Care4Conway: 2/3/13

Wednesday, February 6, 2013

SVT

This post is heart related, but not "Conway's heart" related. It seems as though I had an episode of a very fast heart rate, or Supraventricular Tachycardia, yesterday. It started when I was playing catch with my students during afternoon recess. I mentioned to a coworker that I must have overdone it and so I spent the next hour sitting mostly. The heart pounding didn't get any better, and when I stood up or tried to walk across the classroom I felt horrible. After school I went home and called my OB doctor. Her nurse told me to drink some water and lay down for an hour and see if it improved. If it didn't, I was instructed to visit the Women's Evaluation Unit at the hospital where they see pregnant women rather than in the ER. I went in and sure enough, my heart rate was 168. They immediately transferred me to the ER where I was seen right away for an EKG and before I knew it I had a room full of doctors, nurses and techs. I've never had such prompt attention in the ER! We took Conway in once and he ended up being admitted for severe heart failure and they didn't move that quickly! Well, they administered a drug through an IV called Adenocard to try to get my heart back down to a normal sinus rhythm. It didn't work. They doubled the dose to the maximum dose and that did work. The doctor warned me it would feel uncomfortable but oh my! The way the drug made my chest feel almost induced a panic attack. Thankfully it only lasted a short time and it worked on the second dose. I asked what would have happened if that dose hadn't done the trick and they said they would have had to cardiovert me with the shock paddles like you see on TV. So, I feel rather blessed that it didn't have to come to that! They kept me on the monitors for a few hours and ran blood work. All came back normal. My OB ordered a non-stress test to monitor the baby and she looked great. I finally got discharged around 11:30 and made it home shortly after midnight. By then I was so exhausted. Partly due to the fact that it had been a long day, but mostly because my body had experienced the physical strain equivalent to running for six hours. Even my legs and arms were worn out! I joked with friends that maybe now I could put one of those 26.2 stickers on the back of my car that you see marathon runners have! I followed up with my OB today for my regular check up and she would like me to see a cardiologist and ordered an echo to look at my heart. We're hoping to get that done sometime in the next two weeks so she can get the cardiologist's opinion on all of this before my next OB appointment. I've already gotten recommendations from Connie's doctor on who I should try to see. Quick Conway update since it's been awhile: He's doing great heart-wise. We've already had his new pacemaker checked more times since August than he probably had in the previous two years, but all is well with it. He fell one day in gym class and his teacher was concerned that it was on his pacemaker and he was hit in the stomach a time or two during the school day with balls so we sent transmissions each time. He is just getting over a stomach bug (just like most of the country apparently) but other than that, has been very healthy this year. He is going for an OT eval in a couple of weeks to check on fine motor development so we'll keep you posted on what we find out. Please keep in your prayers two other LTGA families. One is a very young mom who could use some mentoring to help her navigate her way through this world of congenital heart disease, but seems to be in denial. The other is a family whose LTGA first grader has been on ECMO (bypass) for 100 days waiting for an angel heart as his is failing. His parents could use some strength for sure during this long journey. God knew the plans for these families before their special children were even born, but it can sure be hard to trust when you are faced with such unknowns.

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Conway's Heart Story

Conway's Heart Story

Conway David Beckemeier was born on March 3, 2007. His heart defects went undetected during pregnancy and he was diagnosed at two days of age with L-TGA, a large VSD, sub pulmonic stenosis and Ebstein’s Anomaly. Just before turning six months of age, he underwent open heart surgery to reroute the bloodflow in his heart. Called the "double switch", this procedure is the most technically challenging for pediatric cardio-thoracic surgeons to perform. The version of the double switch that Conway received on 8/28/07 was called the Rastelli-Senning with VSD closure and sub pulmonic resection. He suffered a grand mal seizure following the surgery that lasted over an hour and had several other post-op setbacks including surgical heart block, which required another operation on 9/18/07 to insert a pacemaker. Following surgery and such a long hospital stay, Conway developed an oral aversion (he would not eat) and he was 100% NG tube fed for eight months. He also lost muscle tone and required both physical and occupational therapies. In April 2008, he had a cardiac cath and attempted balloon angioplasty on his pulmonary arteries that did not work. Although his recovery was very long, he had a solid year or so of being a "normal" kid . Then in May of 2009, it was discovered that Conway was having rhythm disturbances, specifically atrial flutter. His pacemaker allowed it to go undetected for several weeks until he showed signs of heart failure and was admitted to the ICU for a week to be placed on IV heart meds and undergo cardioversion on 5/6/09. He went home and his heart function started recovering when he had another episode of flutter (6/16/09). This time, he was again hospitalized and put on IV milrinone, but he converted back to normal sinus rhythm by himself. At that time he was placed on the anti-arrhythmia drug, amiodarone. On 7/22/09 he had to be cardioverted again for yet another episode of flutter. The following week, he got worse instead of better. His cardiologist did a full work up and it was determined that his aortic, mitral and tricuspid valves were all leaking worse and were felt to be the cause of his heart failure. On 8/24/09 he had a cardiac cath and attempted ablation. The electrophysiologist was unable to induce a single arrhythmia. Then, just two days later, he went into atrial flutter on his own. He was placed back in the cath lab where he underwent mapping and a total of 17 burns were made to try to knock out his arrhythmias for good. The next day, 8/27/09, he had his second open heart surgery to repair his mitral valve called ring annuloplasty. He also had a partial Maze procedure done. His surgeries are performed at C.S. Mott Children’s Hospital at the University of Michigan (Ann Arbor). This time he was discharged just six days later! His Left Ventricular function improved drastically. In December 2010 we noticed he began getting more winded during physical activity. A January 2011 cath showed that he is outgrowing his RV-PA gortex conduit, but he was not symptomatic enough to warrant intervention. In April 2012 Conway’s fatigue increased and an echo at the end of May revealed that the ratio between the right and left sided pressures has gotten too high and it is time to replace the homograft that was placed when he was five months old. He had a cardiac cath on 5/25/12 which confirmed the echo findings. He had surgery on 8/8/12 to replace his pulmonary valve and RV-PA conduit, add an additional pacing wire to his left ventricle, and change his generator to a bi-ventricular model which is shown to preserve function and help the heart muscle pump more efficiently/effectively.