Most common heart-related
conditions
- provided by America's leading
cardiologists
Abnormal Heart Rhythms
Abnormal heart rhythms, or arrhythmias, occur when
the heart beats irregularly. When the heart beats
too quickly, it is called tachycardia, and may be
caused by an underlying cardiovascular problem or
an abnormality in the heart's electrical system.
Slower heartbeats, called bradycardia, often a normal
finding in athletes, can also be caused by medications
or an electrical heart block, a more serious condition.
Click on a program below to learn more about abnormal
heart rhythms.
Corrective Devices
What is a Pacemaker?
A pacemaker
is a battery-powered device that sends signals to
the heart to help it beat
properly. Tune in to find out more about
these life-saving devices.
Participants:
Melanie Gura, MSN
Douglas P. Zipes, MD
Webcast Transcript:
ANNOUNCER: Everyone has heard of pacemakers,
but most people don't know what an important
role a pacemaker can play in maintaining
a healthy heart and lifestyle.
MELANIE GURA, MSN, RN: An artificial pacemaker
is a small, battery-operated device that can
actually take over the role of the heart's electrical
system when needed. It consists of the wire,
or the lead electrode system, and the pacemaker
or device itself.
The population for pacemaker implantation is
not limited to age, sex or race. There are approximately
100,000 pacemakers implanted yearly in the United
States, and they may be prescribed for a variety
of conditions.
Bradycardia is the most common rhythm problem
that is associated with pacemaker implantation.
This is when the heart becomes too slow, and
patients have symptoms such as shortness of breath,
fatigue, dizziness, or even fainting spells can
occur.
Atrial fibrillation is a very common heart rhythm
disorder in which the upper chambers of the heart
beat erratically and chaotically and rather fast,
and sometimes it's also too slow.
Heart failure is a condition in which the heartbeat
cannot meet the normal volume of blood and oxygen
to supply all parts of the body.
Syncope, also known as a common faint or passing
out, is usually less severe, but can occur frequently
in patients.
ANNOUNCER: Surgery is usually the next step
to regaining a healthy heartbeat.
DOUGLAS P. ZIPES, MD: A pacemaker is put in
under local anesthesia. So we make a tiny incision
in the chest, and the actual procedure itself
lasts 45 minutes to an hour and a half, depending
upon what is done. This is certainly not open-heart
surgery. It's very simply done.
MELANIE GURA, MSN, RN: Implanting a pacemaker
has very little risks associated. But however,
whenever there is a surgical procedure, complications
can arise. One of the complications that can
happen in the early postoperative phase can be
bleeding at the incision and sometimes it will
cause a hematoma or a little blood clot over
the pulse generator and some bruising.
Rarely, a lead can become dislodged or displaced,
and the patient would have to go back to have
the lead repositioned by the physician
DOUGLAS P. ZIPES, MD: The complication rate
is very, very acceptable,
considering the tradeoff of the wonderful things
the pacemaker does.
What are the Different Types of Pacemakers?
A pacemaker is an implanted device that helps
the heart beat more regularly. Learn more about the
different kinds of pacemakers and the heart problems
they are used for.
Participants:
Jamie B. Conti, MD
Webcast Transcript:
ANNOUNCER: A pacemaker is a battery-operated device
that is implanted in the chest to help the heart
pump blood more effectively. There are different
kinds of pacemakers, and it's important to know
what they are and what conditions they are used
for.
JAMIE B. CONTI, MD: There are a variety of pacemakers
that are available. There are single-chamber pacemakers,
which means a pacemaker with one wire. Those are
used in patients who rarely have a problem, but
occasionally need a little bit of extra help keeping
their heart rate up.
There are two-chamber pacemakers, which are used
for people who in general need considerable support
of their heart rate with a pacemaker, and one of
those wires goes in the top chamber, the atrium;
the other wire goes in the bottom chamber, the ventricle.
There are also three-lead pacemakers that are relatively
new. Those are used to treat congestive heart failure.
One of those leads goes in the atrium, the top chamber.
The second lead goes in the right ventricle, which
is one of the bottom chambers. And the third lead
goes through a vein that wraps around the heart
and can pace the left ventricle and thus help us
with our treatments of congestive heart failure.
Once you have a pacemaker, it is important to follow
up with your physician on a routine basis. We need
to see our patients physically in our office at
least once a year, and then we check their pacemaker
over the telephone at a set schedule, depending
on how old the pacemaker is. The older it gets,
the more frequently we check it so that we know
when the battery needs to be changed.
How will Life Change with a Pacemaker?
After a pacemaker is implanted, a patient
may need to make some changes in his lifestyle to
prevent adverse effects. Tune in to learn more about
managing life with a pacemaker.
Participants:
Douglas P. Zipes, MD
Jamie B. Conti, MD
Webcast Transcript:
ANNOUNCER: After pacemaker implantation, there
are important steps and precautions patients
must take
to ensure that their pacemakers continue to
function properly.
DOUGLAS P. ZIPES, MD: After the pacemaker is implanted,
the symptoms produced by the slow heartbeat or the
fast heartbeat should be taken care of by the pacemaker;
that's the reason for the implantation. And then
we follow the patient. Many of the follow-ups are
done electronically or over the telephone so the
patient does not have to come in physically to be
evaluated.
With other patients, they indeed do need to come
in. They may have what we call comorbidities. In
other words, they have another problem, heart failure
or coronary disease, that needs to be followed as
well as just having the pacemaker.
ANNOUNCER: And after several months of limiting
physical activity, patients can usually resume their
normal routines.
DOUGLAS P. ZIPES, MD: We generally restrict an
individual from major arm movements, such as lifting
your arms above your head, combing your hair, playing
golf, because that movement can make the wire in
the heart move and change its position. After several
months, that's no longer an issue, but until that
time we generally want an individual to just kind
of restrict their upper arm movement.
JAMIE B. CONTI, MD: People often ask, you know, "What
can I do after I have a pacemaker implanted? Will
I be limited in any way?" We have patients
whose heart rates were so slow because of being
marathon runners or extreme sports people. When
they get their pacemaker, they can go back to regular
activity.
ANNOUNCER: Although microwave ovens and other household
appliances no longer affect people with pacemakers,
there are still precautions to take in public places.
DOUGLAS P. ZIPES, MD: A couple of cautionary things.
One is when you go to the airport, notify the airport
security as you're going through the detector that
indeed you do have a pacemaker implanted, because
it can set off the alarm. The other is, there are
theft detector electronic equipments that are found
in department stores and bookstores and so on, and
they will have no impact on the pacemaker if the
individual just takes a leisurely stroll through
the theft detector equipment, but we would not want
the individual to stand right within that field
and be exposed to it
ANNOUNCER: In the end, a pacemaker will help a
patient live a more normal and active life, with
little to no inconvenience.
Arrhythmia
What is an Arrhythmia?
Has your heart ever skipped a beat or starting
beating too fast? You may have experienced an arrhythmia.
Tune in now to learn more.
Participants:
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Douglas P. Zipes, MD
Webcast Transcript:
ANNOUNCER: At one point or another, everyone has
sensed that their heart has "skipped a beat" or
felt as though their heart was beating too fast.
Both are symptoms of arrhythmias, or abnormal heart
rhythms.
DOUGLAS P. ZIPES, MD: An arrhythmia is a disorder
of the heartbeat. As I tell my patients, the heart
is not a Swiss watch that beats with absolute, unerring
regularity. Rather, it's a biologic organ that can
have occasional hiccups.
ANNOUNCER: There are a variety of causes for arrhythmias.
Some are congenital, or from birth. Others can be
caused by an inflammation or infection of the heart.
A heart attack or coronary disease can also cause
abnormal heartbeats, as well as some antibiotics.
DOUGLAS P. ZIPES, MD: The arrhythmias are diagnosed
in a variety of ways. The first, obviously, is you
need to come to me, so something has to have triggered
your feeling that, "Perhaps I'm having a heartbeat
disorder."
There are different types of arrhythmias. Some
are so brief in duration that the heart rate or
rhythm isn't highly affected. Atrial fibrillation
is a common arrhythmia and can vary in degree.
NANETTE KASS WENGER, MD: Atrial fibrillation is
an abnormal heart rhythm. It simply means that your
heart is beating irregularly, and sometimes fast.
Sometimes atrial fibrillation is very well tolerated.
And some patients, particularly when the rate of
this rhythm abnormality is slow, have no symptoms.
Many patients who have atrial fibrillation have
palpitations, an uncomfortable sensation of their
heart beating, and in some patients it adversely
affects the function of the heart.
DOUGLAS P. ZIPES, MD: At the other end, the arrhythmia
can be severe enough as to cause sudden death. That's
what we call ventricular fibrillation. That means
that the bottom chamber, the ventricles, fibrillate.
They beat at a rate of 400 to 600 times a minute,
and if you look at that it looks like a bag of squiggly
worms. Without any contraction to force the blood
to the brain, you lose consciousness, and if it's
not stopped within three to five minutes you die.
Some arrhythmias definitely should be treated.
Others should be ignored, and you get along with
your life and forget about them. For the latter,
it would be the occasional extra heartbeat that
causes the palpitation, and shrug it off and just
keep on chugging.
Atrial Fibrillation
What is Atrial Fibrillation?
Atrial fibrillation is an irregular heartbeat,
involving irregular contractions of the two upper
chambers of the heart.
Participants:
Eric L. Michelson, MD, FACC
Senior Director, Clinical Development, AstraZeneca
Adolph M. Hutter Jr, MD, MACC, FAHA, FESC
Past President and Editor-in-Chief Conversations
with the Experts American College of Cardiology
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Editorial Consultant:
Jacqueline A. Noonan, MD, FACC
Webcast Transcript:
ANNOUNCER: Many people are diagnosed with an irregular
heartbeat such as atrial fibrillation. It's
a condition that affects the way the heart malfunctions.
ERIC MICHELSON, MD: Atrial fibrillation is an irregular
heartbeat, a time when the upper two chambers of
the heart, known as the atria, instead of beating
in a very coordinated, rhythmic way take on an irregular
heartbeat, have irregular contractions.
ADOLPH M. HUTTER, JR., MD: Normal rhythm, by the
way, means that the upper chamber of the heart beats
before the lower chamber of the heart each heartbeat.
So it goes like this. And it's a more organized
heartbeat. It responds to heart rate changes with
stress and things like this better. Atrial fibrillation,
the upper chamber's just quivering. It's fibrillating,
and the ventricle controls—beats at its own
rate.
ANNOUNCER: The effects of atrial fibrillation can
vary depending on the patient.
NANETTE KASS WENGER, MD: Sometimes atrial fibrillation
is very well tolerated in some patients, particularly
when the rate of this rhythm abnormality is slow,
have no symptoms.
ERIC MICHELSON, MD Some people may become symptomatic,
either palpitations, shortness of breath, easy fatigue
ability.
ANNOUNCER: In other patients, atrial fibrillation
can have more serious consequences.
JACQUELINE NOONAN, MD: The atria are beating on
their own very rapidly. And because it's going very
fast and doesn't empty as well as it should, it's
a place where some kinds of blood clots can occur
ERIC MICHELSON, MD: When you're in atrial fibrillation,
the blood in the atria may tend to form clots, which
could put you at risk for having a stroke.
The Difference Between Atrial Fibrillation and Sinus Rhythm
A person with atrial fibrillation has two
options; they can remain in atrial fibrillation or
restore sinus rhythm. Learn the factors that may have
an impact on your decision.
Participants:
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Jacqueline A. Noonan, MD, FACC
Pediatric cardiologist, University of Kentucky College
of Medicine, Lexington, Kentucky
Eric L. Michelson, MD, FACC
Senior Director, Clinical Development, AstraZeneca
Editorial Consultant:
Adolph M. Hutter Jr, MD, MACC, FAHA, FESC
Webcast Transcript:
ANNOUNCER: An irregular heartbeat or atrial fibrillation
means the heart's upper chamber beats at an
irregular rate than when it's in sinus rhythm.
NANETTE KASS WENGER, MD: Sinus rhythm is the normal
rhythm of the heart. It means that the heart beats
absolutely regularly and typically the rate is between
60 and 100 beats per minute. Importantly, when you
have sinus rhythm, the usual things that cause you
to need a faster heart rate—exercise, fever
and so forth—allow your heart to speed up.
The things that cause you to be able to handle a
slow heart rate—sleep, resting—allow
your heart to slow down.
ANNOUNCER: For those diagnosed with an irregular
heartbeat, one of the first questions asked is whether
to remain in atrial fibrillation or have sinus rhythm
restored. Many experts feel the answer can vary
depending on the patient.
NANETTE KASS WENGER, MD: There is no right or wrong
answer. It's different for different patients. Some
of the recent research studies have shown that if
you can tolerate the atrial fibrillation well and
have no problems with the medications used for its
management, then atrial fibrillation may be fine
for you.
If atrial fibrillation causes symptoms, if you
have palpitations, if it seems to adversely affect
your heart function, if it limits your exercise
tolerance, then probably you will do well in sinus
rhythm. But this is something that you decide in
partnership with your treating physician.
JACQUELINE NOONAN, MD: Being in sinus rhythm would
be the best, but sometimes it's very difficult to
make the heart go from atrial fibrillation into
sinus rhythm. It's very important that the heart
rate itself be reduced from a very rapid rate to
a more normal rate. That can be done with medicine
that will slow the heart rate, even though you're
still in atrial fibrillation. But some of the drugs
you have to take may cause more harm than good.
It's not always possible to convert with drugs alone
back to sinus rhythm.
ERIC MICHELSON, MD: At the present time, studies
suggest that for many individuals who are only minimally
symptomatic, it may be sufficient for such patients
to be managed with an anticoagulant, a blood thinner,
to reduce the risk of stroke, a drug to help keep
the heart rate sufficiently slow so that you're
asymptomatic to the extent possible, and only for
those patients for whom atrial fibrillation is either
highly symptomatic, or they have other medical conditions
that make it more compelling. For those patients,
we do try then to restore sinus rhythm.
ADOLPH M. HUTTER, JR., MD: Both options have been
studied against each other in randomized trials,
and both are equally as good for the patient. So
you can stay in atrial fibrillation, have the same
outcome in terms of your quality of life, your risk
of a stroke, risk of death. Staying in atrial fibrillation
is just as good as trying to get back into normal
rhythm.
The options for a person with atrial fibrillation
are to remain in atrial fibrillation or to restore
sinus rhythm. This decision may depend on several
factors and should be based on the individual person's
needs.
Can Warfarin Work for You?
Because atrial fibrillation may cause blood
clots and stroke, warfarin is often given to patients
with the condition fibrillation to help thin their
blood and protect them from having strokes.
Participants:
Eric L. Michelson, MD, FACC
Senior Director, Clinical Development, AstraZeneca
Nanette K. Wenger, MD, M.A.C.P., F.A.C.C., F.A.H.A.
Professor of Medicine, Division of Cardiology, Emory
University School of Medicine, Atlanta, Georgia
Adolph M. Hutter Jr, MD, MACC, FAHA, FESC
Past President and Editor-in-Chief Conversations
with the Experts American College of Cardiology
Webcast Transcript:
ANNOUNCER: For patients with atrial fibrillation
- a type of irregular heartbeat, a drug often
prescribed is warfarin to help prevent the most
serious consequence
of this condition.
ERIC MICHELSON, MD: Warfarin is a drug that's been
around for a long period of time, with which we've
had a lot of experience. It's the only available
oral anticoagulant or oral blood thinner, meaning
it's the only drug we can take by mouth to keep
our blood thin, and in atrial fibrillation, the
single most immediate concern for patients is to
make sure they're protected from having strokes
which may be related to clots which form in the
chambers of the heart known as the atria. So in
atrial fibrillation, these clots tend to form, and
these clots, if not prevented with a blood thinner
like warfarin, may lead to strokes.
ANNOUNCER: These dangerous clots can sometimes
form inside the two upper chambers of the heart.
NANETTE KASS WENGER, MD: When the upper chambers
of the heart, the atria, fibrillate, it means that
they don't have coordinated pumping function. They
simply quiver, like a bowlful of Jello. And because
of that, the blood may clot in the corners of those
atria.
Now, those blood clots may go anywhere—to
the lung, to the brain, to the body. And atrial
fibrillation is one of the most common causes of
stroke, with its disastrous consequences. So the
older you are, the more likely you are to have stroke
from atrial fibrillation. But younger patients are
not truly protected, so that warfarin, the blood
thinner, is absolutely necessary to prevent clots
forming in the atrium and those clots going to the
lung and all over the body.
ADOLPH M. HUTTER, JR., MD: The point is that everybody
in atrial fibrillation has to be protected from
a stroke. Warfarin is a very good drug to do it.
However, many patients get equal protection from
aspirin, 325 mg. Not a baby aspirin, a regular adult
aspirin. And we can identify by certain risk factors
which form of therapy is better for you.
The information
published on this page has been provided by the
Heart Authority
in collaboration with Cardiosource – American College of Cardiology
|
