A Moment of Serendipity

My plan for the week after the Auckland main event was to write a blog post about my experience in the main event.

However, the events of  Tuesday night, Nov 25th, derailed all my motivation with respect to blogging about poker, with the events percolating through my brain over the days since Tuesday likely to be affecting my poker play for a while, so I'll write about my Tuesday night experience instead.

On Tuesday evening I had an appointment with a cardiologist to discuss an episode of arhythmia (irregular heartbeat) that I had experienced in mid-October. I had had an episode of arhythmia lasting about 30 minutes, during which time I had found it hard to walk up a hill that I normall take with ease. I had done a little bit of googling and had self-diagnosed as Paroxysmal Tachycardia - which seemed to be reasonably benign in the scheme of things.

The cardiologist had requested that I have an echocardiogram immediately prior to my appointment with him. When I viewed the price tag associated with the procedure, one of the thoughts that went through my mind was that I hoped this procedure wasn't just a way for the cardiologist to pump up his income. For a fourty minute procedure, it seemed to be expensive.

Echocardiogram done, ECG with cardiologist's nurse done. Into the appointment to discuss my arhythmia. Or so I thought. He led off by asking whether the lady who had performed the echocardiogram had discussed the findings and when I said "No", he then informed me that while the Echo had been scheduled to check the Atria of my heart out as he suspected Atrial Fibrillation, in a moment of serendipity, they had found I had a bicuspid Aortic Valve. Plus an Aortic Aneurysm. That, at 5 cm, was, in his opinion, probably right on the cusp of requiring an operation in the near future.  It would appear that the money spent on the echocardiogram was money well spent....

When your specialist's body language has the following elements - anxious, concerned expression, arms clasped in a protective fashion across his chest, eyes in the main looking down with only occasional eye contact, body position in general looking uncomfortable - it is difficult to remain fully focussed on what he is saying. While I felt calm in a surreal way during the appointment, in retrospect I wondered whether he thought he was informing his patient that his patient was a "dead man walking".

At one point in our meeting he was looking for the results of blood tests ordered by my GP. I said to him that my GP had told me that "he was jealous of my blood test results". He then muttered "Well, he won't be jealous of your echo". When I related this tale to my GP, my GP laughed out loud... luckily we both saw the macabre funny side of it.

The next steps in this journey will be to have a CT coronary angiogram, with a follow-up visit to the cardiologist shortly thereafter. Normally he would have requested a MRI as the next step. I'll include the part of his letter to my GP that summarizes the current status of this particular journey.

This is a very significant finding. Bicuspid aortic valves are the most common congenital anomaly. Bicuspid aortic valves can be familial and are associated with thoracic aortic root dilatation and a high risk of aortic rupture. The usual indication for surgery for a thoracic aortic aneurysm is a 55mm dimension but for a bicuspid valve with high risk features the indication is 50mm which is what has been measured on the echo. In addition, Hamish has a family history of abdominal aortic aneurysm. This is a risk factor.

It is imperative that we image the thoracic aorta more fully either with a CT scan or with an MRI scan. Whilst we would normally undertake an MRI scan because of the absence of radiation, a CT scan gives us the option of imaging the coronary arteries. Because it is possible that aortic surgery may be required sooner rather than later I think a scan of the CT thoracic aorta and combined with a CT angiogram is the best first investigation.

I have explained to Hamish that he may very well need thoracic aortic surgery in the near future. This is major surgery but once the dimensions reach surgical indication the alternative risk is that of thoracic aortic rupture and sudden death.

If we are not yet at surgical dimension we really want to delay progression of the aortic root dilatation. The two drugs that have been shown in clinical trials to achieve this are beta-blockers and losartan. Because of the probable paroxysmal atrial fibrillation it makes sense to use a beta-blocker in the first instance as this may provide rate control and also reduce the progression of aortic root dilatation. I have warned Hamish of beta-blocker side effects including fatigue, lethargy, dyspnoea, wheeze and occasionally impotence. These side effects may improve over time"

Because bicuspid aortic valves can be familial I'm now in the position of having to let my sons know that they will have to have echocardiograms to check whether they too have bicuspid aortic valves or not. Bicuspid aortic valves, along with other risks, from my reading of various articles, appear to carry about a 45% risk of developing Aortopathy such as mine. With one theory being that the changed haemodynamic flow produces different forces on the aorta when compared with the haemodynamic flow through normal tricuspid valves. And another being that there is a genetic weakness with respect to the aorta wall's connective tissue leading to a tendency for the aorta to dilate. Regardless of which theory may be correct, if either of my sons are found to have bicuspid aortic valves, they will likely have to have follow up echocardiograms at regular intervals to see whether they are developing cardiovascular issues that require intervention.

Seems like, just to be on the safe side,  I need to have my affairs in order sooner rather than later. For the week after getting this serendiptious news, I continued to play poker, even less well than normal,  as a way of distracting myself from this issue, However, today I have found that, while my desire to self-educate was low for most of the past week, I've found I've come back to watching poker videos today. Which I view as a good thing.

In the meantime, CT angiography scheduled for December 3rd, with follow up appointment with cardiologist on December 8th.