Despite pandemic-related stresses that permeated the world, 2020 also was a year of positive transformations for Patrick Burkhart, an advanced heart disease patient who also has multiple sclerosis (MS).
Burkhart retired early from a career in higher education administration and development in 2016 at age 62, three years after his first MS flare up. Then, he and his wife, Ann, moved from Chandler, Ariz., to Toledo, Ohio, to care for Ann’s mother. “We purchased a condo and two months later, while stripping wallpaper, I suddenly felt sick. So, I rested but began to feel numbness in my arm. Fortunately, I understood the warning signs and called 911,” said Burkhart. His left main coronary artery was almost entirely blocked. He was having a heart attack, often called the “widow maker.” Ninety minutes later he was undergoing emergency triple bypass surgery.
The complexity of his heart disease care was increased because of his MS, so he was referred to the Heart Failure Clinic at the University of Michigan. “It was hard to know where my fatigue came from, the MS or my damaged heart,” said Burkhart. A cardiac electrophysiologist in Michigan implanted a defibrillator and later convinced Burkhart to implant a CardioMEMS unit, used for continuous monitoring of hemodynamics – pressures in the lungs and hearts – in patients with advanced heart disease, often called heart failure. In January 2020, the University of Michigan team performed an arrhythmia ablation in an attempt to block errant electrical signals that had increased his arrythmia burden to dangerously high levels.
On March 12, 2020, the Burkharts began to drive from Toledo as part of their move back to Arizona, where they have three adult children, one each in Cottonwood, Mesa and Tucson. As COVID-19 closures swept across the United States from east to west, they managed to drive a day ahead of each state’s closure until they reached their new home in Cottonwood.
“Because of my risk factors, I wanted a cardiologist in Arizona who was at the forefront of CardioMEMS technology, and happily, I found that person in Dr. Nancy Sweitzer,” said Burkhart. Dr. Sweitzer, professor of medicine and director of the University of Arizona Sarver Heart Center, is board certified in advanced heart failure and transplant cardiology.
Burkhart had his first appointment with Dr. Sweitzer virtually in April, 2020, and she referred him to Mathew Hutchinson, MD, professor of medicine and director of the Cardiac Electrophysiology Program at Banner – University Medical Center Tucson, for an in-person appointment in August. Burkhart has a widened QRS complex on his ECG, an abnormality that suggests a significant degree of disease in the electrical system that couples the heart’s electrical activity to mechanical contraction. In the setting of a wide QRS complex, the main pumping chamber of the heart, the left ventricle, becomes uncoordinated and loses the synchrony essential to efficient pump function. At this time, Burkhart’s ejection fraction (the percentage of blood pumped out of the heart to the body in a beat) was 30% (normal is between 55 – 75%). The pressures measured by his CardioMEMS device had been consistently above the optimal range. Dr. Hutchinson adjusted his medication, placing him on Amiodarone to reduce the frequency of his arrhythmias.
This helped Burkhart feel good enough to get on a ladder in October to hang shade screens. “My defibrillator went off while I was on the ladder,” he said. “Thank goodness I was holding on.” The defibrillator sent data to the electrophysiology team, and Burkhart contacted Dr. Sweitzer. After Drs. Sweitzer and Hutchinson reviewed the defibrillator data and consulted with one other, they recommended a new cardiac resynchronization therapy defibrillator (CRTD), which was implanted in December. The CRTD paces the heart with each beat in multiple places, bypassing Burkhart’s diseased electrical conduction system and making his heart contractions much more efficient.
“This procedure transformed my life. I had become so accustomed to expecting the slow deterioration of my health – being diagnosed with MS seven years ago and managing the aftermath of the heart attack four years ago. But my condition has improved so much, I actually had some difficulty accepting how much better I feel,” said Burkhart.
“Mr. Burkhart actively takes care of his health and does his research. His advocacy combined with the collaboration and expertise of the heart failure and electrophysiology teams, helped return his heart and lung pressures to normal. We’re able to monitor these implanted devices remotely and provide daily patient consultation if necessary, which is important for people living in outlying communities,” said Dr. Sweitzer.
Burkhart recently bought a Jeep and has the confidence to wander dirt roads deep into the beautiful national forests that surround Cottonwood – confidently driving beyond cell tower range. Many Arizonans would agree, there’s no better way to cope with COVID fatigue.