My hidden aortic aneurysm: How a visit to my PCP saved my life

Clay B. Paulson always looked after himself and felt good, but when his wife encouraged him to schedule a checkup with his primary care provider, he realized he hadn’t seen a doctor in over a decade. The visit that followed ended up saving his life.

An initial diagnosis of a heart murmur led to further testing, revealing a serious heart condition known as an aortic aneurysm. After life-saving heart surgery, Clay has a new appreciation for his life—and an important message to share about taking care of your health.

This is his story.

A life-changing visit to the doctor

I’ve always considered myself to be a healthy guy. I haven’t always had the best habits, but when it came to physical work or athletics, I could always hold my own. Besides feeling healthy, I also work in healthcare, specifically cardiology, so I understand the importance of looking after yourself.

Earlier this year, I was having a talk with my wife about my unhealthy habits—I needed to make some simple changes to my diet and exercise routine. She also suggested that I get a physical. I realized I hadn’t seen a primary care doctor in a decade, so I set out to make an appointment. I was looking forward to the visit, but at 47, I also realized we may have to discuss conditions like diabetes or high cholesterol.

At my visit, after filling out some paperwork, I had my blood pressure taken and I was connected to an electrocardiogram or EKG, which measures the electrical signals of the heart. The physician listened to my lungs and heart with a stethoscope, and he was paying attention to a particular spot. He asked me if I’d ever been told that I had a heart murmur.

A flow murmur is the medical term for an unusual sound that occurs as blood flows through the heart or its surrounding arteries. Flow murmurs are common among children and teens but usually go away by adulthood. Although flow murmurs are usually not serious, my doctor recommended I get an echocardiogram, which is an ultrasound that looks at the structure and function of the heart. 

After my echocardiogram, to my complete surprise, I was told that I would need surgery.

My recollection is the doctor said, “You have an aortic aneurysm and need open heart surgery.” 

The doctor asked me if I was having any symptoms. A few weeks previously, I had gone on a hike in Santa Fe and had some shortness of breath while there. I had chalked that up to getting over a chest cold and the altitude, nothing more.

He explained that my aorta was 5.4 cm in diameter, whereas the typical one is 3 cm. Think of an aneurysm like a balloon—when it gets overinflated, it explodes. I started on blood pressure medication immediately, as well as something that would help my heart relax.

My life-saving open heart surgery

The next day, I received a call from a doctor. He said to me: “Clay, I didn’t sleep last night. I don’t know how long you’ve had this aneurysm, and I don’t know how fragile it is. I want you to go directly to the hospital. I’ve already made a phone call and they are expecting you.”

I immediately told my family and left the office. It was clear to me that everyone was scared, especially me. I was beginning to grasp how serious this was. 

My wife and son showed up to the hospital later and I received some good news: the aneurysm seemed local to one spot and all other areas looked good. The doctor explained that we would repeat the echocardiogram at the hospital. I then took several pills and medications to lower my heart rate.

The next day, I was told that I needed surgery right away. The aneurysm was bigger than previously thought. I was quickly moved to the operating room; it was all a bit of a blur.

I woke up in the cardiovascular intensive care unit (CVICU). When my surgeon came by the next day, they explained that the surgery had removed a part of my heart called the aortic root and replaced it with synthetic material. It turns out my aortic valve was also in bad shape and had to be removed and replaced with a mechanical heart valve. My surgery lasted about three hours.

While I was in the hospital, loved ones came to visit me from near and far to see how I was. I began to hear things like “lucky” and “saved.”

When I was feeling well enough, my chest tubes were removed and I started physical therapy, where I was encouraged to walk around. More than a handful of people told me how good I looked for a guy that just had his chest cracked open. I had to take their word for it.

I had wonderful nurses who were attentive to my every need. I was given a pillow in the shape of a heart and told to hold it close to my chest if I needed to cough to reduce any pain. I asked many of those nurses to sign my pillow throughout my stay. I will never forget their kindness.

Getting a pacemaker

I was still attached to various monitors, and I became aware that my heart rate was low. It was running around 40 bpm or so. I was told this was quite normal after the type of surgery I had. It can take some time for the brain and the heart to re-establish communication.

It can also take some time for the various chambers of the heart that participate in rhythm to start working together again. Unfortunately, in my case, another surgery was needed to insert a pacemaker.

The day arrived when my pacemaker needed to be fitted. I was taken upstairs to the Cath Lab where these procedures take place. However, I once again woke up in the cardiovascular ICU. There was some fluid in my chest from the first surgery that was putting pressure on my heart. I was at risk of experiencing something called a “collapsed lung.”

After navigating that last hurdle, it was finally time to go home after 12 days and 11 nights in the hospital. The nurse spent time going over the 12 medications I was to pick up and the precautions I had to take. No driving for six to eight weeks and I needed to keep my left arm in a sling to allow the pacemaker to get to know my body and the wires that went to my heart to settle in.

Pulling into the garage and walking into the house was emotional. I had barely been with our son over the past few weeks, and I hadn’t seen our dogs or smelled the familiar smell of home.

Our son had cooked dinner, and it was ready when we walked in. We stood in the kitchen or sat at the bar and ate jalapeno popper chicken—it was the most delicious meal I’d ever had. After dinner, I pet the dogs and sat down in my chair.

Getting used to a pacemaker is interesting. The idea that my heart is being controlled by a computer is a bit disorienting.

The most meaningful way I experienced this was when trying to go to sleep. I would lay down to sleep and could feel my heart beating quickly in my chest. Prior to the pacemaker, a couple of deep breaths would slow that down. It made it hard to fall asleep when it felt like I had just walked up five flights of stairs.

I began taking short walks each day and trying my best to eat three healthy meals per day. I was sent a monitor where I could check my blood levels on my own each day to determine how well my blood was clotting, which took some getting used to. I am starting cardiac rehabilitation soon, which will make me feel stronger.

Reflecting on my journey

Overall, the physical part of this journey is manageable; bones and tissue heal. The larger part of the journey for me has been emotional.

I often think about talking with my wife and agreeing to get a physical. What if I had delayed getting that scheduled? I think often about my physical and how the doctor was able to hear a murmur. What if he hadn’t taken the time? What if he hadn’t heard the murmur? I was fortunate to have folks in my life who could make this all happen very quickly and continue to expedite things to this day.

The reality is, I would have died. Based on what I know today, I would have died soon. I would have left a son fatherless, a wife without a husband, brothers with one less brother, a mother without a son for the second time. Those are all very heavy thoughts for me.

Then there is the flip side to that. My life was saved. Call it luck, good fortune, good timing or God’s grace. I am so grateful to be alive. I hope I always feel that way. The sun shines brightly and I enjoy feeling its warmth on my skin. I enjoy contact with people and telling those I care about that I love them.

I am unsure why I was so fortunate and why others are not. If I was saved for some special reason, it’s not clear today what that reason is. But I am scheduled to have genetic testing done soon so that hopefully, future generations can identify this problem early and deal with it before it becomes a crisis.

My life has been touched by grace and expert hands. I am here today and will be here tomorrow. I will tell my story to anyone who will listen. I hope it is a reminder of what healthcare can be and of the miracles that occur when people care about you.

This article was written by Clay B. Paulson.

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