Writer’s note: Affairs of the Heart is a three-part series describing the writer’s personal experience with open heart surgery. It is designed to increase awareness about maintaining a healthy heart through proper nutrition and exercise. But it will also alert the reader about certain congenital conditions that proper diagnosis can reveal.

Part One deals with how the writer discovered his condition, his lifestyle leading up to the diagnosis and what he did to determine a course of action.

Part Two deals with the surgery itself in September at Mission Hospital in Asheville, his 8-day stay there, first in intensive care, then in progressive care, and finally his discharge.

Part Three deals with the author’s cardiac rehabilitation at Angel Medical Center in Franklin.

The author is a resident of the Otto community. He earned his BA in journalism in 1972 and has been writing on a variety of topics over the past 40 years.

Part I

Kurt Volker with his wife, Sharon, leads an active, healthy lifestyle, which is not the habit of the typical open heart surgery candidate.

To look at me, you’d think I was the picture of health. A muscle-toned, 162 lb., 5’10”, 66-year-old white male, 5’10” tall, who enjoys a healthy, active lifestyle of hiking, biking, kayaking, swimming and working out with his wife Sharon at the Franklin Fitness Center on a regular basis. I quit smoking 40 years ago and consume alcohol rarely, usually on social occasions.

Since my high school days, I’ve never been overweight and other than the day a came into this world, have never been the hospital overnight. The only thing that even approximates a physical problem was when I had cataracts removed from both my eyes in 2000. My wife Sharon and I both follow a low fat/no-fat nutrition plan. So what prompted the need for open heart surgery?

Let’s go back to 2005, a year before I retired from my position as Natural Resources Specialist for the Broward County Parks and Recreation Division in Fort Lauderdale, Florida. The year before, we had bought our dream home in the lovely community of Otto.

Sharon and I were attending our usual 11 a.m. service at the First Presbyterian Church there. The pastor had just begun one his typical inspiring, and always humorous, sermons when I began to notice a pronounced change in the rhythm of my heartbeat.

There had been telltale signs for nearly a year, an occasional skipped beat, but it had been getting more worrisome. And this day, it really got my attention. Beat ... skip beat ... beat ... skip beat ... beat ... skip beat. This continued for nearly a minute and I began to feel flushed and slightly lightheaded, but with no pain, no shortness of breath.

When my heart finally resumed its natural sinus rhythm, normalcy returned and we stayed through the remainder of the service. I decided then and there, however, to make an appointment with a Fort Lauderdale cardiologist first thing Monday morning.

During a consultation with the cardiologist later that week, I described the episode in detail. He listened to my heart and confirmed what I had known for some time, that I had what’s often called a heart murmur. This is a relatively common condition in the general populace, characterized by the backflow of blood from the left ventricle into the left atrium. It is a result of the mitral valve not closing properly. The technical name is mitral valve prolapse. For most people, this is a relatively benign, inherited condition which can lie dormant for years before the valve starts to become problematic. It is more common in women than in men.

Before continuing, this might be a good place for a short course on how our heart works. We’ll call it Heart 101. I’d like to credit St. Jude Medical for the following information which I found in a pamphlet titled Helping Your Heart.

Why is the heart sometimes called a pump? (Figure 1)

Figure 1

What does the heart look like? (Figure 2)

Figure 2

After picking up oxygen, the blood returns to the heart through the pulmonary veins into the left atrium. When the left atrium is fill, it pumps the blood into the large chamber below it. The left ventricle then uses its strong muscles to pump blood into the body.

How does the heart beat?

The millions of cells in your heart react to small pulses of electricity. Your heart makes its own electrical pulses in a special area in the upper part of the heart called the Sinoatrial Node or SA Node.

What is the sinoatrial (SA) node? (Figure 3)

Figure 3

This contraction pushes the blood in the atrium down into the ventricle.

What is the AV node?

The AV node or atrioventricular Nodes is another specialized cell cluster, located between the atrium and the ventricle. It holds the pulse for just a few hundredths of a second before releasing it into the ventricle. The result is that the atrium beats first, pushing blood into the ventricle, and then the ventricle beats after it has been filled with the blood from the atrium.

How often does the heart beat?

A normal heart beats 60 to 100 times each minute, regularly and in rhythm, so the time between each heartbeat is roughly the same. Depending on the body’s need for oxygen, the heart can beat faster or slower. Your body tells your heart how much oxygen it needs.

As the old adage says, “Knowledge is power.” But now let’s to my initial consultation with my cardiologist.

He ordered a series of tests to determine the general condition of my heart and the extent of the mitral valve prolapse.

These included a stress test on a treadmill, a carotid artery sonogram, and an echocardiogram designed to look directly inside the heart. The last two tests are completely non-invasive, much like a routine sonogram for an expectant mother.

The stress test showed a strong, healthy heart, excellent respiration, and overall excellent conditioning for a man my age, 62 at the time. Same for the carotid sonogram, strong pulse, no blockages, no problem.

The echo however showed that there was mild regurgitation of blood back into the atrium from the ventricle and a mild enlargement of the atrium itself. The enlargement is caused by the heart having to work harder to compensate for the slight loss of blood not being pumped to the rest of the body. He recommended that I monitor the situation annually, which I did.

By 2008, my heart’s condition had worsened slightly, although I was completely asymptomatic… no shortness of breath, no pain, no nothing. The skipped beats had subsided dramatically due to the elimination of caffeine from my diet and a few supplements to help the mechanical/electrical connection within the heart.

The author and his family continue to enjoy the natural beauty of the western North Carolina mountains, and can now be confident that a strenuous hike won’t lead to a heart attack.

Flash forward to August 2009.

The echocardiogram showed that between 2008 and 2009, my mitral valve had deteriorated from moderate to severe regurgitation and the enlargement of the left atrium had gone from moderate to severe. Dr. Kegan strongly advises me to consult with Dr. Harry Burton of Asheville Heart, one of the top cardiac surgeons in the country.

From everything I had heard, and everything I had learned from my research, Dr. Burton was indeed the correct choice. He is a specialist in heart valve repairs and has been doing this procedure for more than 30 years. He has also performed virtually every type of heart procedure other than a heart transplant.

Dr. Burton has been affiliated with Mission Hospital in Asheville since 1981 and has authored or co-authored numerous papers on surgical techniques, is a fellow in the International Society of Thoracic Surgeons, and meets regularly in France with some of the world’s top cardiac surgeons to share knowledge and compare techniques.

He explains very clearly that this was the optimal time to have the valve repaired — and that due to my conditioning and nutrition, “your recovery will pay off in spades.”

Following his evaluation, Volker was scheduled for heart surgery at Mission Hospital in Asheville, shown here.

On the one hand, it is a no-brainer. The surgery will quite literally save my life. On the other hand, the thought of someone cutting into my chest and then into my heart leaves me a bit squeamish.

Without hesitation, we set Sept. 16, 2009 at 8 a.m. as the date and time for my surgery at Mission Hospital in Asheville.

In the next installment, Kurt will describe his surgery and stay at Mission Hospital and his overall impressions of his experience there.