“I always say, if it isn’t broke, don’t fix it,” said 42-year-old Kevin Ulrich.
This is exactly how Kevin used to look at his health. As an Army veteran and member of the New York National Guard, Kevin was required to receive regular medical check-ups. However, after his time in the service ended, he, like many people, didn’t see any reason to continue routine doctor visits since his previous exam results had always come back normal.
It wasn’t until several years later Kevin opted to go in for a routine physical.
“Since I was starting with a new health insurance provider, I was required to schedule a visit with my new primary care doctor,” said Kevin. “Shortly into the exam, an EKG (electrocardiogram) test showed I might be on the verge of a heart attack. I went to see a cardiologist the very next day.”
Kevin learned he had a genetic heart condition known as hypertrophic cardiomyopathy (HCM) — a disease of the heart where one part of the muscle becomes enlarged or thickened. It can make the EKG severely abnormal, mimicking a heart attack in many cases. In fact, HCM is known as one of the leading causes of sudden cardiac death.
Kevin’s specialists put him on medication and monitored his condition closely. At one point, doctors even believed his heart muscle was shrinking. Yet shortly thereafter, Kevin became fatigued and began experiencing dizziness as well as pain and swelling in his legs. Normal daily activities such as climbing the stairs became difficult. Running into communications roadblocks and differences in opinion on the right approach to treat his specific case, Kevin grew frustrated with the care he was receiving.
“There was a breaking point when I suddenly collapsed on the job,” said Kevin. “It was evident I wasn’t getting better and I needed to find someone who could help me.”
Three days after Kevin’s collapse he went to see Dr. Srihari S. Naidu, a leading HCM expert and director of Winthrop’s Cardiac Catheterization Center at Winthrop-University Hospital in New York. Kevin came to their first meeting prepared with the results from his previous tests. Fortunately, Dr. Naidu opted to run his own tests on Kevin, including a cardiac MRI that showed significant scarring in his heart (a feature of HCM) and that the thickness of his heart muscle was actually double what previous test results had shown.
“When Kevin came to see me, he was experiencing severe heart failure. Not only was it affecting his heart, but it was impacting his lungs, kidneys and overall blood circulation as well,” said Dr. Naidu. “Kevin’s heart was only pumping to his body about half the amount of blood an average heart pumps. It wasn’t a surprise he was suffering from fatigue, dizziness, severe shortness of breath and leg pain.”
Kevin felt confident in Dr. Naidu and valued his expertise. Taking into consideration Kevin’s current health, Dr. Naidu considered both open-heart surgery (septal myectomy) as well as a minimally invasive alternative called alcohol septal ablation, which has been found to be appropriate for patients with severe symptoms and in cases where medications have failed. It is especially useful in patients who either are poor candidates for open-heart surgery (such as the elderly) or those who strongly prefer a minimally invasive option.
After an angiogram revealed an artery led straight to Kevin’s obstructing muscle, indicating a high likelihood of procedural success, Dr. Naidu offered Kevin the alcohol septal ablation procedure as a reasonable alternative to open heart surgery in his case. After considering his options carefully and listening to the risks and benefits of each, Kevin agreed.
During the procedure, a thin tube called a catheter was inserted through a blood vessel in Kevin’s leg and advanced up to the heart. Then a balloon was inflated to close off Kevin’s artery and prevent the alcohol from leaking into other areas of the heart. Then, pure alcohol was injected onto the obstruction to eradicate the problematic tissue.
“I was awake during the entire procedure,” said Kevin. “I felt no pain. The only discomfort I experienced was a burning sensation when the alcohol was injected, but that went away almost immediately.”
The procedure took about an hour. Typically following alcohol septal ablation, a temporary pacemaker is implanted, but considering Kevin was at high risk for sudden cardiac death from the severity of his HCM, he already had an internal cardioverter-defibrillator in place at the time of the procedure. An internal cardioverter-defibrillator functions also as a pacemaker.
Although he was required to stay in the hospital for monitoring, Kevin could feel a difference almost immediately. He was released from the hospital three days later.
“I would recommend the procedure to anyone who is in a condition like I was,” said Kevin. “Three days following the procedure I was like a new man.”
Three weeks later, Kevin received clearance from Dr. Naidu to start jogging and doing cardio exercise again, although he does have to avoid heavy lifting and other strength-training exercises.
Looking back Kevin feels fortunate that he had the option to undergo a less invasive procedure.
“As a father of three, I didn’t want to dedicate that much recovery time if I didn’t need to. If I could have a procedure with the least amount of stress to my body and less recovery time, and it was still going to work, then why not?” said Kevin. “I always compare it to my line of work. If you have a leak on your roof that can be fixed by replacing a single shingle, rather than tearing the whole roof off the house, why wouldn’t you do the least expensive and easiest thing?”
Kevin is back to coaching youth football and lacrosse teams for his children.
“Before the procedure I couldn’t even walk from my doorstep to my mailbox without having to hold onto something and catch my breath,” said Kevin. “Now I’m walking the length of the football field and back with no problems.”
He encourages others who are experiencing the same or similar heart problems to seek a center of excellence for care. Kevin says if he would have known the severity of his condition and all the treatment options right away, he would have addressed the problem a long time ago.The most common type of hypertrophic cardiomyopathy is caused by genetic abnormalities that affect the structural components of heart muscle and the way that the heart muscle is regulated at the molecular level. Currently, about 75 percent of patients with HCM have an identifiable genetic mutation that can be screened with a simple blood test.