Lessons of the Heart

By Jessica Park

When Amy Begemann was promoted to service line director for Boone Hospital Center’s cardiology and cardiovascular and thoracic surgery department in February 2016, she knew she would work with an amazing team of health care professionals, nurses and physicians. What Amy didn’t know is how closely she’d get to see many of them care for a patient.

And Amy didn’t expect that patient to be her husband Richard who, at 66, seemed to be in great shape. He had always been and was still active, tracking daily, miles-long walks on his Fitbit and lifting weights at the YMCA. He had a history of high blood pressure, but experienced no chest pain or shortness of breath and he’d never smoked.

“I was doing 100 push-ups every morning,” Richard says.

He did start noticing pain in his left shoulder, but thought it might be from stress on his rotator cuff from weightlifting.

“That was actually a symptom,” Richard says. “But we didn’t know that yet.”

Amy’s new role made her aware of the importance of calcium scoring screening, a diagnostic test to detect heart blockage in people who haven’t previously been diagnosed with coronary artery disease but have major risk factors, such as high blood pressure, high blood cholesterol, obesity, diabetes or a family history of heart disease. The test uses a CT scan to check for calcium deposits in the walls of the coronary arteries, which may indicate early development of coronary artery disease and narrowing or blockage of coronary arteries. These build-ups of calcium can develop before a person feels any symptoms.

Given her husband’s history of high blood pressure, Amy recommended that Richard ask his primary care physician to have the test done.

Richard’s physician, Susan Johnson, MD, with Boone Medical Group, referred Richard to Boone Hospital Center, where he had calcium scoring screening exam. The screening involves a non-invasive CT scan to take images of your heart in its resting state while an EKG records your heart activity.

The next day, as they packed for their vacation, the Begemanns received the call with his results. His calcium score was very high, indicating a higher risk of heart attack. Further testing was required.

“We were going to Florida for Cardinals spring training and were going to be gone for almost a week,” Amy says. “I asked them, ‘Do we need to cancel our trip?’”

The vacation plans were still a go, but Richard was scheduled to undergo a nuclear stress test – the next step in diagnosing blockage — and had an appointment with a cardiologist at Missouri Heart Center after he returned.

“We didn’t get to keep that appointment,” Amy says.

While on vacation, Richard began complaining about his shoulder pain. He was also unusually fatigued.

Amy says, “The day we flew back to Missouri, he said, ‘Something’s not right.’”

His condition grew worse after they landed in Saint Louis. Before the family made it home, they stopped at Boone Hospital Center’s emergency department, where Richard received an EKG and the physician pulled up his cardiac calcium scoring results.

“The doctor told Richard, ‘I don’t feel comfortable letting you go home,’” Amy says.

Richard was admitted that day and underwent cardiac catheterization to check for blockage in his arteries.

“I thought they’d put a few stents in his arteries, and then we’d be on our way,” Amy says. “When the doctor came out to the cath lab waiting room to talk to me, I almost fell out of my chair.”

The results: Richard didn’t just have severely blocked coronary arteries, he had one of the most severe kinds of blockage.

“They call it the Widowmaker,” Richard says, referring to the blockage in his heart’s left anterior descending artery (LAD). An LAD blockage can stop blood flow to the entire left side of the heart, the side which pumps oxygenated blood into the rest of the body and, if not detected and treated, frequently results in sudden and fatal heart attack. (Despite the nickname, women also have LAD blockages.) Richard’s artery was about 80% blocked.

He was discharged and scheduled to return to Boone Hospital on Monday for triple bypass surgery. He recovered and was able to return home that Thursday.

Richard says all the nurses and techs who cared for him in the ICU and cardiology units were great and that he couldn’t have asked for a better surgeon than Richard Mellitt, MD.

Amy was with her husband as he went through multiple areas of the cardiology service line, including EKG, echo testing, cardiac catheterization, the cardiology inpatient unit, and then cardiac rehabilitation visits following his surgery.

“I no doubt knew we were in the right place. I was fully confident in all of the staff and knew our physicians are rock-solid. It was definitely an experience,” Amy says.

“If I hadn’t had this job, we would not have known to have the calcium scoring screening. And as much as Richard does with our son – taking him to school and to practice, the what-if factors were exponential,” she continues. “He really is the poster child for early detection.”

Cardiac rehabilitation therapist Greg Thackery agrees: “Richard is a good example of how the calcium scoring test helps.”

Richard has attended cardiac rehab sessions for three times a week since his surgery. During his sessions, he receives heart health education and exercises under supervision while his heart rate is monitored.

“I told Greg I’m like a well-oiled machine, except I’m broken!” Richard jokes while pedaling on an exercise bike. He’s eager to recover and resume his regular activities, including his mowing business, which his sons and neighbor assist with with while he recovers.

“He’s not used to being dependent,” Amy says.

Calcium scoring screening, while not covered by most medical insurance, is available through Boone Hospital Center for an out-of-pocket cost of $100. Richard says it was a very small price to pay for peace of mind and he’d gladly have paid five times that, knowing what he does now.

Amy’s knowledge of the value of calcium scoring screening has also increased. “I should probably have the screening done now,” she says.

Richard’s primary care provider, Dr. Johnson, was also amazed by outcome.

Richard says, “She said to tell me to tell Amy that she saved my life!”