Looking back to October 2010, Laurie Kollmann realized that things weren’t quite right. She remembers feeling rundown and having some difficulty climbing stairs, and she began gaining weight.
She didn’t think much about it at the time. She had been working longer hours (as a seamstress for Ripon Athletics – a team apparel manufacturer in Berlin), and just figured she was getting rundown.
Then, in November 2010 she fell while working on an addition to her home. “One minute I was working, and the next minute, I was just down. I don’t remember how it happened.” Then she fell again, this time slipping on ice. Both times, she bruised badly.
In December, Laurie noticed her legs were badly swollen, and she began having trouble breathing. “I just couldn’t seem to get a good lungful of air,” she says. “That’s when I realized I might be in trouble.”
On December 28, 2010 Laurie’s husband, John, took her to the Emergency Department at Ripon Medical Center. Tests were run, including a chest X-ray and blood work. She was given oxygen to help her breathing, and medications to alleviate the fluid buildup in her legs.
Her primary care physician, Douglas Wonder, DO, with the Fond du Lac Regional Clinic, told Laurie her heart had begun to fail, and referred her to Juan Diaz, MD, a board-certified interventional cardiologist with Agnesian HealthCare’s Dale Michels Center for Heart Care. Laurie saw Dr. Diaz on January 4, 2011.
“Patients often do minimize their symptoms,” says Dr. Diaz. “Trouble climbing stairs is just because they’re tired, or out of shape. A sore arm is just a sore arm. Sometimes patients don’t want to believe that anything more serious is going on.
“‘Heart failure’ doesn’t necessarily mean the heart has stopped. It means the heart is not keeping up with the demands of the rest of the body – for any number of reasons. When it’s mild, many patients don’t even notice. If they do notice, they sometimes dismiss the symptoms to other causes, or deny they’re having issues, or they just don’t put two and two together.
“When the symptoms are moderate to severe, patients tend to notice. Laurie noticed.”
Heart failure symptoms include congestion, shortness of breath, dizziness, fatigue, weakness, water or fluid retention, rapid or irregular heartbeat, and loss of consciousness.
“Dr. Wonder had noted many of the classic, undeniable symptoms,” says Dr. Diaz. “She was dizzy, short of breath, her legs were swollen and she had lost consciousness once – maybe twice. She also had a heart murmur and high blood pressure. There was no doubt she was in heart failure.
“Now, we had to find out why all these things were happening.”
Dr. Diaz performed an echocardiogram – an ultrasound that enabled him to visualize and assess Laurie’s heart function.
“I immediately noticed a critical aortic valve stenosis – a narrowing of the valve that controls blood flow out of the heart.”
Normally the aortic valve opens to about three to four square centimeters. Anything less than 1.0 square centimeter is considered severe. Laurie’s aortic valve was down to .31 square centimeters. She was admitted immediately.
Additional tests were performed including an angiogram, in which a dye is injected into the heart through a catheter to visualize heart function.
The whole picture was not encouraging. In addition to the valve concern, her left anterior descending coronary artery was 70 percent blocked.
“I told Laurie the news – she was going to need surgery,” Dr. Diaz says.
“It was scary,” Laurie admits. “I knew something was going on. I didn’t know how bad it was.”
Laurie knew she had a family history of heart disease. Her mother had had two bypass surgeries and died at 56, her paternal grandfather had had bypass surgery, and her father and younger brother both had heart disease. But she was surprised when Dr. Diaz asked her if she had had rheumatic fever as a child. “I didn’t think so – I couldn’t remember.”
Laurie’s life was “pretty normal” up to that point. She worked full time as a seamstress. She and John rode his Harley through the countryside for recreation. “We’re not in a club – we just like to get away, for long rides on lonely country roads.” They also have two dogs and a cat, and Laurie reads a lot. “And I sew for fun – believe it or not. You’d think I’d have enough of it at work, but I like to sew.”
When it became evident that surgery was indicated, Dr. Diaz consulted R. Eric Lilly, MD, a cardiothoracic surgeon with the Agnesian HealthCare Dale Michels Center for Heart Care.
“There was no question Laurie would need surgery,” says Dr. Lilly. “At that point, the question was ‘when.’ Actually, we needed to wait.” Laurie received additional medications to reduce fluid buildup, and oxygen to make her breathe easier. When her condition improved, surgery was performed - on January 11, 2011.
An ultrasound of the heart was performed during surgery. We inserted a transducer by way of Laurie’s mouth into her esophagus.. It gives us excellent visualization of all the heart, allowing us to best measure valve function.”
Dr. Lilly placed Laurie on the heart lung machine, then replaced her aortic and mitral valves using artificial valves, and repaired her tricuspid valve.
He also performed a bypass on her left anterior descending coronary artery. “We borrowed a segment of vein from Laurie’s leg, and placed it below the blockage.”
“There was a lot going on with Laurie’s heart,” says Dr. Lilly. “She was quite sick.”
He also confirmed that Laurie most likely had had rheumatic fever as a child. “You can tell from the way the valves degenerate,” he says.
Rheumatic fever is an inflammatory disease that can occur following an untreated streptococcal infection – most commonly strep throat. “Most likely she suffered an episode of strep throat as a child which wasn’t adequately treated,” says Dr. Lilly. “When strep throat is diagnosed, treatment with antibiotics is important so that complications like rheumatic heart disease are avoided.”
Symptoms of rheumatic fever typically occur two or three weeks after the initial infection, and almost always include arthritis-like symptoms – hence the name “rheumatic fever.” In rheumatic fever, the body forms abnormal antibodies that attack the heart. Sometimes heart damage occurs immediately, and sometimes it occurs over several years. In Laurie’s case, it took years.
After the surgery was complete, but while Laurie was still under anesthesia, Dr. Lilly performed another echocardiogram. “Her heart and valves were working well mechanically, ” Dr. Lilly says. “However the electrical function was another matter.”
“Laurie had third-degree, or complete, heart block. The electrical impulses were not getting from the upper part of her heart to the lower part,” says Dr. Lilly. Not uncommon following heart valve surgery, the block can be caused by permanent damage to the heart electrical conduction system or mere swelling in the heart muscle itself. In surgery involving three of the four heart valves, he said, it happens at least 10% of the time. Sometimes it resolves itself, and sometimes it doesn’t.
In Laurie’s case the block did not get better, so one day after her heart surgery, Dr. Diaz implanted a two-wire pacemaker. “It goes just under the left clavicle – it feels like a bump,” he said. “One wire controls the atrium – the upper chambers, and the other controls the ventricle – the lower chambers.”
Laurie spent four more days in the intensive care unit, and went home January 16, 2011. She recovered at home for several weeks, and participated in Agnesian HealthCare’s heart rehab program. She then eased her way back into work, resuming a full-time schedule in April 2011 – up at 4:30 a.m., then to work, and home by 3 p.m. Now she exercises on a treadmill at home, walks around the block at work, and has quit smoking.
“At first I was on about 20 different medications,” says Laurie. “I’m down to five now.”
“Yes,” confirms Dr. Diaz. “Aspirin, a beta blocker, a statin, medication for hypertension and a fluid pill. She will continue those, while her heart and body recover. We advise heart patients to stay on a low-fat, low-cholesterol diet, and if they smoke, to quit. Laurie quit – that’s good.”
Laurie recalled those awful moments when she first heard that her heart was sick. “It was like ‘bad news, good news,’” she says. “When you hear your heart is failing, you think the worst: you think you’re going to die. Then you hear they can fix it. But it’s still scary.”
She remembers when Dr. Lilly came and talked to her and her husband just before surgery. “He was so calm and confident,” she said. “He made us both feel at peace.”
Dr. Diaz will continue to see Laurie periodically to monitor her heart and the pacemaker. “We can ‘interrogate’ the pacemaker, and re-program it if necessary,” he says. “But we haven’t had to re-program it in Laurie’s case. She’s done very well.”
Laurie says she watches what she eats now, and is little more cautious about doing physical things. “I let John lift the heavy stuff.”
She’s looking forward to getting out and riding the motorcycle again. “John drives. I just……ride.”