I’m coming to the end of a busy week on-call, and now very much looking forward to a day off tomorrow! I see so many patients during a week on-call, that there are always some interesting cases for my weekly blog, and this has certainly been the case this week. From a ‘human factors’ perspective, one story tops all the others; I felt so sorry for this lady. She was due to get married this week, and like many soon-to-be-brides was feeling a bit nervous. She noticed some palpitations, but thought nothing of it for obvious reasons. However they got worse and more frequent, to the point that the day before the wedding they were so bad as to attend hospital. We hooked her up to a heart monitor, whereupon we saw pages and pages of a really fast, abnormal heart rhythm. No wonder she was feeling unwell! The good news is that we were able to treat her with medication which really settled things down, but the bad news was that it wasn’t in time to save her wedding day which had to be cancelled. She was remarkably stoic about the whole experience, focusing not on the cancelled Big Day, but the successful medical treatment of her heart.
Speaking of being stoic, after last week, I have indeed re-kindled my daily meditation practice, and thank goodness I did. Yesterday I thought I would help my wife out by nipping to the supermarket for a few bits we needed. The supermarket near me has a rather tricky car park. There were no spaces on one level, so I cautiously approached the lower one, knowing it was a bit tight. Despite crawling at a snails pace, I managed to scrape one wheel really badly. £12 on shopping, I’m guessing £100 to get my wheel fixed?! There are times that I wouldn’t have been able to let this go mentally, but I was totally OK with it. Just because I left home with an intact wheel, there are no guarantees I would return with one. Life is inherently unfair, and if I am able to accept that as a fundamental truth, it makes it far easier to deal with curveballs. I’m still not sure I would have coped well with my wedding being cancelled the day before though, that is Zen-master level meditation!
The next patient to mention is something I don’t think I’ve ever actually seen before, or at least, it’s an incredibly rare form of a relatively rare condition. A lady in her 50s presented with chest pain last week before last, and the initial diagnosis was a heart attack based on the ECG findings. However, when she had a coronary angiogram to look at her arteries, they were normal. An echo (ultrasound) of her heart was also normal, so she was discharged. She then re-presented with further pain, and a bit rise in her troponin, which is a blood test that typically rises with heart muscle damage (such as a heart attack) or inflammation. I’ve written before about the condition myocarditis (literally – inflammation of the heart muscle) but what made this case so unusual is the cause of the myocarditis.
This lady is asthmatic. In asthma, sometimes patients can have over-activity of a certain type of white blood cell, called an eosinophil. These cells play a crucial role in the immune system, particularly in combating infection and allergic reactions. They are normally found in relatively small numbers in the body, but in her case, the count was huge, many many times the upper limit of normal. My hypothesis is that huge over-activity of her eosinophils has led to the condition eosinophilic myocarditis. Steroids to reduce the inflammation form a crucial part of treatment, but like I say, this is really rare, and I’m not sure I’ve ever seen a confirmed case.
In this week’s research video, I hope you’ll indulge me as I discuss a trial that I have been heavily involved in, which got published in a very high impact heart journal this week. It’s not every day that I author a paper, particularly one in such a good journal, so I couldn’t really talk about anything else. It’s about a first-in-human trial of a new heart sensor, and I was the highest volume implanter in the UK. Do check out the video, and whilst I appreciate it may be a bit niche for many, the link to the article is here
I’ve also done an ‘ask me anything’ video this week, which sees me looking very dishevelled with a heart rate of 181…
Have a great week!