A Heart in Chaos, Part VIII: Questions, Questions

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First, with a grateful nod to all of you who’ve been sending me good wishes: I’ve had no recurrence of what I call the grand mal, the racing heart and irregular pulse, for well over a month.
I’ve been steadily stepping up the exercise and the cardiac workload, cycling whenever possible up and down Burlington’s hilly streets, even (though only last week) running up a steep flight of stairs.
Yesterday I played soccer in my usual goalie position and realized that when the play was at the other end of the field, my pulse actually returned to a calm tempo, alert but, so to speak, taking a breather. Today I actually broke into a run (well, at least a brisk trot) on several occasions and scored a couple of goals. Every so often I might skip a single beat, but there was no sign of that arrhythmic chaos, that fundamental and disturbing loss of control over my most core function.
So is this a sign of the medication (which I’m still taking at pretty much a minimum dosage) working, or of my general fitness improving, or simply the healing qualities of time? My cardiologist wisely avoided the question, adopting an “if it ain’t broke any more, don’t try to keep fixing it” approach.
All the same, I can’t help feeling that the situation is like being in the trenches in World War I: just because the artillery barrage has stopped doesn’t mean the Armistice has been signed. We are just as much in the dark about whether everything is better as we were about what caused things to go wrong in the first place.
So here, in no particular order, are some of the questions I find accompanying me like notes saying “Kick me” that some prankster has taped, without my knowledge, to the back of my jacket.
If the issue is strictly one of arrhythmia, why does it also feel like an issue of congestion? According to the tests (see preceding chapters in this saga, notably “A Beautiful Heart”), I don’t suffer from congestive heart disease and, in fact, my cholesterol is lower than it has been in more than a decade. Yet when I first started trying a modest amount of exercise after the major events of late July, my heart felt as though it had to work ten times as hard as usual just to move me from A to B. Walking uphill felt like walking uphill carrying a hundredweight of potatoes. Nothing to do with rhythm–it was much more about efficiency: simply to ingest and distribute the oxygen I needed was a major, major effort.
And speaking of oxygen, I keep wondering about the relationship, perhaps more metaphorical than mechanical, between this cardiac stuff and my asthma. My asthma has been noticeably worse this year–not to any deadly extent, but I’m using my albuterol inhaler four or fives times a day instead of once. If I’m getting less oxygen, don’t you think that’d trigger the heart to work harder, to labor more to make up for the reduced intake?
And that leads to another question, one that I’ve been politely told is seriously off the rails, but maybe someone could explain to me exactly where I jumped the track and started heading across the open countryside. It goes like this. My researches in cardiology haven’t yet got to the place that tells me how the heart knows how fast to beat.
If (in evolutionary terms) the four-chambered mammalian heart developed as creatures needed to be able to take in and distribute more oxygen more quickly (a factor so important that apparently the monitor lizard of the Komodo dragon–I forget which–developed a five-chambered heart, so vital was the quick change from stillness to rapid movement), then the lungs and the heart developed together, with an intimate and entwined sense of purpose. Somewhere in that mechanical combination there must be some kind of sensor that measures how much oxygen is being absorbed into the bloodstream, and if it’s insufficient to meet the needs of the moment, it must trigger an instinct to breathe more rapidly and for our hearts to beat more quickly.
So this suggests a different way of looking at A Fib. What if it’s not a heart problem but an oxygen sensor problem? What if the sensor is faulty and starts telling the heart Beat like crazy! This is an emergency, dammit! And in fact tells the heart to beat more urgently than it can reasonably do in a controlled and regular manner?
This suspicion (and I must stress it’s no more than a suspicion, and I don’t know what the hell I’m really talking about) is reinforced by the fact that the chaotic signals that set the heart into atrial fibrillation originate at or around the pulmonary vein and/or artery. It seems to this ignorant layman that there’s more to this heart-lung connection than meets the eye.
Meanwhile, the most counter-intuitive issue of all heads off in a completely different direction: why would arrhythmia strike when the heart is not under pressure at all but is actually slowing down? After all, not only were both of my major attacks late in the evening, but a friend with serious arrhythmia tells me his attacks always start at night, when he’s asleep.
Answers, as they say, on a postcard, please. Because knowing more about one’s condition is a vital part of feeling better. You know where to reach me.
Tim