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He had a broken heart but didn't know it


St. Louis Post-Dispatch (MO)

09-27-13

Sept. 26--Daniel Watt had a broken heart and didn't know it. A checkup earlier this year found a problem with his heart rhythm, which turned out to be atrial fibrillation.

This could be the worst type of heart problem in that he was physically active, otherwise healthy and never had an inkling of a symptom.

But his type of problem is a major cause of ischemic stroke in older people, stroke caused by a blood clot, said Dr. Phillip Cuculich, a cardiologist and assistant professor of medicine at Washington University School of Medicine.

"It's not necessarily life-threatening," Cuculich said. "But it increases the risk of stroke by 500 percent."

Upon diagnosis, Watt began taking the blood thinner warfarin, also called Coumadin. The popular anti-clotting therapy usually is given to people in danger of or recovering from problems caused by blood clots. Clots can turn off blood supplies to organs and cause part of that organ to die. That can include the brain and the heart.

The blood thinner came with its own problems, Watt said. He is active and plays squash regularly. "I was living with (fear) that if I had an injury, what would happen with the bleeding?"

In addition, he had to watch his consumption of foods with Vitamin K because they can interfere with the blood thinner. "And I really missed them," Watt said.

A cardiologist suggested he visit Cuculich to find out about a new procedure that can fix the danger caused by atrial fibrillation.

The left atrium of the heart, the chamber that pumps blood back into the body -- especially the brain -- has a small reservoir called the left atrial appendage. No one knows what it's for or its evolutionary history, Cuculich said. But while it doesn't serve a purpose, the medical community has figured out it can cause serious problems.

When the heart beats normally, the blood pushes through with no problem, Cuculich said. But with the heart rhythm disrupted for long periods, blood moves slowly enough to pool in the reservoir. The blood clots. Pieces of the clot start breaking off. If a piece makes it to the brain, it can cause an ischemic stroke.

The most popular remedy is blood thinners to prevent or dissolve the clots. But that doesn't help the disrupted heart rhythms. That calls for other procedures and medications.

Cuculich considered Watt a good candidate for the new Lariat procedure, approved by the U.S. Food and Drug Administration in 2009. The procedure began in California, where it was developed.

The procedure has a major advantage. There's no cutting, Dr. John Lasala, a cardiologist and chief of interventional cardiology at Barnes-Jewish Hospital, said in a statement. He also worked on Watt's case.

The doctors run a catheter from the groin to the heart; another probe enters through the chest, similar to laparoscopic surgery.

In short, the doctors throw a loop around the appendage and choke it off. Over time, the appendage shrivels up and dissolves.

"We knew something like this could be done (for years)," Cuculich said. "But only recently did someone develop the tools."

Watt had the procedure done on Aug. 9, a Friday, and "I was back to work on Wednesday." And he's also back to playing squash.

The procedure takes about three hours, Cuculich said.

It's much less invasive than open-heart surgery, Cuculich said. "Normally a surgeon wouldn't close the (appendage) unless there was another reason to operate, such as bypass surgery or to fix a valve," Cuculich said. "A surgeon wouldn't go in just for that."

"Currently, we are offering this procedure to patients at high-risk for stroke, or have already had a stroke, but cannot tolerate oral anticoagulants, like warfarin," Cuculich said. "These patients are often eager to look for ways to lower their risk of stroke."

Cuculich cautioned that the procedure isn't a treatment for atrial fibrillation, only a problems cause by the condition.

Lasala said the procedure is bound to become more popular. "The population is getting older, so we're going to see more (atrial fibrillation), and we have to have better ways to treat this," he said.

Watt said he's happy to be off the warfarin and free of the fear of accidents that could cause bleeding. He's also back to eating a regular diet and physical activities.

"I was pleased to be a part of something new and innovative," he said, "to be a part of something that will help other people, that's pretty good."

Do you know a "How I did it?"

Suggest a candidate to:

Harry Jackson Jr.

St. Louis Post-Dispatch

900 North Tucker Boulevard

St. Louis, Mo. 63101-1099

Email --harry.jackson@post-dispatch.com

Phone --314-340-8234

___

(c)2013 the St. Louis Post-Dispatch

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Copyright St. Louis Post-Dispatch (MO) 2013

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