Facing the Importance of Heart Health: My Peculiar PDA
By: Elizabeth Spangler
I will never forget the look on my doctor’s face when I went for my annual physical at age 15. Having just pulled her stethoscope away from my chest, she looked both surprised and confused. Even to a 15 year old, this was alarming. She – a doctor I had seen my entire life – told me she heard a loud murmur in my heart that she had never heard before. Describing the sound as “loud and mechanical- like a motorcycle starting up,” she asked another physician to come and listen. He too thought the sound in my heart was rather unusual, and they suggested I see a cardiologist.
So began my decade long journey with a patent ductusarteriosis (PDA).
For most people with a PDA, the murmur is heard or other symptoms present in infancy and the PDA is closed. A PDA is not something that physicians look for, and because mine was not audible until I was 15 and I had no other symptoms, it remained undetected. Given that I was 15 and in good health, no one suspected a PDA. Yet no one could figure out what was causing the loud industrial sound that even my untrained ears could hear through the stethoscope. I had several echocardiograms, but there was only one view in which my PDA could be seen, and it took attempts by several doctors to finally discover and diagnose the PDA. Due to the unusual nature of my case, it was even presented at the Pennsylvania State Cardiology conference.
My parents debated about what to do. I was young and healthy, a cross country and track and field runner who displayed no problematic symptoms. My father is adamantly opposed to any kind of surgery that is not absolutely necessary; my mother is a hospital administrator who is less skeptical of medical intervention. In the end, the decision was not to intervene.
As I continued through high school and college I experienced the loss of my grandfather due to congestive heart failure and my grandmother getting a pacemaker. I also worked in the Cardiology department at the Veteran’s Hospital in Philadelphia on a study examining sleep apnea and obesity as risk factors for cardiovascular disease. Heart health, or a lack thereof, was all around me. Nevertheless, apart from invariably shocking any doctor who listened to my heart, my PDA did not tangibly impact my life.
However, after college I worked as a healthcare consultant, doing strategy work for pharmaceutical and medical device companies. Some colleagues were working on a project for a company that made mesh implants. They knew about my PDA, and as they studied congenital heart disorders, they became concerned about its long-term impact on my health. They told me how the little extra stress on my heart over time could lead to problems, including congestive heart failure. In addition, the strain of increased blood flow to my heart during pregnancy could cause complications. With newer laparoscopic surgeries, closing a PDA was simple, effective and relatively risk free. My colleagues strongly urged me to consider re-investigating my PDA as an adult and consider having it closed.
I was fortunate to be able to see one of the top pediatric interventional cardiologists in the country, and he clearly explained the risks both of the procedure and of not doing anything. After consideration I decided that the potential for long-term heart problems outweighed the minimal risks of the procedure, and I had a PDA occluder device inserted in my heart to close my PDA in February of 2008. The procedure went well, and almost five years later I have had no complications.
Heart health is a long-term issue. While I was visibly healthy as a 15 year old runner, throughout college, and my first few years after college, my heart was constantly working just a little bit harder than it needed to because of my PDA. Just as cardiovascular disease or congestive heart failure do not happen over night but after decades of added stress and strain on the heart, so too might my heart not have had issues until much later in life. I do not know what would have happened if I had chosen not to close my PDA, but I am thankful that now I can be a bit more secure that my heart will be healthy well into old age.
Given that heart disease runs in my family, I see the importance of taking steps at an early age to promote heart health. In my case that has included undergoing a procedure to close my PDA. Though I may not see the effects now, I am confident it will have a positive long-term impact on my health.I have been blessed with access to excellent cardiologists, generous health insurance, and modern technology that allows the closure of a PDA to be minimally invasive and relatively risk free. Each of these factors has played a role in helping me achieve better heart health, and for this I am truly thankful.