February 21st, 2017

The Cough That Was So Much More

janie cough that was so much more

Janie was usually in great shape and at age 66, proud to compete in triathlons. But after months of a lingering cough, she could barely carry a chair to the beach. Three doctor’s visits later, she finally discovered the cause of her new struggle—and how she could feel better again.

Janie Seigler thought she had a terrible case of bronchitis. Her symptoms started in the winter and lasted well into the summer.

“I couldn’t stop coughing,” she recalls. “I couldn’t catch my breath. I had to rest after carrying a chair from my car to the beach.”

The tiredness was out of character for Janie, a 66-year-old Portsmouth resident. She prided herself on being a fit, active woman who competed in triathlons.

Thinking she might have asthma, Janie’s primary care doctor sent her to a pulmonary specialist. The specialist suspected the problem was not Janie’s lungs, but her heart. A cardiologist soon diagnosed her with heart failure.

Janie started heart medications, yet her condition quickly deteriorated.

“I was vomiting nonstop,” she says. “I didn’t have the strength to brush my teeth.”

By November, Janie needed a wheelchair to get around. That’s when her doctor referred her to Dr. John Herre, a cardiologist at Sentara Heart Hospital.

“Janie’s case was typical of many heart failure patients,” Dr. Herre says. “They suspect bronchitis, pneumonia or asthma when in fact their hearts are failing. Vomiting is also a classic, overlooked sign of heart failure. When your heart isn’t pumping efficiently, you fill up with fluids, which makes you feel nauseated.”

A heart catheterization showed that Janie’s heart was only pumping blood at 20 percent of capacity. The normal range is between 55 and 70 percent. Janie was at a high risk of dying from advanced heart failure.

The Sentara Heart team worked to secure a spot for Janie on a heart transplant list and evaluated her for a ventricular assist device, which would serve as a bridge until a donor became available.

Dr. Herre also started Janie on an infusion of milrinone lactate, a powerful medication that opens up blood vessels. The results were dramatic: Janie’s blood pumping function improved by 15 percent after just five days. The improvement was enough to keep Janie off the heart transplant list.

Once home, Janie took medicine for three months to meet requirements for a heart device. She also wore a defibrillator called a LifeVest that protects people at high risk for sudden cardiac arrest.

Unfortunately, tests conducted a few months later showed little improvement in Janie’s heart function, and she received a biventricular defibrillator, a combination pacemaker and implantable cardioverter defibrillator. It stimulates the heart’s right and left ventricles to help it beat more efficiently.

“We used the combination device because Janie also had left bundle branch block, a condition that impedes electrical impulses in the heart,” Dr. Herre says.

Janie’s blood pumping ability jumped to 50 percent, slightly below the low end of normal.

“I’m now back to walking three to four miles every day,” Janie says. “It’s a relief to feel like my old self again.”