Heartbeat signals: Listen to your body

As a young Spokane mother who keeps fit, Katy Bruya nearly dismissed the little signs that led to her life-altering diagnosis of heart failure four years ago.

Today, medications keep her condition stable and artificially slow her heartbeat. That’s quite different than a day in November 2013 when she learned pregnancy hormones from carrying her second child had damaged her heart.

The medical world calls it pregnancy-induced cardiomyopathy, an uncommon condition among diseases of the heart muscle. About 1,000 to 1,300 women in the U.S. develop the condition each year, according to the American Heart Association.

“My cardiologist said the conduction system of your heart is failing; there was no but,” said the 46-year-old Bruya, who will be a main speaker at the Spokane Go Red for Women Luncheon Feb. 21.

Although it’s rare, the pregnancy hormones that weakened her heart muscle is similar to how a virus carried through the body can damage the organ, she said.

“I sat there really stunned. Basically, the pregnancy hormones had damaged my heart, but it took four years for that damage to really show up.”

With her diagnosis, Bruya learned that tests showed the percentage of blood her heart pumped through the body was at 38 percent. Healthy hearts pump at about 55 to 66 percent, she said.

Now Bruya, a Washington Trust Bank senior vice president, wants to tell other women that they should listen to their bodies and heed any advice to see a doctor.

She had early warnings that seemed minor at the time. Regular jogs quickly winded her, but she attributed it to needing to be more fit.

An obstetrician detected a heartbeat irregularity when she was pregnant with her daughter, now 8. Bruya and her husband also have a son, 10. That heartbeat irregularity appeared to correct itself, but she had gone to a cardiologist.

“Ultimately, I had what is called SVT, supraventricular tachycardia, which is where your heart races,” Bruya said.

“My cardiologist met with me right after I gave birth, and I had a follow-up EKG. Everything was fine, so I kind of forgot about it. Four years later when my daughter was 4, I had a minor medical procedure, and it’s standard that they hook you up to a heart monitor.”

The anesthesiologist told her the monitor indicated a heart block, and that Bruya should see a cardiologist. “I thought, oh yeah, there was some irregular heartbeat thing when I was pregnant.”

But Bruya did return to the cardiologist, who asked about any symptoms. Bruya at first came up empty, listing all that seemed right.

“I said, ‘I’m thin. I’m fit. I’m healthy. I don’t eat fast food. I don’t smoke, drink.’ I always thought of heart disease as the obese guy in the armchair who is 100 pounds overweight and smoking. But I told her, ‘I do get out of breath when I run, like I get out of breath right away.’ ”

Bruya excused that to the doctor by saying she was out of shape and jogged alongside really athletic people. “That’s when my cardiologist stopped me, and said, ‘No, someone with your build – you’re trim, you’re not obese –– you shouldn’t be running out of breath.’

“That’s a huge red flag.”

Bruya has since learned much about the mechanics of her condition. The cardiac conduction system is the electrical function of the heart, she said, and although people often interchangeably use two terms, heart attack and cardiac arrest, they aren’t the same.

“You hear about people having heart attacks; that’s plumbing, like your artery is clogged,” Bruya said. “When it’s electrical, it’s called cardiac arrest, meaning your heart just stops beating.”

“It’s like unplugging a light. All of a sudden the heart will just stop, and that is what I’m at risk for.”

She also learned the term “ejection fraction,” an important measurement of how well a heart is functioning.

With an echocardiogram, doctors determine the percentage of blood pumped out of the heart’s left ventricle during each beat, hence the ejection part. It’s a fraction because even with a healthy heart, some blood remains within the chamber.

“That’s the percent of blood your heart is pumping into your body, good oxygenated blood that makes your body work,” Bruya said. “For most people, it’s at 55 to 60 percent. Mine was at 38 percent, which is why I was running out of breath; my heart just couldn’t keep up if I started to jog.”

“For perspective, my cardiologist told me that you’re at risk of sudden death if your injection fraction is at 35 percent, and you are on a heart transplant operating table at 17 percent.”

“So I was sitting there thinking, I’m at 38 percent right now, and four years ago my heart was fine. At the rate we’re going, I’m going to be dead by the time my kids hit their middle school years.”

But her condition was curbed through medication, heeding doctor’s orders and focusing on staying healthy. That included taking beta blockers, and a few exercise restrictions at first.

It wasn’t a case of sitting on the couch, Bruya added, but rather giving her heart a rest to heal and stop damaging itself, she said. Over time, the health care approach got her ejection fraction to 50 percent.

“My issue wasn’t lifestyle. It wasn’t, get your cholesterol down, quit smoking or eat better. It was electrical, and the only thing I could do was take prescription medicine. She put me on three different prescriptions to basically force my heart to slow down.”

“Everything was great, and then it tanked again a year later. I went back in saying. ‘I’m out of breath again.’ They did another echocardiogram and it had gone down, so we kind of changed up the drugs. Now I’m stable.”

Bruya’s cardiologist said the timing had been crucial in listening to advice to revisit her office.

“She did tell me, ‘If you had waited until you discovered this on your own, or if you had waited a year from now, we would be having a really different conversation.’ This would be life-threatening later.”

The beta blockers have a few side effects, she said, mainly that she can get tired and sometimes feels like she’s moving through molasses, but Bruya sees the positives. She wears a wrist heart monitor if she’s exercising and eases up if it hits a certain beats per minute.

The cardiologist wants her to keep fit.

“Her words were, ‘Don’t be a cardiac cripple; just listen to your body.’

“I will be on these drugs forever. I will never be a marathoner. I will get out of breath when I exert myself.”

Bruya also sees some humor in her story. While undergoing multiple heart tests, she got strange looks when showing up for appointments.

“For all these tests I’m doing, I’m in the waiting room with people literally named Mildred and Vern who are 85 using walkers or with oxygen tanks. Every time they called my name they’d bring a wheelchair, because that was just standard.

“I was half the age of everyone there. They’d show up for appointments 45 to 50 minutes early. I’d come skating in with one minute to spare.”

Bruya said she wants to tell women to pay attention to their own health. That includes mental health if receiving a major diagnosis. She at first had nightmares and worried about her young children but sought therapy. It also helped that her family is very supportive, she said.

“My advice to women is listen to your body and don’t discount even the smallest thing, because if you wait, it could be too late,” she said. “It was lucky I was hooked up to a heart monitor, or I never would have gone to the cardiologist.

“As women, we get too busy taking care of everyone. We put ourselves last. Spend time and money to go to the doctor and ask the questions.”