— or — What happened on my summer vacation So here is the most startling detail about my Australian journey: I spent nearly four days of it in a Sydney hospital! The Angina Monologues On August 8, the night before we began our trip (which included a day and a half layover in LA), I was heaving a large heavy suitcase into the trunk of the car, when I felt a bit of pain in my chest, near the shoulders. I figured I had pulled a muscle, and it was no big deal. After a few minutes rest, the pain went away. Fast forward two days: we were leaving LA for Sydney, and ended up at the wrong terminal. So we rushed all our bags to the next terminal (up hill, on a sidewalk). When we got there, I felt a little chest pain again, and I felt like I was out of breath. I sat down, and again it went away.

Ultimately, over 5 days, I had several similar episodes. The most severe was at Darling Harbour in Sydney, the evening following our arrival. We walked up 3 flights of stairs to a bridge across the harbor, and this time I felt really lousy at the top, and it took me longer than usual to recover. I told my parents about the pain for the first time, because later I had to ask them to slow down so I could sit on a bench. I suppose it should have been clear. Temporary chest pain is one thing, but chest pain that comes with exertion should set off all kinds of alarms.

The next day, we did some tourism at the Circular Quay, home of the famous Harbour Bridge and Sydney Opera. I took it pretty slowly, and felt okay all day. The next day, Friday 15 August, we had planned an all-day bus tour (7:30 AM to 8 PM) to the blue mountains, and other rural destinations. I felt okay leaving the hotel, but as soon as we were on the bus, waiting for other passengers, anxiousness about being away from the city all day began to set in, and I felt worse and worse. We got off the bus before the tour even began, and took a taxi straight to the hospital.

An annotated screen shot from the computer in the cardiac cath lab. Here, the computer has estimated the shape of an artery where constricted blood flow can be seen. The measurement shows that 51% of the 1.96mm diameter is blocked; this is a 76% blockage in area. This is the worst—a 93% blockage. An 89% blockage in another branch of the same artery. Success—you can see from the branching pattern that this is the same artery that has an 89% blockage above, but now it is down to 20%. This is the ECG that was produced during my stress test (Bruce protocol, stage 4).

At St. Vincent’s I was examined quickly in the ER, but then had to wait around in a gown for the better part of the day… waiting, anxiously, to hear that I was not having a heart attack and I could go enjoy the rest of my holiday. Unfortunately, my blood test came back with elevated troponin, which is released into the blood stream when the heart muscle suffers damage. This result finally got the attention of a cardiologist, and before long I was rushed to the cardiac cath lab for emergency angiography… they guided a catheter into my femoral artery, and maneuvered it up into my heart, so they could X-ray and tinker with it. Although the procedure was relatively painless, it was nevertheless the scariest experience of my life. Especially during preparation: they placed gel-laden orange pads on my chest, in case of cardiac arrest. (When they carted me around for various tests, I always went with a battery-operated EKG monitor and defibrillator…) Amidst all the tinkering, all I could really feel was a severe hot flash whenever they released the X-ray dye. Anyway, it turns out I had a 93% blockage in the LAD (left anterior descending) coronary artery. :( Now that I’ve got you on the edge of your seat, I’ll cut the story short with the good news. As part of the same procedure, still working just through the femoral artery, they enlarged the bad artery and inserted two stents—small metal scaffolds that keep it open. Moreover, these are the new Cypher stents, that are coated with medication to prevent them from blocking again. The procedure was successful, and I recovered in a private room with a view of the city, closely monitored by clever machines and helpful nurses. Before leaving the hospital, I had an echocardiogram (a kind of sonogram) where they determined that my heart was now working quite well. They said it looked like the stent was applied before much damage could occur. For medical folks and fellow nerds, the technical diagnosis was “very mild anteroseptal hypokinesis, left ventricular ejection fraction: 60%.” (Apparently, a normal ejection fraction at rest is 55–65%) Since he knew I was a computer scientist, one of the interventional cardiologists burned for me a CD-ROM of the pictures and movies they took during angiography. You can see the results on this page. (I’m also thrilled to report I was able to extract and process the DICOM medical image format using entirely open-source tools on Linux, specifically MedCon and ImageMagick.) Prognosis I left the hospital, and slowly resumed tourism. Before leaving Sydney though, I had another test that gave me much more confidence: an echocardiogram after spending 10 closely-monitored minutes power-walking and jogging on a treadmill, which brought my heart rate to 196 bpm. The cardiologist said my heart looked relatively healthy, and that I should resume (i.e., start) exercise. We then flew from Sydney to Melbourne, and had a relatively normal last 5 days of ‘vacation’. Now I’m safely back in New York, and I’m taking blood thinners, blood pressure meds, cholesterol meds, etc. But I’m really feeling much better. I haven’t exactly worked out yet the philosophical implications of being by far the youngest patient in the cardiac ward, and what that means for my life expectancy. But all signs seem to indicate that, if I manage my risk factors well, I should be fine. In balance, it might even be good that I had this early ‘warning’.

Where now? See animated slides from my angiogram Read responses from some friends Skip to Victoria Back to Sydney aquarium Up to Australia ’03

Published September 2003 Updated 5 October 2003

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