Rich Bugay had an appointment with the Division of Gastroenterology and Hepatology at Mayo Clinic in Rochester, Minnesota, on a Monday, where he had hoped to get answers and relief for what he thought was refractory acid reflux — until his doctor discovered a heart murmur. The next morning, Rich was told he had congenital heart disease and a severely dilated aorta that could rupture. Just two days later, Rich underwent lifesaving heart surgery. After a whirlwind four days, Rich was on the road to recovery.
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Rich Bugay, an HVAC business owner, husband, and father to two children, hadn't been feeling well for over a year. What started out as sinus issues gradually turned into severe acid reflux and exhaustion, making it hard for Rich to get through the workday.

"I wasn't feeling well — I had a lot of acid reflux and stomach discomfort. I had been going to a lot of different doctor visits, like my family practitioner, and I wasn't getting any answers," says Rich. "And so, at some point, I decided I wanted to go to the best place I could go."

Watch: Rich's story

Rich and his wife, Lori, left their house in Escanaba, Michigan, and drove more than six hours to Mayo Clinic in Rochester for an appointment with Dr. Houssam Halawi, a Mayo Clinic gastroenterologist.

During the appointment, Dr. Halawi listened to Rich's history, concerns and symptoms.

"And what caught my attention was, he had a lot of different symptoms that didn't really belong in the GI (gastrointestinal) world," says Dr. Halawi. "And at that point, in my mind, I was thinking this is not an acid reflux problem."

When Dr. Halawi listened to Rich's heart, he heard a suspicious murmur. He knew something — potentially big — was going on, and he recommended that Rich receive an urgent echocardiogram. An echocardiogram is a common test that uses sound waves to create pictures of the heart to find heart disease and other heart conditions.  

Rich was hesitant to have the echocardiogram since he just wanted some relief from his presumed acid reflux and didn't think he had a life-threatening issue.

Knowing that Rich would most likely go home if the echocardiogram couldn't be scheduled quickly, Dr. Halawi asked the scheduling team if there was any way they could arrange the echocardiogram for the next day. When the scheduler asked, "Would tomorrow morning work for you?" Dr. Halawi didn't expect it to be that quick.

Rich and Lori decided to stay at Mayo Clinic for the echocardiogram the next morning.

Confirming suspicions

Kylie Marvin, the sonographer who performed the echocardiogram, immediately noticed something was seriously wrong. She walked out into the hallway and informed Dr. Charles Jain, a Mayo Clinic cardiologist, about her findings.

"His aorta was severely dilated, well over what we would traditionally consider as the surgical cutoff for elective intervention," says Dr. Jain.

A severely enlarged aorta — the pipe that delivers blood out of the heart — could have acute complications, such as a rupture, which can be life-threatening.

The echocardiogram also showed that Rich had a bicuspid aortic valve.

The aortic valve usually has three cusps. A bicuspid valve has only two cusps. Rich's bicuspid valve wasn't closing tightly, which was causing blood to flow backward.

Dr. Jain called a radiologist and arranged an urgent CT scan for Rich that same day. The results of the CT scan confirmed the findings, and Dr. Jain called Dr. Gabor Bagameri, a Mayo Clinic cardiovascular surgeon, who was willing to make room in his schedule to quickly see Rich and arrange for surgery.

"At Mayo Clinic, the needs of the patient always come first, and even in the middle of the night, 24/7, you can always reach for help," says Dr. Bagameri.

He encouraged Rich that his heart problems were fixable and advised him not to wait to undergo surgery.

"He let me think about it and came back into the room about five minutes later and he says, 'OK, so we're going to do this Thursday, right?' I say, 'You know it.' And he says, 'I knew you were going to say that!' So, we were ready," says Rich.

"Like a well-oiled machine"

On the day of the surgery, Rich said everything was very structured and organized. The surgery itself was a success, as was his hospital stay.

"Like a well-oiled machine, everything just went so well, so smoothly," says Lori. "I've never experienced anything like that before, and that's how healthcare should be everywhere. Everyone deserves to be treated like they do here."

Now, nearly six months after his procedure, Rich feels almost 100% better.

"They saved my life," says Rich. "I'm a completely different person — I feel like a million bucks. I can do what I want to do, and my energy levels are much better."

Looking back on the experience, Dr. Halawi recognizes that Rich wouldn't have had such a positive outcome without every single person involved at Mayo Clinic. Dr. Jain echoes that sentiment, "When there are patients who are having a significant abnormality, particularly with urgency, such as Rich's, everything is already set up for teamwork to be natural, and fortunately, this makes it all relatively seamless."

Reflecting on his healthcare journey, Rich says that you need to advocate for yourself.

"If you haven’t been feeling right for a long time and feel like you're not getting answers, come to Mayo Clinic because they'll get to the bottom of it," says Rich.

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