CdA cardiac nurse needs heart transplant after getting rare inflammatory disease

Jan. 19—When Windy Manzardo first noticed her irregular heart palpitations, she knew what to do.

It was November 2021 during her shift as a cardiac nurse at Kootenai Health when something didn't feel right. So during her shift break, she hooked herself up to a cardiac telemetry monitor .

People often can feel palpitations from stress or high caffeine intake, but her heart rhythm wasn't typical.

"I hooked myself up real quick to one of our monitors at work, because I kept having these palpitations and they were lasting, so I thought I should just take a look," said Manzardo, 49. As she and co-workers viewed the monitor, they were shocked.

"It's ugly ventricular tachycardia," she said.

Ventricular tachycardia is a heart rhythm problem, or arrhythmia, caused by irregular electrical signals in the heart's lower chambers. A heart typically beats 60 to 100 times a minute at rest. With V-tach, the heart beats too fast and doesn't pump well for enough oxygenated blood.

Manzardo and co-workers waited for a confirmation from an electrophysiology doctor, who at a glance sent her straight to the ER. Later admitted to the hospital, she had a cardiac MRI ultrasound and echocardiogram. Lab results showed elevated cardiac troponin, indicating damage to the heart.

It took another six months to get a diagnosis of the root problem: cardiac sarcoidosis, a rare inflammatory disease.

Recently, Manzardo was placed on a waiting list for heart transplant surgery in Spokane. She's showing signs of heart failure.

Following that initial hospital stay more than a year ago, Manzardo briefly wore an external defibrillator at home. But within days, she returned to having slower ventricular tachycardia.

Manzardo spent most of her six years in the Kootenai County hospital job in its heart center, where surgeons perform heart ablations, install pacemakers and do heart catheterizations. Manzardo got those patients ready for the procedures and assisted in their recovery. Earlier in her career, she did heart stress-testing for 10 years.

Her experience also told her that V-tach is serious. It can lead to ventricular fibrillation and cause sudden cardiac arrest, according to the American Heart Association.

"If you go into V-tach and it's fast and it doesn't get converted, you can't sustain that," she said.

Near Thanksgiving 2021, Manzardo became a patient again at Kootenai, this time in the heart center where she worked, to get a defibrillator surgically placed. The device provides an electric shock to the heart to convert it back to a normal heart rhythm. At the time, specialists thought a virus might be affecting Manzardo's heart, and that medication and the defibrillator could solve the problem.

Instead, it was a medical roller coaster for much of a year.

"I say to people all the time that being a cardiac nurse and having cardiac problems is a blessing and a curse," she said. "Definitely, there are times I wish I didn't know what was going on."

Raised in Clark Fork, Idaho, Manzardo met her husband, Paul, at the University of Idaho. They settled in Coeur d'Alene and have two sons. Kyle, 22, plays baseball in Montgomery, Alabama, for a minor league Tampa Bay Rays team. Marcus, 19, plays baseball for Spokane Falls Community College and wants to be a physical therapist.

This past holiday season, the family had another scare. At breakfast with two friends in late November, Manzardo's defibrillator went off, and then kept going off.

"They're cardiac nurses, so as soon as my defibrillator went off, they called EMS," Manzardo said. "They call what I had a V-T storm."

The device did its job with electric shock over and over again to convert the heart rhythm back to a normal range.

Manzardo, now the heart patient asking questions, began suspecting then that she would need a heart transplant.

"I'm not going to lie; it was terrible," she said. "Not only do I know that is horribly dangerous because my defibrillator is going off, but also in my mind I'm thinking, why does my defibrillator have to keep going off?"

The EMS crew took Manzardo again to Kootenai's ER. Her next worry was waiting for medication to stop the issue. By the time doctors tried lidocaine, "I did eventually convert," she said. "I'm thinking, again because of my cardiac nurse brain, I don't think there is anything after lidocaine."

She eventually was flown via Life Flight to Spokane and stayed nine days at Providence Sacred Heart Medical Center , where a doctor first mentioned a potential heart transplant.

"I wasn't surprised."

Cardiac sarcoidosis isn't easy to diagnose. Manzardo credits Coeur d'Alene electrophysiology specialist Dr. Michele Murphy Cook for catching it in May.

Her cardiologist specializes in the heart's electrical system, Manzardo said. "You have your plumbing and electrical system in your heart, which is how I like to explain it."

In the first several months, Manzardo had other ultrasounds and echocardiograms. The tests kept showing a low ejection fraction, a measurement of the percentage of blood leaving the heart each time it contracts. When it didn't go up, her doctor mentioned cardiac sarcoidosis.

As the immune system overreacts, sarcoidosis can cause clusters of inflamed tissue called granulomas to form in organs. It commonly affects lungs, skin and lymph nodes but can impact the eyes, heart and nervous system.

A biopsy of tissue is the best way to diagnose sarcoidosis, Manzardo said, but that's tricky in the heart. A second choice is a cardiac PET scan, which she had done in Spokane at Inland Imaging. It confirmed the diagnosis.

Manzardo started high-dose steroids and immunosuppressant therapy.

"Because of this diagnosis, my doctor wanted me to see an advanced heart failure specialist and set me up with Dr. (Deirdre) Mooney, who happens also to be part of the transplant team at Sacred Heart," she said.

"Cardiac sarcoidosis is a brain teaser; we don't know what causes it, and the treatments we're doing, we don't know much about. It's common to have a heart transplant."

Although she hasn't been able to work, she's hoping eventually for a part-time schedule. Her arrhythmia has stayed under control, but is still concerning.

"I have heart failure, but it's not severe enough to cause severe symptoms. Mine is the arrhythmia stuff, kind of waiting for V-tach to come. If it's incessant like the last one, it's pretty scary. I feel pretty good right now."