cardiac HEALTH ON TIME
SPRING
Severe Arrhythmias Can Be Life-Threatening
SOLUTIONS EXIST TO DETECT AND MANAGE IRREGULAR HEART RHYTHMS
THE HUMAN HEART IS A PUMP designed to circulate blood in and out of the lungs and through the body. But what a pump! This small muscle beats 100,000 times a day, or the equivalent of about 2.5 billion heartbeats in an average lifetime. It adjusts its rate with exquisite precision, depending on how active we are, moment by moment. Unfortunately, heart rhythms can become abnormal, causing arrhythmias that might increase the risk of heart disease and sudden cardiac death. Severe arrhythmias can be life-threatening. Fortunately, new tests and treatments can effectively diagnose and control arrhythmias, preventing further complications. Here’s what you need to know about the risk and what can be done.
Normal heart Sinus node Normal electrical pathways Atrioventricular node
WHEN THE BEAT GOES WRONG
NORMAL HEART RHYTHM
CARDIAC ARRHYTHMIA
The Heart’s Timekeeper. Arrhythmias take many Atrial Fibrillation different forms, from abnormally slow heartbeats, called bradycardia, to dangerously fast beats, Atrial fibrillation called tachycardia. Importantly, arrhythmias may impulses occur as premature atrial or ventricular beats, which are usually not serious. Chaotic signals When the two upper chambers beat erratically, blood doesn’t fully empty from the Rapid ventricular chambers. Some blood pools inside the le impulse atrium, increasing the risk of clots that can lead to strokes or obstruction of arteries. To help prevent this increased risk, patients with permanent or intermi ent atrial fibrillation are usually placed on anticoagulant drugs. Arrhythmias can also occur in the heart’s Atrial fibrillation is the most common form of arrhythmia, affecting about lower chambers, or ventricles. One rare but 3.4 million Americans. This dangerous arrhythmia increases the risk of dangerous ventricular arrhythmia is called blood clots and is responsible for 15 to 20 percent of ischemic strokes. long QT syndrome, which can result in rapid ventricular tachycardia or fibrillation of a special type called torsade des pointes. ELECTROPHYSIOLOGY SERVICES People with this We regularly provide a full spectrum of invasive, noninvasive syndrome are at increased risk of and consultative electrophysiology services. For an appointment, sudden cardiac death.
KNOW YOUR RISKS
SINUS BRADYCARDIA
VENTRICULAR TACHYCARDIA
call 706-721-2426 or visit augustahealth.org/cardio.
The Heart Knows For Augusta business owner, wife, mother and grandmother Gwen Fulcher Young, that May morning was just like any other – busy. She was off and running by 5 a.m., preparing for a morning meeting then a drive to an out-of-town conference. “I was very busy,� admitted Young. “I was very, very stressed, and being a type A plus personality, everything was intense.�
Although Young had suffered from a rapid heartbeat, or arrhythmia, since her 20s, she had always simply taken medication, and as soon as the symptoms abated, she would say, “‘I’m fine,’ and just try to go on with life.� But that morning, after giving Young warnings off and on over the years, her heart finally said, “stop.� “My heart was beating so hard that I could hardly breathe,� said Young. She made it through the meeting but went to her cardiologist’s office on her way out of town, where they told her, “You’re not going anywhere.� It turned out that Young’s heart was racing above 200 beats a minute, but even after a week of hospitalization, it simply wouldn’t calm down. So she was transferred GWEN’S STORY CONTINUES INSIDE
One of Gwen Fulcher Young’s many interests and talents is gardening.
To watch Gwen’s story and others’, visit augustahealth.org/stories. GRU-
Augusta University 1120 15th St. Augusta, GA 30912
NONPROFIT U.S. POSTAGE PAID AUGUSTA UNIVERSITY
STAYING IN RHYTHM Detecting Heartbeat Irregularities
IN SOME CASES doctors can detect arrhythmias simply by taking the pulse or by listening through a stethoscope. However, because the arrhythmia might not always be present, the duration of a test can vary from under an hour to one or more days. Electrocardiogram The simplest diagnostic test is an electrocardiogram (ECG or EKG), which creates a graphic image of the electrical signals that activate each heartbeat. Holter heart monitor Because certain arrhythmias come and go, cardiologists sometimes use an ambulatory ECG, during which patients wear a portable ECG machine called a Holter monitor, usually for 24 to 48 hours. A bu on is pressed to record the ECG reading if symptoms are experienced, but arrhythmias are also detected when no symptoms occur. Electrophysiologic study An electrophysiologic study can pinpoint the exact location where an arrhythmia is occurring. Catheters can be used to trigger different areas of the heart to induce an arrhythmia, allowing cardiologists to observe exactly what’s happening. When indicated, physicians can o en effect a cure with a technique called catheter ablation.
Cardiologists have many ways to get the heart beating normally again. Drugs called beta-blockers slow abnormally fast heart rhythms and limit the effects of adrenaline on the heart. Calcium channel blockers can also slow the heart rate and suppress tachycardias. Several antiarrhythmic drugs also help maintain normal heart rhythm. Research When the heart rate is too slow, permanent pacemakers can be has shown that yoga inserted that take over and set the pace. For patients who are at risk of life-threatening ventricular arrhythmias, cardiologists can reduce heart rate by usually use an implantable cardioverter-defibrillator. This device detects ventricular fibrillation and delivers an electrical shock to the heart in order to restore normal rhythm, but per minute, when used in other arrhythmias can be treated as well. combination with traditional Another treatment that has shown great success is radiofrequency ablation, in which radiofrequency energy, Afib treatments and under via an electrode catheter, is used to freeze or destroy the guidance of a certified the small area of the heart that is found to be the cause of yoga instructor. irregular heart rhythms. Abnormal tissue is usually identified during an electrophysiological study. For certain types of arrhythmia, when medications are not effective or if the patient requires heart surgery for another problem, doctors might elect to perform a maze procedure. During this surgery, the surgeon uses radiofrequency energy or cryotherapy (extreme cold) to make small incisions on the area of the heart where the arrhythmia arises. When the incisions heal, they form a criss-cross, or maze, of scar tissue that does not allow disruptive electrical signals to pass through it.
4 beats
Tilt table test Some arrhythmia patients suffer episodes of fainting (syncope), particularly when standing. Doctors place the patient on a table that can be tilted upward from a horizontal position to vertical, while monitoring heart rate, ECG and blood pressure. Echocardiogram This painless test uses sound waves to show the size and thickness of a heart’s walls and Transducer the size of its chambers. The echocardiogram can also detail the pa ern of contraction of the chambers, and identify abnormalities such as enlarged chambers or diseased valves that could cause atrial fibrillation.
The Heart Knows Dr. Adam Berman, director of cardiac-arrhythmia ablation services, is board-certified in cardiology and clinical cardiac electrophysiology.
RESTORING NORMAL HEART RHYTHMS
Echocardiogram
Stress test Sometimes arrhythmias are more noticeable during exercise. Doctors can monitor heart activity while the patient walks on a treadmill or pedals a stationary bicycle. For patients who cannot exercise, physicians can administer a drug to induce a higher heart rate and identify the specific area of the heart that is abnormal.
CONTINUED FROM THE FRONT PAGE
to the Augusta University Heart Rhythm Center/ Electrophysiology (EP) Lab and the care of Adam Berman, MD, a cardiac electrophysiologist and director of cardiac-arrhythmia ablation services. Young was determined to be a good candidate for catheter ablation, a minimally invasive procedure that uses radiofrequency energy to inactivate the part of the heart muscle causing arrhythmia – and the EP lab at Augusta University’s health system offers the latest technology in the region. Young would undergo two separate series of ablations targeting her different arrhythmias and dramatically improving her quality of life. And her heart, at last, found a little rest. “I am more grateful for life every day,” said Young, who is semiretired and remains very active in the community. “And I am so grateful that I live here, where we have Augusta University Health, [which] has, in my opinion, some of the brightest and most well-trained and sharpest people in medicine … I’m convinced I’m a walking miracle.”
To watch Gwen’s story and others’, visit augustahealth.org/stories.
An implantable defibrillator sends an electrical shock to the heart to help restore normal rhythm.
Sudden cardiac death accounts for
60% of the nation’s yearly death toll.
SUDDEN CARDIAC DEATH Almost half a million Americans die every year from severe arrhythmias, which occur when the heart’s electrical system goes badly awry, causing complex ventricular tachycardias and/or ventricular fibrillations, which are o en fatal. These are usually due to heart a acks or other structural heart problems. Although some cases are never explained, research shows that most occur from structural abnormalities in the heart or from inherited arrhythmias. Recent findings suggest that up to 75 percent of deaths in young victims are linked to inherited heart problems. Many cardiologists advise immediate family members of victims of sudden cardiac death to be tested for arrhythmias and other signs of heart abnormalities.
Practice Risk Reduction MANY FIRST HEART ATTACKS and strokes are fatal, so it’s important to know your risks. At Augusta University Heart and Cardiovascular services, specialists in interventional cardiology, coronary artery disease, congestive heart failure, electrophysiology, cardiac imaging and open-heart surgery work as a team to diagnose and treat the full range of cardiovascular diseases.
To schedule an appointment, call 706-721-2426.
Call 706-721-2426 to request a same-day appointment with Augusta University Heart and Cardiovascular services.
Be proactive about your health! Visit us online at augustahealth.org/cardio, or call 706-721-2426.
WHEN TO CHECK ON THAT CHEST FLUTTER BY SEAN JAVAHERI DO
Q&A
concern. If you have frequent PVCs, however, this can lead to symptoms that can interfere with the quality of your life or even cause a weakening of the heart muscle called cardiomyopathy. At times, especially in those with underlying heart disease, PVCs can lead to an underlying life-threatening arrhythmia. The reasons PVCs occur are not always quite clear. Underlying heart disease or scarring, often as a result of a prior heart attack, may cause electrical impulses to be misrouted. Other causes may include certain medications, alcohol or illegal drugs; high levels of stress; too much caffeine; disturbances in thyroid function; congenital heart disease; coronary artery
ASK THE EXPERTS ABOUT IMPORTANT HEALTH ISSUES
WHAT DIETARY CHANGES CAN I MAKE FOR A HEALTHY HEART? You know you should eat healthy, but how? Start by adding more fruits and vegetables to your diet. Whole, fresh, or minimally processed foods are best, and use herbs, spices, and heart-healthy oils instead of salt and butter for seasoning. Try substituting fiber-rich grains and legumes for meat in some dishes, and limit processed foods, saturated fats and sugar-sweetened beverages. ARE ATHLETES AT HIGHER-THAN-NORMAL RISK OF SUDDEN CARDIAC DEATH? No. When a high-profile athlete suddenly dies, the news makes headlines. Athletes are not necessarily at increased danger for sudden cardiac death. Actual risk factors include a history or family history of arrhythmias, obesity or recreational drug use. Because athletes push their bodies to the limit, it’s important for them to be screened for heart disease risk factors, but being athletic doesn’t increase the danger. People who have been diagnosed with certain heart rhythm abnormalities may be advised against playing strenuous or competitive sports. The decision is best made between the patient and his/her physician.
SUDDEN CARDIAC DEATH IN SPORTS â–
The No. 1 killer of young athletes is sudden cardiac arrest. â–
A young athlete dies from a cardiac incident once every three days in the U.S. â–
It is usually due to a pre-existing condition, such as an undetected structural heart defect or a problem with the heart’s electrical circuitry, which could have been treated.
HEALTHY NEWS SAY ‘NO’ TO TRANS FATS The Food and Drug Administration (FDA) has issued a statement that partially hydrogenated oils (PHOs, or trans fats) are no longer “generally recognized as safe.� Food manufacturers have until October 2018 to stop using the additive in processed foods. The FDA estimates that ridding the U.S. food system of trans fats would prevent 20,000 heart attacks and 7,000 deaths from heart disease in the U.S. each year.
BETTER SLEEP HEALTHIER HEART A study published in the American Journal of Respiratory and Critical Care Medicine links severe obstructive sleep apnea (interrupted breathing during sleep) to an increased risk of cardiovascular disease. The study monitored sleep patterns of 1,645 middleaged or older participants, none of whom had heart disease or heart failure before the study. The study found a link between obstructive sleep apnea (OSA) and an increased level of high-sensitivity troponin T. According to the researchers, heart disease and heart failure can be predicted by this increased risk, suggesting that treating OSA and measuring hs-TnT levels in patients with OSA may prove beneficial.
disease and even heart failure. When accompanied by underlying heart disease, frequent PVCs can lead to chaotic, dangerous heart rhythms and possibly even sudden cardiac death. In some cases, if you have significant symptoms, underlying heart disease, very frequent PVCs or cardiomyopathy, you may need medications or other procedures to treat the PVCs. One such procedure that has been applied with great success is radiofrequency catheter ablation. An electrophysiologist – a specialized cardiologist who works specifically on the electrical system of the heart – performs this procedure, which uses radiofrequency energy to target and destroy the area of heart tissue that is causing the PVCs. This has revolutionized the treatment of the condition and may lead to a significant improvement in symptoms and heart-pumping function and, possibly, reduce the need for lifelong medications. The diagnosis and management of PVCs and other types of abnormal electrical activity of the heart require a coordinated management approach among your primary care provider, a cardiologist and an electrophysiologist to determine the underlying abnormality and the most appropriate treatment strategy.
Sean Javaheri, DO Interventional Cardiologist
Dr. Sean Javaheri is board-certified in internal medicine, cardiovascular disease and interventional cardiology. He joined Augusta University with 11 years of experience in cardiology. He served most recently as an interventional cardiologist at Madigan Army Medical Center in Tacoma, Washington, and, prior to that, as the Chief of Cardiology at Dwight David Eisenhower Army Medical Center. Dr. Javaheri is a fellow of the American College of Physicians, the American College of Cardiology, and the Society for Cardiac Angiography and Interventions and has received specialized training in peripheral vascular interventions. After earning his doctor of osteopathic medicine degree from Chicago College of Osteopathic Medicine at Midwestern University, he completed fellowships in cardiovascular medicine and interventional cardiology at Brooke Army Medical Center and Duke University Medical Center, respectively. While at Madigan Army Medical Center, Dr. Javaheri was awarded the Order of Military Medical Merit and the Legion of Merit and has received numerous teaching and scientific awards, including an ACC Young Investigator Award.
DR JAVAHERI IS AVAILABLE TO SEE PATIENTS AT THE FOLLOWING LOCATIONS Cardiovascular Center 15th Street, 937 15th Street, Augusta, GA 30912 Augusta University Medical Clinic at West Wheeler, 1220 West Wheeler Parkway, Augusta, GA 30909 He can be reached at sjavaheri@augusta.edu or 706-721-2426. For an appointment, call 706-721-2426.
Be proactive about your health! Visit us online at augustahealth.org/cardio, or call 706-721-2426.
Copyright Š 2016 GLC, Skokie, IL 60077 U.S.A. This publication is not meant to replace professional medical advice or service. Personal health problems should be brought to the attention of appropriate medical professionals.
Do you have a pounding sensation or fluttering in your chest? Or skipped or missed heartbeats? How about lightheadedness or feeling like you’re going to pass out? If you’re experiencing any of these symptoms, then you should talk to your doctor, as these symptoms may be a sign that you have premature ventricular contractions (PVCs). These are extra heartbeats that arise from the pumping chambers of the heart, called the ventricles, which can interfere with the regular rhythm of your heart and sometimes cause palpitations. PVCs are very common and may occur in most people at some point. Occasional PVCs in an otherwise healthy person are generally no reason for