The tell-tale heart-Prairie Doc 7-24-13

Posted July 24, 2013 at 12:00 am

Do you remember the short story “The Tell-Tale Heart” by Edgar Allan Poe? It ends with these words:

 “… – no, no! They heard! – they suspected! – they KNEW! – they were making a mockery of my horror! … and now – again! – hark! louder! louder! louder! …

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Richard P. Holm MD

‘Villains!’ I shrieked, ‘… I admit the deed! – tear up the planks! here, here! – It is the beating of his hideous heart!”

I have a real story of a telltale heart. His wife almost had to force him to come to the E.R. She said he was unusually irritable. Although he typically kidded with me, this evening the smile was gone. He complained of a throbbing abdominal discomfort that spread into a tearing pain into his back. On exam he had a pulsating abdominal mass and upon listening with the stethoscope I could hear a repeating and prominent whoosh. My patient had the telltale indications of a dissecting abdominal aortic aneurysm.

The aorta is the largest blood vessel that extends from the top of the heart and it provides oxygenated blood to virtually every cell in the body. It is a multi-layered, high-pressure hose that arches upward and around sending tributaries to neck and brain, arms and then down through the chest past the diaphragm. Once it reaches the abdomen, the aorta sends branches to bowels, kidneys, and finally splits to the two femoral arteries providing blood for the legs.

We measure the continuous pressure exerted within the aorta in millimeters of mercury, and its pressures on average range from 120 down to 80, but in a hypertensive person this can be much higher. After many years of such pressure, and especially after years of smoking, the walls of this mighty vessel can weaken and blood can split into one of the layers of the vessel, dissect down, and finally rupture or blow out the vessel, causing immediate death.

Some 14,000 Americans die from this condition each year and that would be less if proper screening occurred.  My patient did not die, but he went to surgery and within hours a new lining to his aorta was provided. Now, something like 10 years later, he is still alive and joking with me.

I saw him last week, and listened to the beating of his glorious, not hideous, heart.

Dr. Rick Holm wrote this Prairie Doc Perspective for “On Call,” a weekly program where medical professionals discuss health concerns for the general public.  “On Call” is produced by the Healing Words Foundation in association with the South Dakota State University Journalism Department. “On Call” airs Thursdays on South Dakota Public Broadcasting-Television at 7 p.m. Central. Visit OnCallTelevision.com.

The tell-tale heart

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