I have so much to say about this news story that it became this blog post.
For those who don’t want to read the entire article, the tl;dr is: Jamie Waddell, a healthy vaccinated-and-boosted 36-year-old woman, got covid-19, recovered, then got heart failure so severe they put her on a heart transplant list, then recovered from that too.
Why Didn’t The Urgent Care Clinic Test Her for Troponins?
From the article:
Two days later, she was coughing and achy and asked her doctor for a chest X-ray, which came back normal. She called off work two days and went to her local urgent care clinic. She did not test positive for COVID-19 or flu.
“My vital signs at that visit were a little off. My heart rate was a little high. I had a fever,” she recalls. “I came home and basically went to sleep.”
Given that she had myocarditis, a troponin test at this point would’ve come back positive. Then the doctors would’ve known that she had a heart injury, and she needed treatment. Good treatment at this point in time would’ve slowed or perhaps stopped the progression of her heart failure, and she wouldn’t have needed such intense life support.
(After writing the rough draft, I learned that less than 10% of urgent care clinics can perform troponin tests. Much as I dislike it, this answers my question).
A New Myocarditis Blood Test Might Be Around the Corner
Myocarditis reporting data sucks because it’s hard to diagnose. Treatment is often delayed because it’s hard to diagnose. Yes, people with myocarditis test positive for troponins, but so do people who had recent heart attacks, or a variety of other heart injuries. Right now, the most conclusive way to diagnose myocarditis is to do a heart biopsy, but that’s so difficult and risky it’s rarely done. Oh, and sometimes only some parts of the heart are inflamed in myocarditis. If the biopsy takes a sample from a non-inflamed part of the heart, the doctors won’t be able to detect the myocarditis.
Some researchers think they’ve found a biomarker in the blood which is specific to myocarditis and only myocarditis. If true, that’s wonderful and I hope this blood test becomes widely available as soon as possible. It will make it easier to diagnose myocarditis, and it will make diagnoses more accurate.
What Most Shocked Me
To most people, the shocking part is that a 36-year-old woman who often walked 5 miles a day would have such a sharp decline in health that doctors would consider giving her a heart transplant. But it doesn’t shock me. I have read a lot in recent months about how healthy women in their 30s get sudden heart diseases. Statistically, it’s bound to happen.
No, what shocks me is that she recovered from the heart failure.
She was in such terrible shape they implanted two (!) ventricular assistive devices (VADs) in her heart and put her on a heart transplant list. Then…
“I was pumping my own blood and breathing my own oxygen, and I was discharged three days later,” Waddell says. “I was in really bad shape and then all of a sudden, I wasn’t.”
Waddell lost a lot of muscle during her time in the hospital — almost three weeks in total. She could walk, but it felt difficult, and she started physical therapy. Now, Waddell sees a cardiologist and needs some medications.”
The journalist doesn’t understand how astonishing this is.
VADs are mechanical blood pumps. VADs come with so many problems that doctors only use them when it’s the only way to keep a patient alive (i.e. their heart no longer pumps enough blood). Most people with heart failure don’t get VADs because they aren’t that desperate (well, maybe that’s changing as the technology improves, I don’t know about the bleeding edge of VAD technology).
Most people who use VADs only have one. The doctors put TWO in her.
Some people who need VADs don’t get on a heart transplant list because hearts are in such short supply. We don’t necessarily want to increase the supply of heart since most heart donors are like my high school classmate who died of a car crash injury when she was 20 years old (I hope her heart is still alive in someone’s chest, but it would be better if she were alive). That Waddell was listed for a heart transplant implies that she was in bad shape even among people who get VADs.
Until I read this news story, I thought that anyone who had VADs implanted in them would need to keep them until they got a heart transplant or the end of their lives. This is the first case I’ve found of someone who had VADs and was later able to pump their own blood without a heart transplant.
(In the rough draft of this blog post, I made some statements which, upon further research, turned out to be false—I’m still quite ignorant about heart disease! Be skeptical of everything I say unless it’s confirmed by a more reliable source.)
The Part I Wish I Didn’t Understand
“It was definitely surprising to learn that my heart was doing so badly. Again, just nothing I ever would have expected given my lifestyle,” she says. “It’s shocking to go from a person who is very active and no health history whatsoever to needing a new heart.”
I have been much luckier than Waddell (so far), yet before I got my troponin test results I thought about what it’d mean if I had to go down the heart transplant route. It was never more than a remote possibility for me, but that it was a possibility at all…
Before my recent chest troubles, I wouldn’t have understood what she was talking about. Oh sure, I would’ve thought I understood, it’s in plain English, but I wouldn’t have understood, not really.
I hope you don’t understand.
Did She Get Myocarditis Because She Was Vax’d & Boosted?
I saw speculation on the internet that perhaps she had gotten severe myocarditis and heart failure because of her covid vaccine + booster.
The short answer is: nobody knows if that’s a contributing factor.
The covid vaccines can cause myocarditis, even in the absence of coronavirus. (scientific paper) (video explaining the scientific paper to non-experts)
That said, I’m 99% sure the vaccine is NOT the direct cause. Given that she’d had a covid infection mere weeks before, I doubt she got a vaccine booster within the week before her first myocarditis symptoms. Nearly all cases of vaccine-induced myocarditis start within a week of the jab (or do we know that, if myocarditis is so hard to diagnose? Well, until I see evidence otherwise, I’m going to believe that most vaccine-caused cases of myocarditis start within a week of receiving the vaccine/booster).
My guess is that the pathogen which caused her pneumonia also caused her myocarditis, but it’s also possible that her covid-19 infection caused it and it took weeks for the symptoms to emerge.
This is where I’d like to point out that evidence suggests that covid-19 infections may mess up the immune system in such a way that people become more vulnerable to other infections. I don’t understand this scientific paper, but this video supposedly explains it in a way non-scientists can understand. Perhaps covid-19 trashed Waddell’s immune system, and some other pathogen which otherwise would’ve been a nothingburger gave her pneumonia and myocarditis.
What does this have to do with vaccines? Well, it’s possible that the covid vaccine/booster altered her immune system in such a way that it became more inclined to inflame her heart than it would’ve been if she’d never been jabbed. It’s also possible that the vaccine/booster made her covid infection milder to such a degree that it reduced her risk of myocarditis but she was Just That Unlucky and got myocarditis anyway. Maybe both of these things are true and canceled each other out.
As long as myocarditis reporting data sucks, I don’t expect any evidence-based answer to this question.
The Lesson I Want You to Learn
The article says, “[Waddell] hopes her story encourages people to seek help when something seems off and to rest when they’re sick.”
I agree that it’s good to seek help when something seems off and it’s good to rest when you’re sick.
In this case, what she specifically needed was a much faster diagnosis. Had she started treatment the day she felt too much fatigue to walk normally, or even during her first visit to the urgent care clinic, she might not have needed such intense life support.
If you ever suspect you’re in a situation like this, try to get a troponin test.
In the United States, the fastest way to get tested for troponins is to go to an emergency room and declare that you have chest pain. ONLY DO THIS IF YOU HAVE A MEDICAL EMERGENCY. The altruistic reason to only go to the ER in an emergency is that you’d delay care for others with emergencies. The selfish reason is that if you don’t already have covid or other infections, the odds of getting infected in ERs in the USA are high.
Assuming you don’t have a medical emergency, you can try to persuade a doctor to order a troponin test for you. If you can get this done within less than two days, do it that way. If it would take you over two days to get a troponin test through a doctor, you can order a troponin test through Ulta Lab Tests in the United States. (Other over-the-counter lab test companies may also offer troponin tests or offer them in the future, Ulta Lab Tests is the only one I found now).
(I don’t know what’s the best way to proceed outside the United States, though my experience in Taiwan was that I could get most medical lab tests fast if I went to a hospital and asked for them, usually after talking to a doctor).
What Scares Me Most
Severe cases of myocarditis like Waddell’s, believe it or not, don’t scare me that much. That’s because they are rare.
What scares me more is mild myocarditis. It’s much more common, much less likely to be diagnosed in a timely fashion. But even mild myocarditis can weaken your heart and make you vulnerable to other heart diseases—which can kill you.
I don’t want to cause you undue alarm. Hopefully, a good myocarditis blood test will be with us soon. Until then, if you suspect myocarditis, get a troponin test. If you test negative, you’ll know that you don’t have myocarditis. If you test positive… it might not be myocarditis, but you’ll know your heart is in trouble.