Wednesday, May 6, 2009 at 9:41 PM
There are lots of things that can go wrong with the heart. Arteries can become clogged with cholesterol deposits; valves can become leaky or blocked; and the electrical activity that controls the heart's natural rhythm can short circuit. As part of our special coverage this month on heart disease, Heart Stories, ideastream health reporter Gretchen Cuda takes a look at the heart's electrical system.
It's a scene we've all watched countless times on dozens of medical dramas.
Doctor: No that's no good. charge to 300. Clear.
Patient: no, no. Ahhh.
Doctor: Normal sinus rhythm. Take him upstairs.
Scenes like that one from the Television drama ER really do happen – though it’s not always a life-threatening emergency. A normal heart beats in coordinated rhythm when a special cluster of cells called “pacemaker cells” generate an electrical wave that fans out across the heart and causes the muscle to contract. But occasionally, some cells misbehave and contract when they shouldn't. The result is a short circuit that causes the heart's upper chambers to beat out of sync – or fibrillate. The condition, called Atrial Fibrulation, – is sort of an epileptic seizure of the heart explains Bruce Lindsay, a cardiac electrophysiologist at the Cleveland Clinic.
LINDSAY: Arial fibrillation is one of the most common heart rhythm problems we have, and while some people tolerate it without any difficulty, there are others for whom this is a debilitating problem – that they can't breathe well or get around and do things or they're light headed and just can't function
Lindsay says sometimes medications are helpful in correcting these abnormal electrical problems, but often they don't work – and in those cases electrophysiologists have a couple other tools at their disposal. The first is giving the heart a big shock – it's called cardioversion, and it's pretty much like what you see on television. Patients are sedated, and an electrical shock is used to jolt the heart back into a normal rhythm – sort of like re-booting your computer. Lots of people with atrial fibrillation and other irregular heartbeats do this as an outpatient procedure. They're in and out of the hospital in a few hours and back to their daily lives with nothing but a couple of sun-burn like marks on their chest. Lindsay says this is often a good first step in treatment– and for some people the fix works for a long time
LINDSAY: For some it may be years, for others it may be the next day – you just don't know.
When it doesn't work, there's a technique called ablation. Much like a neurosurgeon destroys the cells that go awry in epilepsy and cause seizures in the brain, cardiac surgeons go in and find the cells that are causing the electrical disturbance in the heart and burn them. Usually, destroying a patch of tissue the size of your fingertip is sufficient to cure some types of irregular heart rhythms --for good.
Amanda Kolonick had heart ablation surgery 3 years ago to correct a common heart arrhythmia. She says it started when she was a teenager
KOLONICK: 7th or 8th grad I was playing basketball in a rec league with my friends and all of the sudden – my heart went out of whack. It's like it's spiraling out of control like there is no beginning and no end to a heartbeat, it's just racing so fast. And I thought I must be having a heart attack or something, this must be what a heart attack is.
Kolonick says the episode lasted about 20 minutes and then stopped. But the episodes came back, and became more frequent as she got older. Still, Kolonick did what a lot of people do about their heart symptoms – she …and her parents…ignored them .
KOLONICK: The possibilities of what it could be scared me, and honestly, no one believed me.
Most people told her it was just anxiety or stress. She recalls the first time she told her mom about the attacks
KOLONICK: She said "it's probably just heart palpitations, people get those things."
Eventually in her 20’s Kolonick did see a cardiologist and found out the problem wasn't in her head- it was a tachycardia, the technical term for her racing heart. Her doctor told her about ablation therapy – and she decided to try it. Doctors went inside her heart through a vein in her leg, and stimulated different areas to try and find the cells that were causing the trouble. Kolonick was awake the whole time and remembers when they found it.
KOLONICK: It was like yes, that's it, that's what my heart does –that's the area, you found it.
CUDA: So they literally found the spot and you knew instantly?
KOLONICK: Yes. I was like that's my tachychardia.
Doctor Lindsay says that many electrical problems in the heart can be successfully treated with medication, cadioversion, ablation or an implantable device like a pacemaker – and medical advances are making treatments safer, less invasive, and more effective for a wider variety of symptoms. Since HER ablation three years ago, Kolonick hasn't had a single irregular heart rhythm and considers herself cured. She says she's glad she got over her fear and finally got help – and she’d do it again – in a heartbeat.
Gretchen Cuda, 90.3.