Harold Thalhammer is the “go-to man” at a Laramie, Wyoming-based environmental engineering and consulting company. A facility manager of sorts, he cleans, stocks, shovels snow, landscapes and works logistics for event planning.
With two buildings and 150 employees, something always needs to be done. It’s a fulfilling job that he’s enjoyed for the past 16 years. And even though the 47-year-old is tired at the end of the day, he still has enough energy to get outdoors, taking a walk or riding his bike along the Laramie River Greenbelt Trail, or work out at his local gym.
But that wasn’t always the case.
Shortly after the holidays in 2015, Thalhammer started to lose sleep. Every night as he lay in bed, he struggled to catch his breath. It left him restless and exhausted.
“I didn’t have the giddy-up like I normally had,” he said. “I tired more quickly. I wasn’t feeling great, so I stopped doing those things like working out, and I just focused on work and getting through whatever it was that was afflicting me.”
Into the 2016 new year, things became progressively worse.
“I was panting and thinking, ‘I can’t go through life like this,’” he said.
Having been an otherwise healthy man, Thalhammer had not seen the need to have a primary care physician. Not feeling well, he scrolled through the local listings and made some calls, getting an appointment the following week.
It was a call that may have saved his life.
Taking symptoms seriously
The appointment was Monday morning. Although run-down, Thalhammer still didn’t believe his symptoms were serious. He figured he had a lung infection — something brought on by the cold and wind that penetrates Wyoming’s winter months — and he would be sent home with an antibiotic.
Thalhammer is lean and slender. He’s never smoked, he doesn’t consume alcohol, and he watches what he eats. So when the doctor listened to his heart that day and told him he’d be calling an ambulance to take him to the hospital, Thalhammer was shocked.
“EMTs were strapping me to a table and wheeling me out, especially at a healthy 42, I was like, ‘Wow, I can’t believe this is happening to me.'”
A heart in distress
At the hospital, an echocardiogram showed Thalhammer’s heart muscle was pumping at 20%. A normal heart ejection fraction is between 55% and 65%. His breathlessness while laying down was a sign of heart failure, and the cause: untreated atrial fibrillation.
Atrial fibrillation, or AFib, is the most common type of abnormal heart rhythm (arrhythmia), but is less common in younger adults, explained Dr. Ethan Ellis, a cardiac electrophysiologist and heart rhythm specialist at UCHealth in Fort Collins, Colorado.
Normally, a group of heart cells called the sinus node, located in the top right chamber of the heart, act as the heart’s built-in pacemaker and control the heart rate and rhythm. Signals originating from the sinus node activate the top chambers of the heart (atria) which then communicate the electrical signals to the bottom chambers of the heart (ventricles) which activate to pump blood throughout the body.
During untreated atrial fibrillation, the electrical signals in the top chambers of the heart become chaotic, disorganized, and rapid – overriding the sinus node signals. The rapid, chaotic, and disorganized signals get transmitted to the ventricles causing them to contract in an irregular and often rapid pattern. When this happens it results in pooling of blood which can lead to blood clots forming within the heart. If these blood clots leave the heart and travel to the brain, a person can have a stroke, the greatest risk for people who have AFib, Ellis said.
Additionally, when the ventricles pump in a fast and irregular pattern, this causes the most common symptoms of untreated atrial fibrillation including racing heart, shortness of breath, fatigue, exercise intolerance, chest pain and lightheadedness. For a small subset of patients, it can lead to weakening of the heart’s pumping function, as was the case for Thalhammer.
“(Thalhammer’s) heart was so bad that he had decompensated heart failure,” Ellis added. “He was in severe respiratory distress. It was a life-threatening emergency.”
Luckily for Thalhammer, both atrial fibrillation and heart failure can be treated.
Servicing heart patients in Wyoming
Ellis and his colleagues from UCHealth visit heart patients regularly at Ivinson Memorial Hospital in Laramie. They provide long-term management of such things as AFib, heart failure, hypertension, valve disease and coronary artery disease, as well as specialized heart care for inpatients. They also interpret cardiac imaging studies and cardiac monitors.
Patients requiring invasive procedures can travel to Poudre Valley Hospital in Fort Collins or Medical Center of the Rockies in Loveland, Colorado and subsequent follow up is provided back in Laramie.
At Ivinson, Thalhammer was given blood thinner medication to protect him from a stroke and another medication to slow his heart rate. The next day, he returned for electrical cardioversion, a procedure that shocks the heart back into a normal rhythm.
With medication and the cardioversion, Thalhammer’s heart function improved to 45%.
Looking at long-term management of atrial fibrillation
There is no cure for AFib but it can be suppressed with medication. However, these medications, called antiarrhythmic drugs, come with their own risks, Ellis said. It is also common for patients to have a recurrence of AFib despite medications. When medications do not suppress AFib, or if patients have side effects from medications or prefer to avoid long-term medications, an ablation procedure is an excellent option for long term suppression of AFib.
Cardiac ablation as a treatment for AFib
Ablation procedures are used to treat abnormal heart rhythms. Cryothermal (freezing) energy or radiofrequency (heating) energy are used to kill and scar small regions of heart muscle tissue that contribute to the development of abnormal heart rhythms. For some arrhythmias, ablation can be curative. The ablation procedure for Afib, called pulmonary vein isolation, is not a cure for atrial fibrillation, but is the most effective treatment strategy available for long term suppression, Ellis said.
It is a highly specialized procedure where catheters are inserted through the veins in the groin and extended up to the heart. Electrodes on the end of the catheters are then used to record the heart’s electrical signals and identify regions where abnormal heart rhythms originate. Other catheters are then used to freeze and cauterize the problem areas in the hopes of eliminating arrhythmia.
It is twice as effective as medications to control atrial fibrillation, Ellis said.
Thalhammer discussed this option in-depth with Ellis. Thalhammer would come early to MCR the day of the procedure, which would take about 4 hours, and he would be able to go home the next day. Thalhammer would then need to take it easy for the next week, avoiding activity such as lifting more than 10 pounds, allowing time for the catheter entrance area to heal.
“Ellis knows this stuff as well as anyone possibly could, and that made me feel good,” Thalhammer said. “He explained it wasn’t a silver bullet — it is still possible that my AFib could reoccur — but that he didn’t see that happening until my 60s or 70s. But he felt this would give me a good quality of life for decades and allow me to resume my normal activities, such as my physical job, with no limitation.”
Living with atrial fibrillation
Following his ablation procedure at MCR, Thalhammer’s heart pumping function returned to normal and his symptoms of heart failure resolved. It’s now been more than four years since his procedure and he’s had no reoccurrence of AFib.
Because he originally did not recognize his symptoms as serious, Thalhammer was concerned he wouldn’t recognize them a second time. Ellis also implanted a loop recorder, a small device about the size of a thumb drive, above Thalhammer’s heart after his procedure. The recorder keeps track of Thalhammer’s heart rhythm, and the date is reviewed by UCHealth.
Thalhammer had the device removed about three years later because the device had not recorded any irregular rhythms. Ellis talked to Thalhammer about how to recognize signs that his heart may be out of rhythm.
“The big thing is to check your pulse in the neck or wrist,” Thalhammer said. “He showed me how to do that; how to feel that normal pumping sensation, and if I don’t feel this — if I feel fluttering — then it is possible it is out of rhythm. I’d contact Dr. Ellis, and we’d go from there.
“I monitor my situation, but I live carefree mostly — and that’s where I’ve been for the past four years,” Thalhammer continued. “I meet with Dr. Ellis once a year in Laramie. He checks on things; asks me how I’m feeling.”
He compares the procedure to Lasik surgery, which Thalhammer said he’s also had done.
“Yes, I could struggle with glasses and contacts, but once you have that procedure done, you have years of worry-free vision, excellent eyesight and not the hassle of glasses,” he said.
“I know AFib is still there, and it could come back, but it’s really off my radar,” he added. “I can focus on my life, my relationships, my work, hobbies and activities. I can focus on those things and not worry about taking all these medications. I’m taking some but not nearly the extent I would have had to take had I not went this route. That peace of mind is great.”