Stephen Howatt always loved sports. When the 23-year-old and his friends weren’t playing basketball or floor hockey a couple of times a week, they’d get together for games of dodge ball. So he had no reason to think anything life-changing was about to happen when he headed out for another round of dodgeball last May.

After playing, though, Howatt was short of breath. He knew something was wrong when his breathlessness lasted an entire weekend.

“My heart was also going really fast, and I was getting kind of scared,” the Coquitlam resident says on the line from his home. Howatt went to a doctor, who gave him beta blockers, a type of medication that slows the heart rate, and advised him to rest. But his rapid pulse persisted, and over the ensuing days Howatt started to feel nauseated and increasingly exhausted. He figured he was dealing with side effects from the drugs.

Then one day after a shower, Howatt lay down on his bed and didn’t have the strength to get back up. His parents took one look at his pale face and called an ambulance.

“I don’t remember much after that,” says Howatt, who slipped into a state of unconsciousness that lasted more than a week. “When I woke up, it was quite a shock.”

He awakened at St. Paul’s Hospital to learn he had gone into cardiac arrest and then critical heart failure.

The cause? A virus.

“It just came up out of nowhere,” Howatt says of his heart trouble. “It’s been quite a ride.”

Although most people associate viruses with the type of nasty cold that’s going around these days, infectious germs can strike in other ways.

“Viral infections can cause myocarditis, or inflammation of the heart muscle, which can lead to weakened heart or heart failure,” explains Jennifer Kealy, nurse and patient educator at St. Paul’s acute-heart-failure program. “Virtually any virus can cause myocarditis, but the most common are enteroviruses, the influenza virus, and the common viruses of childhood, such as rubella and varicella. Other causes include bacterial infections such as Lyme disease, and autoimmune diseases such as lupus. In most cases, no definitive cause is found, and the cause of the myocarditis is presumed to be a virus.”

Certain adenoviruses, which usually infect the upper respiratory tract, are another potential cause of heart failure, according to a 1999 study in Circulation: Journal of the American Heart Association. These can cause left ventricular dysfunction, and the resulting muscle damage can be so severe that it can cause sudden death.

Furthermore, Chlamydia pneumoniae, a bacterium that commonly causes infections of the airway, can trigger or aggravate atherosclerosis (a build-up of cholesterol on the artery walls) and lead to heart attacks, according to a study published in Clinical Cardiology in 1997.

“Perhaps the most distressing thing about viral myocarditis is whom it strikes,” Kealy adds. “We see it in young patients who have had no significant previous illnesses. It’s pretty scary because it can hit anyone at any time.”

Howatt’s doctors were never able to determine exactly what type of virus caused his heart problem. However, because his heart had failed, Howatt had to be fitted with a ventricle-assist device (VAD), a mechanical, battery-powered pump. Known as a “bridge to transplant”, the VAD, which can last up to five years, is used to keep patients alive until they receive a new heart.

“It was a shock, to be sure,” Howatt says of waking up to discover a cord from the VAD sticking out of his stomach. He also had to get used to having two brick-size batteries on his belt at all times.

“I was checking the power constantly,” Howatt says. “I was so worried about it running out.”

Howatt’s case turned out to be one of the few where the heart repairs itself over time. He had his VAD removed earlier this month.

“My heart is recovered enough that they could take it out,” he says. “It feels strange not to have it; I had it for 10 months. The doctors said there could still be a transplant in my future. But I want as much time as possible with my own organs.”

Besides viral infections, other causes of critical heart failure include heart attacks, heart “shock” after surgery, and problems with the heart’s valves or rhythm.

Heart failure is the leading cause of hospitalization of adults in Canada, according to the Providence Heart and Lung Institute at St. Paul’s hospital. More than 15,000 people in B.C. alone experience heart failure every year. Only about 35 in this province a year require a VAD.

Right around the time Howatt was at St. Paul’s, Kealy noticed several of her patients struggling with similar issues. They had to adjust to things like doing daily dressing changes and showering without getting external parts of the device wet.

Some people were nervous about travelling. Others had to learn how to reestablish intimacy with their spouse, who had taken on the role of caregiver, while others had questions about the impact a VAD would have on their sex life. Kealy decided to start up a support group for VAD patients that’s been meeting monthly ever since.

“They were all talking about what it was like walking around carrying batteries in holsters and getting funny looks from security guards at banks, who thought they were packing heat or were wired for something,” Kealy explains. “They talked about beeps going off—the VAD will sound an alarm if the battery is low—or changing the batteries in public and getting stares.…

“Anxiety is a big issue as well,” she says. “There’s the fear that the pump is going to stop. There’s the fear of the unknown, of wondering when they’re going to get their transplant.…It’s helpful to talk to and get support from someone going through the exact same thing.”

Besides Kealy, a psychologist and cardiac surgeon attend the support group, which also has a Facebook presence (VAD Support Group).

Howatt has been going too. Now he’s concentrating on recovering from having his VAD removed and rebuilding his strength.

“I go for walks,” he says. “It’s a bit nerve-racking not having it. We worry about not having backup. But it’s also a relief.”