In 2006, I reported my experience with chronic and advanced heart failure, which occurred in 2003. The memory of my hospitalization from years ago had begun to fade until my cardiologist recently encouraged me to share the entire experience up to present and the personal insight it has given me. I had been dyspneic for some time but rationalized it as the result of a hot summer. I went to the emergency room, where I was diagnosed with heart failure and was transferred to a tertiary care center. I found out that my ejection fraction was 10%, and I had evidence of pulmonary hypertension and mitral regurgitation. Furthermore, my chest x-ray showed massive cardiomegaly, and I was hypotensive. In addition, I had several runs of nonsustained ventricular tachycardia. On a positive note, my coronary arteries were normal, and cardiac magnetic resonance imaging showed no hyperenhancement.
Because of this last finding, there was hope for recovery, because the myocardium appeared to be viable but noncontractile. During hospitalization, intravenous inotropes were avoided despite my low blood pressure, and evidence-based therapies, such as angiotensin-converting enzyme inhibitors, β blockers, digoxin and micronutrients were instituted. Despite side effects likely related to low blood pressure associated with these medications, I stood fast and persevered in taking these lifesaving medications faithfully. I fully recovered within months, as I described in my previous report. Most recently, I thought it prudent to be seen by my cardiologist, although I was feeling fine and had been discharged from his care several years before. The results of this office examination were normal.
I retired from full-time cardiology and electrophysiology and had continued to work outpatient clinic locum tenens, traveling around the country for several years until 2010. In 2004, an opportunity arose to participate in a new program, educating local law enforcement and corrections officers on recognizing individuals in crisis because of mental illness, intellectual disabilities, or substance abuse. The weeklong class focused on training them to use verbal de-escalation techniques and safely resolve potentially volatile encounters. Embarking on my second career with great enthusiasm, I learned how to incorporate a business, design a Web site and brochure, create lesson plans and examinations, meet clients, and bid contracts, all the while furthering my own education in my new role. Although daunting at times, lecturing to armed, skeptical, veteran sworn law enforcement officers became extremely rewarding. I quickly saw the change in their attitude over the week of didactic lectures and role play toward individuals with special circumstances. It required a different approach and the use of a new set of tools than those they had learned as recruits. It is not that different from what seasoned cardiologists learn and experience when caring for those with heart failure, a different attitude and use of their tools.
My activity level remains steady. I spend part of each day on an elliptical training machine and riding a bicycle, continuing a prudent lifestyle and taking what I consider a minimum of daily medications: carvedilol, captopril, spironolactone, and atorvastatin. Currently, I do not experience dyspnea with exertion or at rest, lightheadedness, palpitations, presyncope, or syncope. My pulse is regular and my blood pressure normal. My echocardiographic results confirm my recovery and stable clinical course ( Table 1 ). Part of my time is spent presenting at local, regional, national, and international conferences on crisis intervention team training and establishing a working program in the community, getting others on board with a better approach to helping others, and dispelling stigmas and stereotypes. As I alluded to, had I not had a caring and dedicated cardiologist then and now, things may have turned out very differently for me. It is up to the cardiology community to dispel some of the myths and stigma attached to patients with heart failure and step up to the challenge and embrace newer information and treatment.
