It can be terrifying: that feeling when your heart flutters, misses a beat, speeds up or slows down. Generally these palpitations, also known as arrhythmia, are harmless. But they can signal minute--and potentially deadly--malfunctions in the heart's muscles and nerves. Murphy Peterson, Jr., an attorney who lives in Waynesboro, Pennsylvania, knows that all too well.
A year ago, his irregular rhythm left him so tired that he had trouble going up and down stairs. Testing at Summit Cardiology revealed a potentially fatal arrhythmia. Today, he logs miles on his elliptical machine, makes a daily two-hour (one way) commute to his high-pressure job, and credits his cardiology team for his recovery.
"The care they gave me was amazing," he says. "I've never felt so healthy."
Dr. Anthony G. Johnson, an interventional cardiologist and electrophysiologist at WellSpan Health, leads the team that keeps Murphy healthy.
"The majority of arrhythmias--80 to 90 percent--are benign," he says, adding that it's important to have these irregular beats checked out. "Most of the time, we end up reassuring patients that they can keep doing the activities they enjoy. We give them lifestyle tips to minimize or resolve the symptoms. But sometimes, the condition is lifethreatening."
A thorough patient history represents the first step in assessing arrhythmia. Dr. Johnson looks for clues: When do symptoms occur? Are they associated with specific activities? Do lifestyle factors contribute? Will weight loss help? For instance, sleep apnea, associated with obesity, causes arrhythmia. Stress may be the cause. Medications may play a role. When possible, Dr. Johnson uses biofeedback, not pharmaceuticals, to help patients deal with conditions such as anxiety.
To further assess the heart's function, patients may wear a monitor for 24 to 48 hours, or for up to 30 days or more. An EKG or an electrical stress test also may help the cardiologist pinpoint the specific location of the defect at the root of the arrhythmia. A problem in the heart's upper chambers is generally benign. Lower-chamber issues are often serious. If necessary, problem-causing tissue is treated by inserting a tiny electrode into the heart. The specific area is heated to 55degC for 30 seconds in a procedure that typically restores the muscles and nerves to normal function.
Particularly serious arrhythmias-- like Murphy's--may require the placement of an implantable cardioverter defibrillator (ICD). This device springs into action when it detects an abnormal heart rhythm. "Dr. Johnson answered all my questions and made sure I understood my condition and treatment. He gave me time to digest information and came back and asked if I had more questions. The amount of time he spent amazed me."
The ICD, slightly larger than a pacemaker, allowed Murphy to resume his high-energy life. For the team at Summit Cardiology, that's the goal for each patient--whether an individual just needs to know that they can continue to lead the life they love or they need complex and precise investigations and procedures to get the heart healthy again.
How Arrhythmias Raise Stroke Risk
Though it's important for everyone to know the signs of stroke, it's crucial for people who have an irregular heartbeat, especially those with a type called atrial fibrillation. Patients with this diagnosis are two to seven times more likely to have a stroke than people who don't have atrial fibrillation. Janora Hovetter, Stroke Coordinator, Clinical Educator and Stroke Certified RN at Summit Health, explains why.
"When the heart beats, it squeezes," she says, "and that pushes blood through each of the heart's four chambers. With atrial fibrillation, instead of beating, the top two chambers of the heart quiver irregularly like a bowl of gelatin. It doesn't pump well so some blood is left sitting. And when blood is stationary, clots form."
Those clots can cause strokes. Blood flowing through the heart sweeps clots out into the circulatory system. If they end up in a blood vessel that's smaller than they are, they create a blockage. Cells need oxygen, and when blood can't get through to bring it to the cells, they die.
Stroke patients who are found to have an arrhythmia can be treated with medications, including aspirin and other anticoagulants. "The most important thing for patients," says Hovetter, "is to be diligent about keeping follow-up appointments with their primary care provider, and to monitor their stroke risk factors, including high blood pressure, diabetes, high cholesterol, smoking, too much alcohol intake and obesity."