PRACTICE TALES Rings and Ribbons I had known T. for many years, looking after her through her childhood and teenage years. She was now in her early twenties, and was going through an alternate life style stage. She had be<strong>com</strong>e an urban hippy, and she dressed in loose caftans, had long flowing hair, wore no makeup and lived with a group of like minded people in an old house. She presented to the surgery bec<strong>au</strong>se she was very concerned about her heart. For no apparent reason it would start racing, and the rapid heart rate would last anything from a few seconds to a quarter of an hour before stopping. This would happen every few days, and she didn’t like her body doing such strange things. She denied any use of illegal drugs or alcohol, and when I examined her, the blood pressure and pulse were normal. I suspected that she had paroxysmal atrial tachycardia (PAT). Paroxysmal means occurring suddenly and irregularly for no apparent reason. Atrial refers to the atrium, which is the small upper chamber of the heart, and which regulates the rate at which the heart beats. Tachycardia means "rapid heart" in Latin, and indicates that the heart is beating far faster than it should. Paroxysmal atrial tachycardia is therefore a sudden rapid beating of the heart, which starts in the atrium. The diagnosis can be confirmed by performing an electrocardiogram (ECG) while an attack is present, but this is often difficult to arrange. PAT is relatively <strong>com</strong>mon in women, may be triggered by hormonal, emotional or other factors, and is not harmful. Most attacks last only a few minutes, and c<strong>au</strong>se minimal dis<strong>com</strong>fort to the victim. The main problem is often the anxiety c<strong>au</strong>sed, as many patients believe that they are having, or about to have, a heart attack. If the attacks last for longer periods, or occur very frequently, medication can be given to prevent them. The need for long term treatment depends on the severity and frequency of attacks. I started to reassure her that PAT was the most likely explanation for her problem, but suggested that I should have a listen to her heart just to make sure it was behaving properly. She was wearing a loose caftan, tied at the waist with a woven rope belt, and the broad neck was held on her shoulders by lacing at the front. She promptly undid the lacing, and let the top of the caftan fall about her waist. En route to examining her heart, my stethoscope wavered slightly from its direct course to the appropriate area immediately below her left breast. It was impossible not to note her breasts, or more precisely, the nipples. Each nipple was pierced from side to side, and through the hole was looped a one centimetre diameter gold ring. This in itself was extraordinarily unusual, but hanging from each ring was a 15 centimetre long pink ribbon. 11
PRACTICE TALES I brushed aside the left side pink ribbon and listened to her heart. Shakily I reassured her that all was well, she had PAT, and treatment was only required if the problem worsened. Happy that her body was not letting her down too badly, she left the surgery. Neither of us made any reference to the rings and ribbons. 12
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