Heart Sounds

Artery Occlusion

I’m sitting at the breakfast table reading the newspaper when my vision closes in at the edges for an instant and then clears. It’s a Sunday morning in late September, and I’ve just come up from lifting weights in the basement. I try to move my right arm and find I can’t. It’s dead weight, as is my right leg. I try to call for my wife, who’s in the kitchen, but I can’t form the words I want to say. I’m nine days away from my fifty-seventh birthday, and, when I got out of bed this morning, I thought I was in perfect health.

Brain Bleed

At the emergency room, the neurologist says he’d like my permission to give me the tPA (tissue plasminogen activator), the clot-busting medicine that has to be started within three hours of the first symptoms of a stroke. He wants me to understand there’s a three percent chance that the tPA will cause a bleed in the brain. Still, this is my best chance for recovery. I offer my approval by raising my left arm and giving the neurologist a thumb’s up. The IV drip of tPA begins. I don’t know, then, that statistically the odds are still against me. tPA only cures one out of ten stroke patients.

Cerebral Infarction

Also known as an ischemic stroke, it results when there’s a disturbance in the blood vessels of the brain. After my CT scan, my neurologist tells me he suspects a piece of plaque has come unhinged in my brain and is blocking a blood vessel. He tells me that as the tPA does its work, this piece of plaque may flip around, causing momentary periods of recovery and relapse as I regain and lose again the use of the right side of my body and my ability to speak.

Death

Hemorrhagic stroke—bleeding in the brain—is less common but more frequently deadly than ischemic stroke.

Echocardiogram

I get lucky. The tPA works its magic and by evening I’m able to lift my right arm, able to stand, my right leg steady. My speech is back to normal.

The next morning, my neurologist comes into my room in the Neuro ICU, and I greet him with a wave of my right arm.

He says, “Well, that looks much better today.” Then he admits that he was very concerned about me. “Now,” he says, “it looks like you’re on the mend.”

The problem is he doesn’t know what caused my stroke. He does know, though, that it wasn’t a piece of plaque as he originally thought. It was a blood clot that somehow moved to my brain. But how? It will be a day of tests, he says.

A while later, I lie in my hospital bed as a technician moves a transducer around my chest. The transducer sends out high-pitched sound waves and records the echoes they make as they bounce off the internal structures of my heart. A computer converts the echoes into moving images on a monitor I can’t see. The sound waves bounce off blood cells, and, when they do, their pitch changes. I listen to the swoosh and swirl, the thud and thump. The computer colorizes these Doppler signals and gives an image of the direction and velocity of my blood flow. That’s how I find out that I have what the doctors suspect is a hole between the atria of my heart.

Foramen Ovale

“A PFO,” my cardiologist tells me. “A patent foramen ovale.” During fetal development, a hole in the septum between the atria of our hearts allows blood to move from the right atrium into the left. Since our lungs are nonfunctional when we’re in the womb, we don’t need the blood to pass through them. We get our oxygen from the placenta. The opening between the atria, the foramen ovale, is crucial then to our well-being in the womb. We have a layer of tissue that acts...