When a Strong Heart
Firefighter and emergency medical technician (EMT) Ray Sayah wasn't just in good shape. At age 32, he was in peak condition.
"I'm used to a lot of daily physical activity. Every year I do the Firefighter Stairclimb up the Columbia Center tower in Seattle. I snowshoe in the winter and I was training for an ultramarathon," he said. "I was eating very well — a healthy diet with no processed foods."
But in 2011, he suddenly realized something was wrong.
"I went to do my first snowshoe trip of the year and I found that I wasn't as strong or as fast as usual. I thought maybe I had bronchitis. I was coughing a lot," he said. "Over the course of three months, my activity level declined."
He became permanently pale, grew more and more tired each day, and developed persistent swelling in his legs. Within weeks, he was unable to fight fires or go on emergency calls. He had to take a desk job at the firehouse.
"I had a coworker who is an EMT take a look at me, and he discovered there were some weird irregularities on my EKG," Ray said.
An EKG, or electrocardiogram, measures the electrical activity of the heart, which is represented as a simple wave-like line. Given how poorly Ray felt, a more sophisticated test was in order. In May 2012 he went to the Northwest Hospital Cardiac Imaging Center to have an echocardiogram, which uses ultrasound to evaluate the heart's structure and function, giving doctors a detailed view of the organ in action (see "Echocardiography: A Simple Test That Saves Lives" in this newsletter).
Thomas Richardson Jr., M.D., F.A.C.C. of Western Washington Cardiology was called in to evaluate Ray's echocardiogram.
"He's a young guy, very active. The diagnosis was initially difficult because his symptoms weren't as bad as you would expect for the condition he had," said Dr. Richardson.
It turned out that Ray was suffering from constrictive pericarditis. His pericardium — normally a thin, flexible membrane that surrounds and protects the heart — had thickened and become rigid. It was severely restricting his heart's ability to beat.
"The same viruses that cause a common cold can cause pericarditis. It's unpredictable. Usually the condition is pretty benign — some chest pain and discomfort when breathing. Patients are treated with an anti-inflammatory medication like ibuprofen or naproxen and the symptoms typically go away in a few weeks," explained Dr. Richardson. "In a minority of patients, the pericardium thickens after the initial episode of pericarditis and then constricts the heart causing shortness of breath and heart failure symptoms."
Ray was in that minority. His condition required immediate attention.
"Dr. Richardson was a great help. He fast-tracked me into treatment and I ended up getting open heart surgery at UW Medical Center," said Ray.
The surgical team relieved the pressure on Ray's heart by cutting an 8 cm-by-9 cm rectangle out of his pericardium.
"My heart was able to beat freely at that point," said Ray. "Within four weeks of the surgery, I was back at my desk job and walking every day. Eleven weeks after the surgery, I climbed Mt. Olympus out by the Hoh River carrying 60 pounds of gear."
And just a week after climbing Mt. Olympus, Ray was cleared to return to full-time active duty as a firefighter. He wasn't taking any heart medication and his final echocardiogram showed that his heart function was completely normal.
"Just four days after being cleared, I was able to fight a forest fire. It was really great to be out there again. It was a good test of how I would do after having surgery. The conclusion that my fellow firefighters and I reached was that I was just fine," Ray said.
This summer, Ray plans to be even more active than he was before his surgery. He is currently training for a mountain climbing trip to Alaska. His goal is to summit Mt. Denali, the tallest mountain in North America, by next June.
Dr. Richardson cautions that the threat of pericarditis shouldn't keep the average person up at night, but being aware of the warning signs is important.
"A severe case like Ray's is not very common. But if you come down with a cold and develop shortness of breath and chest pain while breathing, you should seek further attention," he said.
As for Ray, his brush with pericarditis has taught him a valuable lesson — one that he is eager to share.
"You can be any age and have a heart problem. Be aware of the warning signs. Whether you're young or old, you should get preventatively screened by a cardiologist. If you notice any glimmer of difference in your level of fitness, it could have something to do with your heart and you should see a cardiologist."