Cardiac complications

NEEDS TO BE EDITED TO PORTRAY THE CORRECT PICTURE AFTER CLARIFICATION. WITH THANKS TO DR BAR-COHEN

One of the complications from the heart bypass has been that Reuben has a residual murmur. The other, newly noted, is that he has an Ectopic Atrial Tachycardia (EAT), an unusually high heart beat (228bpm compared with 110s normal). EATs are rare arrhythmias most commonly found in children.

Last weekend we had a job working through what the likely causes were, we were all involved in noting physiological changes which might suggest another cause, withdrawal symptoms from narcotics? an infection? the fact that his intravenous line which sits on his heart is tickling it (the line was pulled out of his heart)? but everything came up blank and the Drs were stumped. Dr De Oliveira was stumped. Not what you want really.

Yet it took an electrophysiologist to review his heart rhythms to immediately see that Reu's tachys are caused by his SA node, the heart's natural pacemaker, not sending electrical impulses. As a result, cells in the Right Atrium think, there's no signal, let's send off our own signals with the result that multiple signals are sent out and Reuben's heart tachys to the 228bpm.

He's now on a Beta Blocker medication which manages cardiac arrhythmias, at the initial dose, slowed his heart so much that he had Bradys (low bpm), the opposite to Tachys (high bpm). So I suggested they drop the dose from 3mg to 2mg and his numbers are a healthier low 100s.

This picture provides an illustration of the location of the defects fixed:

• Ventricular Septal Defect - the large hole between the lower ventricles that was patched with his heart's outer membrane
• Atrial Septal Defect - the small hole between the upper ventricles also patched
• Pulminary Valve - the narrowed valve to the lungs was dilated
• Coarctation of Aortic Valve - the narrowed valve that brings oxygen rich blood to all organs of the body was dilated
• Patent Ductus Arteriosis - the valve that should have closed after birth was ligated

These defects lead to Reuben's congestive heart and the need for his cardio bypass on 20 August.

Last weekend was a tense time. Thanks Erica for helping me through it, yet again! We hope his heartbeat will steady out and that he can eventually be weened off this additional med. I asked the electrophysiologist if a pacemaker (meaning another cardio bypass) would be the worst case scenario and he said "You don't want to know the worst case scenario". That said, a pacemaker couldn't actually fix the arrhythmia and either the beta blocker can be weened in a few weeks time or Reu will have the arrhythmia for life.

It's a sad realisation, that perhaps, once a cardio kid, always a cardio kid. After yesterday's horror which has kept me up through the night, Reu is now in a room of 4 with a nurse in the room at all times. And in the bed next to us is sweet Marcio whom Dr Starnes performed his magic on also on 20 August and then discovered he had 3 valves so had to go back in again for a second bypass.

Remember too, my friend Vivian whose baby Carlos (di George syndrome) was admitted on 12 July as was Reuben and we were next door neighbours for 2 months? Well, after several weeks on the floor after discharge from the PICU and watching Reu go through the bypass and then the trach, Carlos's health hasn't been improving and with infection after infection, cold after cold, Dr Starnes suddenly decided to operate on Carlos next Thursday. Vivian called me because she knew we'd been precisely there. Congestive heart failure is all you achieve through waiting for a bypass.

I kindly ask for your thoughts and prayers to pass onto Vivian and Peter, who, like Jason, has been there day after day, week after week, month after month, whilst juggling the demands of their sweet 2 year old daughter at home. A very lovely family!