even make a heart beat.

I certainly wouldn't have the comparison readings without regular marfan's testing, so I recommend that not just for the ole 'exploding heart' issue and valve issue but to establish a baseline if or when heart issues progress. Marfan's would mean a physical patch or bypass or transplant but with electrical signals from the mystery portion of the brain controlling heart electricity, changing the heart wouldn't make a difference, alas.

Elizabeth McClung said...

Vanessa: Yes, I did look at that and think, 'Why exactly did they let me go? And why didn't they check my heart structure?' I don't think protocols are as rigorous at our cash strapped hospital (but that Zip line at the Winter Olympics was good, yah? Because the Olympics means no health care for another year).

And also thinking, 'How did I stay conscious? Or more important, alive? And how did I stand that for over three days? Dr. Cool indicated that he felt it was a 'flare' like a bunch of sinus tach reset by electrical charge would be a flare and not an underlying condition. Since I am erratic and have been since the hospital, I think it is an underlying condition - but hesitate to return.

Raccoon said...

That looks like so much fun!


But, you made it out. And you kept all of the test strips for souvenirs.

Next time, don't wait so long?

Elizabeth McClung said...

Raccoon: I 'liberated' the strips as all ER documents are usually destroyed here, for reasons I am not sure about, and so never enter medical records. But yes, now, I will wait maybe only 1-2 days.

Thanks to Linda who took the pictures and stayed the whole time.

I have been working to get all systems functioning again, which is challenging, as things keep going off line. How much will power I have I know not, but it seems stretched thinner. Anyway, here is to better days, sunshine and the small good things.

Neil said...

Oh, my goodness. Who needs television when you've got an ECG machine doing all that? Not the sort of entertainment you really WANT to watch, though.

I presume they don't need to save the strips because they have the description and diagnosis; so why bother saving the evidence, since it only takes up space?

Bravo for Dr. Cool, Brava for Linda staying with you and photographing you in such attractive (OR NOT!!) surroundings. And big bear hugs (virtual ones that don't hurt) to you for being who you are.

Praying for at least one night of pain-free sleep for you,

Lene Andersen said...

thank you for sharing the strips and the photos of you in the ER. Your fearlessness in showing all aspects of your disease to help us understand your situation better never ceases to astound me.

and holy crap! that you live through this every day is astonishing.