Hospitalization Chronology December 9 - 16, 2014

Tuesday evening, December 9... I was in the basement in our home on Aspen Street in Philadelphia working on my model trains. I was not exerting myself. At around 5 pm an episode of chest and throat tightness and palpitations came on me. I began to feel poorly. I stopped what I was doing and decided to try a short walk outdoors with our dog to see if the air and walking might help me feel better until the episode passed. However, I still felt bad after returning from the walk. In addition to the chest and throat pressure and malaise, I noticed some problem with the peripheral vision in my right eye. I sat on our sofa and alerted Dan that I was in distress and that I felt it advisable to go to an ER that specializes in stroke. We discussed the options in terms of hospitals. We opted to take a taxi cab to HUP, the hospital of the University of Penn Pennsylvania, since we are familiar with it. Upon arriving at the ER I explained my condition and I received immediate attention. I was in significant discomfort but a nurse provided me with two Nitroglycerin pills. These made me feel much better. A blood sample was drawn and I was placed in an observation room for the night.

Wednesday morning, December 10... at 4 AM I was admitted to the hospital and given a room 1169 in the CICU (Cardiac Intermediate Care Unit) on the 11th floor of HUP. I was put on a variety of anti-coagulants including an IV Heparin drip, and Plavix and Aspirin orally. Blood tests had revealed a low level of Troponin, an indicator of heart muscle damage or stress. Weary from the episode and lack of sleep, I tried to get naps whenever I could. I was scheduled for tests including an echocardiogram, which I got Wednesday morning, and a heart catheterization. Being out of my room for most of the day, I missed the visit of the care team and so I was lacking information about my condition. Later my nurse told me that my troponin levels were trending up. In the afternoon I was taken to the cath lab and prepped for the procedure. However, when my attending Cardiologist, Dr. Witlack, learned from me about my vision abnormality that I reported as happening at the same time as my cardiac episode, he decided to have the vision issue evaluated prior to the heart cath for safety in case there could be loose embolisms floating somewhere. So the next test I had was a CT scan of my brain. That ended the tests for the day so I was finally able to eat a small meal, my first solid food since Tuesday mid day.

Thursday, December 11... I found out that, while the CT brain scan was negative, neurologists wanted further detailed evaluation of my brain so three MRI studies were ordered. I finally spent 45 minutes in an MRI machine in the afternoon under significant sedation due to my claustrophobia. No further tests that day so I was able to have a nice salad for dinner courtesy of Louise and chocolates that Dan bought for me. The same morning Dan and I were able to speak with the attending physician's substitute and his team. We asked various questions about troponin levels, why was Lipitor prescribed (ad a precaution,) the cath will evaluate the coronary arteries and the aortic valve. A post release plan will be provided. If the aortic stenosis is believed to be the cause of my episode, options include scaled back activity or AVR. Options were not discussed in the event of coronary artery disease.

Friday, December 12... A cardio physician named Mike visited to explain that the brain MRIs show several small strokes which could be older or could account for the vision loss I experienced Tuesday during my episode. He mentioned the possibility of additional heart studies to determine whether something is being thrown off that could cause the strokes. My cardiac cath was scheduled for that afternoon, but it was decided that I should have a TEE before the cath to insure the safety of the procedure. A further glitch was my history of difficulty in swallowing. This made it necessary to schedule a series of contrast X-Rays of my esophagus to insure that there were no abnormalities. I had the X-Rays done Friday afternoon. The TEE and cardiac cath were pushed off until after the weekend.

Saturday and Sunday December 13 and 14th... Various meetings with doctors took place. In addition to the TEE and cath scheduled for Monday, there may be a full chest CT scan ordered for later in the week. Two days must pass in between the cath and the CT scan to allow contrast media to dissipate from my system. Also pending is a carotid artery ultrasound.

Monday December 15...I had a TEE and cardiac cath back to back. The cath was negative for coronary artery disease. The heparin drip was ended.

Tuesday December 16...discharge day. AVR is recommended. A CT Angiogram is scheduled. Left the hospital mid afternoon with copies of all of the imaging. RX for nitro glycerin, 40 mg Lipitor and daily baby aspirin.