I’m sat writing this in the glorious sunshine after a day’s gardening, and it makes such a nice change to be warm! Only last week I was having real issues with Raynaud’s in the mornings, and here I am today in suncream. I’m not a very good gardener, and find it quite a chore, but I do like sitting back with a coffee and admiring the flowers once all most of the weeds are gone.
A heart condition was like buses this week – wait for ages then two come along at once, oddly on the same day. I’m not one for reading the news these days, it’s all too depressing for the most part, so when my wife asked if I had heard what happened to Emma Willis this week the answer was no. Actually, it was ‘who’s Emma Willis?’, I’m terrible with celebrities, but a quick google and I definitely recognise her from the tv. She’s normally fit and well, but was diagnosed somewhat out the blue with a hole in the heart. Such holes are not that uncommon, but what is more uncommon is to have got to the age of 48 blissfully unaware. She had it closed in a keyhole procedure, where the hole gets sandwiched between two discs on either side of the septum – the dividing muscle layer between the left and right sides of the heart.
Usually, patients present much earlier in life, often with breathlessness. The pressure is higher on the left than the right side of the heart, but if a hole is present, high pressure blood can be forced through the hole. The right heart (and the lungs which it pumps to) do not like seeing this high pressure, and over time can enlarge, and weaken, leading to breathlessness. Holes in the heart can run in families, and are often, but not always, also associated with other structural abnormalities of the heart such as valve issues.
On the same day I hear about Emma Willis, I saw a patient on my ward who had come in with breathlessness. He was in atrial fibrillation, an incredibly common heart rhythm abnormality. It is commonly associated with breathlessness, particularly if the heart rate is fast. However in this man’s case, the heart rate was plum normal. A standard test in this scenario is an echocardiogram, or ultrasound of the heart. My patients was in his late 70s, so it came as somewhat of a surprise to me that the echo showed a large hole in the heart, or secundum atrial septal defect, to give it the proper medical name. How someone can get to this age with no symptoms is a bit of a mystery to me, and I suspect it was only the fact his heart became irregular that was the ‘straw that broke the camel’s back’ and caused the breathlessness. I’m also surprised he had not had any heart rhythm disturbances until now. This then presents a dilemma. Is there any benefit to closing a hole that has been open for decades? I’m not so sure it is.
These sort of cases are one of the things I love about my job. No matter how much you have seen, there will always be things that come as a surprise, and always new things to learn. I’m very lucky to have a job that can provide that.
I hope everyone running the London Marathon today does well and enjoys it. Rather a warm day for a marathon! I have entered a few times, but never got a space, and expect that door is now closed and will end up as one of my life’s regrets. I noticed a research study on marathon running published this week though, so given it’s our national marathon today, thought it would be a good one for this week’s video.