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Monthly Archives: March 2014

Reflections of heart stories – Ella

My next memorable story:-

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One morning at the end of surgery I was asked to phone a mum about her 9 month baby Ella. I pride myself in knowing the young children in the practise but on this occasion I could not  recall having seen Ella. When I phoned, even after talking to the mum I still could not think who we were discussing even after asking mum directly. Mum’s main worry was that Ella was constipated and all she wanted was something to ease the problem. With a combination of not knowing the baby and the fact she was under 12months I was not happy to prescribe anything over the telephone so I asked the mum to bring her to the surgery.
Examination of baby
After about half an hour mum arrived carrying Ella. Mum was a short slim lady, hence I would not have expected to see a large baby but this baby was pale and small and certainly not at all wholesome. Infact I was instantly concerned. When a baby is not thriving it can be for absolutely any reason  and it was imperative that the infant was examined thoroughly. It was not long before I discovered the reason. Ella had a loud machinery heart murmur diagnostic of an atrial septal defect (hole in the heart) and was in heart failure with a very fast heart rate  and poor breath sounds. There was no time to waste but before doing anything I had to break the news to mum. Like many Mothers she took the news very well and was almost relieved to think she was not being an over anxious mum, but when she asked dad to come to the surgery he was devastated. Meanwhile, I had telephoned the paediatricians to arrange an urgent referral. Ella was seen promptly but it was evident this baby needed specialist care and she was eventually referred to Great Ormond Street after stabilising her heart failure. Ella went on to have open heart surgery and made an excellent recovery. The memory of this came back a couple of weeks ago when she ran upstairs ahead of mother for her routine immunisation full of chat about school and thrilled to let me see her scar and listen to her heart and share her story with the medical student.

Congenital heart disease is caused when something disrupts the normal development of the heart. As a baby develops during pregnancy, there are normally several openings in the wall dividing the upper chambers of the heart (atria). These usually close during pregnancy or shortly after birth. In this case it was a failure of a hole in the wall between the two upper chambers of the heart to close.
Heart-ASD
It’s thought most cases of congenital heart disease occur when something affects the heart’s development during about week five of pregnancy. This is when the heart is developing from a simple tube-like structure into a shape more like a fully developed heart.
While some things are known to increase the risk of congenital heart disease, no obvious cause is identified in most cases.
To learn more about congenital heart disease the following link is useful:-
http://www.nhs.uk/Conditions/Congenital-heart-disease/Pages/Causes.aspx

 
 

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Reflections of heart stories – Mrs.Evans

My next memorable story:-
I had only been working in General Practise for a few weeks and was well aware that patients I saw were either new patients or those who could not get an appointment with their usual doctor and reluctantly  were willing to consult with the ‘new’ doctor.

As I was the doctor on call for home visits that day I remember being asked to go out on an emergency call to a patient with chest pain.
Doctors bag
I arrived at a block of flats and made my way to the second floor and after knocking the door a distant,weak, breathless voice requested that I  should  enter. There was Mrs. Evans sitting in a chair, breathless clutching her chest and a look of great dismay at seeing a strange doctor arrive ( patients at that time were used to seeing ‘their doctor’ call at any time of day or night and wanted an explanation as to why a strange doctor was present)  I immediately apologised and gave a feeble excuse as to why Dr Llewellyn was not available. It was immediately evident that she needed urgent hospital admission. After a brief explanation of my concern I asked to use her telephone (mobile phones did not exist) as I wanted to call an ambulance. I had read her notes prior to the visit and after arriving took a brief recent history of her current problem. I was aware she had a pacemaker fitted and she had had heart problems and that day had felt very weak, dizzy and tired. Before I had chance to fully examine her she suddenly arched her back gasping and at the same time exclaiming, “I want to change my will, I want to change my will,” and then slumped back in the chair lifeless. I gently pulled her to the floor and started cardiac massage and within the next minute or so the ambulance-men arrived with oxygen and ambu-bag.
She became vaguely conscious and she was carried by stretcher to the ambulance. Her pulse  remained very slow and  I assumed her pacemaker was failing and she needed to go to Cardiff which was about 20 miles away, as the local hospital would not be able to replace the pacemaker. In those days ambulances were minimally equipped and ambulance-men had very limited first aid training so they relied on the GP to advise the best course of action. Having recently worked  on a busy general medical ward I was well versed at stabilising patients before transfer to a specialist unit. Hence, I directed the ambulance to the local cottage hospital and  there I put up an intravenous infusion with isoprenaline to maintain the heart rate until the patient reached Cardiff. Giving the accompanying experienced nurse appropriate instructions the ambulance sped off in haste along narrow roads to its destination. In due course  Mrs.Evans was fitted with a new pacemaker and discharged after 10 days.
The day after her discharge I was sitting in my consulting room in earshot of reception when I heard a bold voice exclaim, “I would like to see a doctor but please don’t let me see that dreadful doctor that thumped me on the chest and took me to the wrong hospital. I am lucky to be alive!”

Mrs.Evans had had a pacemaker fitted to treat third degree heart block which is a problem that occurs with the heart’s electrical system. This system controls the rate and rhythm of heartbeats. (“Rate” refers to the number of times your heart beats per minute. “Rhythm” refers to the pattern of regular or irregular pulses produced as the heart beats.)
Heart blockWith each heartbeat, an electrical signal spreads across the heart from the upper to the lower chambers. As it travels, the signal causes the heart to contract and pump blood.
Heart block occurs if the electrical signal is slowed or disrupted as it moves through the heart.

Third-degree heart block limits the heart’s ability to pump blood to the rest of the body. This type of heart block may cause fatigue (tiredness), dizziness, and fainting. Third-degree heart block requires prompt treatment because it can be fatal.

I would like to think that I had saved her life but the patient never recognised that. But as a wise old GP told me, “Never expect to be thanked when you think you deserve it but accept the thanks with grace when you think you don’t deserve it!”

 

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