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Reflections of heart stories – Mrs. Jones

30 May

When I first started at the practice in Ealing I remembered a dear couple from Swansea who I saw in surgery on a regular basis. I have to say that I had a bit of soft spot for them as we often reminisced about Wales as I knew the house she was brought up in and understood her enjoyment of laverbread and cockles.
Laverbread and cockles
Laverbread or ‘bara lawr’ in Welsh is an important traditional food of historical value. A national delicacy made from seaweed, it is collected from the beach then washed and cooked to a soft greenish black paste. Made from laver, one of the most nutritious varieties of seaweed, laverbread is full of health benefits. Rich in minerals and vitamins, full of protein and low in calories, this is a real superfood. A rare plant source of vitamin B12, it is also full of iron and iodine. She was always delighted if I managed to bring some from Swansea market bringing back those memories of welsh breakfast where it is served with bacon and egg. Failing that a few Welsh cakes were just as acceptable.
Welsh cakes

She was brought up in Swansea, Wales and as a young teenager had contracted St Vitus dance (also known as Sydenham’s Chorea) and described it very well and was able to demonstrate the involuntary, rapid, uncoordinated jerking movements primarily affecting the face, hands and feet movements associated with the condition. It was named St.Vitus Dance as St Vitus is patron saint of dancers. This condition was not uncommon many years ago And was found to be more common in females than males, most patients were children, below 18 years of age.
St Vitus dance
It was caused as a result of Group A beta-hemolytic Streptococcus infection and occurred in 20-30% of patients of patients with Rheumatic Fever or up to 6 months following the acute infection.
A vast majority of people at sometime in their life will develop a streptococcal infection of the throat characterised by a fever and white spots on the tonsils and swollen neck glands but nowadays this can be easily treated with antibiotics, usually Penicillin with good effect and it is very rarely associated with more widespread infections other than Scarlet Fever.
It was not uncommon in the 1950,s and 1960’s and I recall my mother saying to me as a child if I was fidgeting excessively, “Keep still have you got St Vitus Dance.?”

Mrs.Jones went on to develop an inflammation of the heart and the important valves of her heart were damaged. In my early days in Medicine I saw many patients with Rheumatic Heart Disease and we were disciplined in medical school to train our ears to listen out for murmurs in the heart using our stethoscopes in order to diagnose this problem. Patients were after brought in as test cases for our final examination. At that time we did not have the technology to aid our diagnoses. Needless to say not every medical student acquired this skill and as qualified doctors still could not pick out a murmur on auscultation. This resulted in many people remaining undiagnosed until they were having emergency surgery or developed another illness or went into heart failure during childbirth.
I recall several maternal deaths due to this at that time and young adults being diagnosed and needing heart surgery often carried out by a General Surgeons.
Ultimately,pig heart valves were used to treat these patients and then metal artificial valves, the clicking of which was audible to the patient and they often complained that it kept them awake at night.

Mrs.Jones tended to restrict her lifestyle and grew up as a slim,but feisty young woman and then decided to study for nursing at St. Mary’s hospital and it was when she became pregnant that her heart condition was diagnosed.

When she acquired St Vitus Dance she was not able to be treated with Penicillin as it had not been discovered when she developed this illness. Fleming recounted that the date of his discovery of penicillin was on the morning of Friday, September 28, 1928. It was a fortuitous accident: in his laboratory in the basement of St. Mary’s Hospital in London (now part of Imperial College).

As a result of this disease she developed significant valvular heart disease and miraculously survived and infact was nearly 90yrs before she died. She had the complication of Atrial fibrillation which is a heart condition that causes an irregular and often abnormally fast heart rate.
image

A normal heart rate should be between 60 and 100 beats a minute when you are resting, and is regular. You can measure your heart rate by feeling the pulse in your wrist or neck. In atrial fibrillation, the heart rate may be over 140 beats a minute, although it can be any speed.
The main difference between a normal rhythm and atrial fibrillation is that you are unable to predict when the next heart beat will come along, as the heart rate is irregular.
This may lead to a number of problems, including dizziness and shortness of breath. You may also be aware of a fast and irregular heartbeat (palpitations) and feel very tired, breathlessness, dizzy and can experience chest pain (angina) but the worst fear is having a stroke.

Moreover,the way the heart beats in atrial fibrillation it reduces the heart’s efficiency and performance. This can result in low blood pressure and heart failure.

Mrs.Jones was able to tap out her atrial fibrillation in the surgery our on visits to the hospital and gleefully educated many student nurses and doctors into recognising this condition. Remarkably, she only developed mild heart failure and never had a stroke.
If you look at my previous blog this will demonstrate how to take the pulse and to recognise atrial fibrillation

https://102theavenue.wordpress.com/2014/02/07/know-your-pulse/
Or upload the app below on to your iPhone – my son assures me it is easy to use
image

When to see your GP
Make an appointment to see your GP if:

  • you notice a sudden change in your heartbeat
  • your heart rate is consistently lower than 60 or above 100 – especially if you are experiencing other symptoms of atrial fibrillation
  • See your GP as soon as possible if you have chest pain.
  • If you notice a sudden change in your heartbeat and have chest pain, see your doctor immediately.

What is happening in the heart when someone develops atrial fibrillation.

The atria are the upper two chambers of the heart that receive blood from the rest of the body. They pump blood into the lower two chambers (the ventricles). Then the ventricles pump blood to the rest of the body. During atrial fibrillation, the atria do not beat normally. Instead, they quiver or “fibrillate.”

Normally, electrical impulses from a small part of the atrium called the sinus node cause the atria to beat. The electrical signal then goes through another part of the heart called the atrioventricular node. Then it goes down to the ventricles, and causes them to beat. First the atria, then the ventricles: it is coordinated, and so the heart pumps blood efficiently. The atria pump, filling the ventricles with blood, and then the ventricles pump.

In contrast, during atrial fibrillation, the electrical impulses come from all over the atria. Instead of pumping efficiently, the atria just quiver. There is an irregular and rapid heartbeat. There is no coordination between the atria and the ventricles. As a result, the atria do not pump all of their blood into the ventricles. Also, the ventricles sometimes pump when they don’t have a lot of blood in them.

A normal heartbeat is 60 to 100 beats per minute, and very regular: beat…beat…beat…beat. During atrial fibrillation, the heart beats at 80 to 160 beats per minute, and is very irregular: beat..beat…..beat….beat.beat.beat….beat.
When the hearts beats rapidly and irregularly, it cannot pump blood out of the heart efficiently. As a result, some people get short of breath. Some people faint.

Atrial fibrillation can lead to the formation of blood clots inside the atria. This is a serious, longer-term problem. These blood clots can travel out of the heart and get stuck in an artery to the lungs (causing a pulmonary embolism), an artery to the brain (causing a stroke) or an artery elsewhere in the body.

How atrial fibrillation is treated
bearing in mind that even if the atrial fibrillation is intermittent it still poses a risk of developing a stroke.

Treatment may involve:

  • medication to prevent a stroke by calculating the level of risk
  • medication to control the heart rate or rhythm
  • cardioversion, where the heart is given a controlled electric shock to restore normal rhythm
  • Catheter ablation, to prevent atrial fibrillation from occurring
  • having a pacemaker fitted to help your heart beat regularly

http://www.nhs.uk/Conditions/Atrial-fibrillation/Pages/Treatment.aspx

Especially during the past 12months Dr Livingston and myself along with our practise nurse have been on a mission to pick up undiagnosed cases of atrial fibrillation and we have diagnosed several cases and they have been treated accordingly. This is something that all doctors should be doing regularly especially if you are over the age of 65.
By the number of older patients I see equipped with modern technology I think they should be either uploading the App or asking their family to do it for them!

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