For a little over four weeks, I've been experiencing some reoccurring symptoms whenever I exert myself, such as climbing a large hill, walking up the Metro stairs, or playing tennis. I'll get shortness of breath, the top of my chest will hurt and I'll get some tingling and numbness in both arms. At first I thought it was because I was out of shape, having not really gotten any exercise at all since J and I returned from Belize, and not really have much exercise before that. Then I thought maybe it was just because the weather was cold and I was getting that cold air deep in my lungs, but it happened last week as I was walking to work during the first warm day of spring, and it seemed to be worse than before. That morning, I called and made an appointment to see my doctor, Brian McBreen.

That appointment was this past Monday and McBreen confirmed with my lay diagnosis that it sounded like the classic symptoms of stable angina. Angina is where the arteries supplying the heart muscle itself have become blocked by plaque buildup (usually from bad cholesterol) such that when the heart tries to work harder, thus demanding more oxygen rich blood from the arteries, it doesn't get it, and the pain ensues. McBreen scheduled me for a thallium stress test on Wednesday at the Georgetown University Hospital. The EKG that Dr. McBreen had performed on me in his clinic didn't show any heart problems, but that was when I was at rest; the stress test would track my heart during exercise.

The thallium stress test is actually two parts. When you get there, they inject you with thallium, a nuclear isotope, and put you under an imaging device to take pictures of your heart function at rest. Then you go to the treadmill, where they hook you up to an EKG machine and monitor your heart as they slowly increase the pace and incline of the treadmill, as well as inject you with another dose of thallium to show where the blood's going (or not going) when you work the heart hard. During this treadmill work, my heart showed some significant changes. I returned to the imaging device down, and the imaging also confirmed some problems, enough that they immediately scheduled me for a cardiac catheterization the next day.

The cardiac cath is an outpatient procedure, and they don't fully anesthetize you, but simply do a local anesthetic in your groin area where the big arteries that feed your legs are. They feed the catheter into that artery and guide it up to your aorta, which is at the top of your heart. Once there, they inject an x-ray dye to even better observe the function of the arteries supplying the heart.

The x-ray confirmed that I had some major blockage in some of my coronary arteries, enough so that they couldn't even do an angioplasty for one bit because the blockage was in a fairly small artery and double the length of what they can stent. In another artery branch, I had something like 80% blockage. That was the bad news. The good news is that I either have extra blood vessels forming around my heart (angiogenesis) that are routing around the blockage and trying to supply the heart with the blood it needs or normally present blood vessels that don't usually carry much blood for the heart are picking up from the vessels that areblocked. Given that, and the fact that the surgeon saw no evidence of damage to the heart muscle itself, meant that they didn't do any angioplasty or other internal procedures.

The doctors have decided to treat my angina symptoms with medication and keep a watch to make sure that those new blood vessels are able to keep up with the heart's needs. My diet and exercise, of course, have become a pretty important priority, too.

I've not written about this before because I just wasn't sure about the whole thing and how bad it was going to be (initially, I was thinking I was just out-of-shape and they were going to tell me the angina was all in my head and not my heart, and then I was fearing the possibility of bypass surgery). But I'm still here, and with the medications and lifestyle changes, will probably be around for as long as I'm supposed to be.

Something like this certainly does change how you view the world, though. It's not necessarily a Paul at Damascus moment for me, but I am thinking about things differently in light of this little message from the regions of my heart.