Transcript The Befores and Afters of Arrhythmias and Hypertrophic

The “Befores” and “Afters” of
Arrhythmias and
Hypertrophic
Cardiomyopathy
Brought to you by:
Andy Lutzkanin
Sara Farag
What Andy wants you to know…
What is an arrhythmia?
 What are some warning signs?
 What are some complications?
 Two basic types of arrhythmia.
 How do we doctors treat arrhythmias?
 What can you do to prevent arrhythmias?

What is an arrhythmia?
What is an arrhythmia?


“Normal cardiac
function relies on the
flow of electrical
impulses through the
heart in an
exquisitely
coordinated fashion.”
Any abnormality in
this rhythm of the
heart is by definition
an arrhythmia.
Symptoms and Signs

What kinds of things did we see with little
Jimmy?
 Rapid
heart rate, sweating, restlessnes, difficulty
breathing, passed out

Some others you may see:
 Dizziness,
blurred vision, chest pain, palpitations
(feeling of irregular heartbeats), anxiety
So why are arrhythmias bad?

Every day problems:
 Uncomfortable,
can fall and injure yourself
(what if you are old and frail and you fall?)

Longer term problems:
 Damage
to heart, kidneys, brain, etc.
 Why? Ineffective pumping=poor blood flow to organs

Worst case scenario:
Sudden Cardiac Death
Paroxysmal
Reentrant
Tachycardias
Types of Arrhythmias
Sick Sinus
Syndrome
Ventricular Tachycardia
Atrial Premature Beats
Ectopic Atrial
Tachycardia
Junctional Escape Rhythm
Sinus Bradycardia
Multifocal Atrial
Tachycardia
Atrial Fibrillation
Ventricular Escape
Rhythm
Atrial Flutter
Paroxysmal
Supraventricular
Tachycardias
Conduction Blocks
Sinus Bradycardia
Sinus Tachycardia
Ventricular Fibrillation
Torsades de pointes
Ventricular Premature Beats
Wolf-ParkinsonWhite Syndrome
Three Basic Types

Increased Automaticity
 “Too
many chiefs, not enough Indians”
 Rob’s example: grandma at thanksgiving
Triggered Events - Not important!
 Reentry

 “dog
chasing its tail”
“Too many chiefs…”


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What normally controls
the heart?
SA node is automatic this is why transplants
work
Other parts of heart may
become automatic
Recall Rob’s demo with
grandma at the
Thanksgiving table
“Dog chasing its tail”



Birth defect or
damage to heart
causes a loop to
form in conduction
system
Electrical signal will
just travel through
loop over and over
Loops can be big or
small
Great, you have a problem.
Now what?

What types of treatment are there?
 Drugs
 Surgery
 Shock
the heart (AED or manual defibrillator)
 Implantable device (defibrillator or pacemaker)
Some important drugs…

Epinephrine
 aka
adrenaline
 Produced in adrenal glands
 “fight or flight” response
 Causes heart to beat stronger and faster

Atropine
 Originally
found in Jimsonweed and deadly nightshade
plants
 Causes SA node to fire more often
 Very toxic at high doses - causes ventricular fibrillation
“Individual results may vary…”

Drugs
 Most
have dangerous side effects including causing
new arrhythmias

Surgery
 Not
always useful
 Can cause further damage

Defibrillators
 Only
fix life threatening situations
 Can cause further damage
 Sometimes unable to save
Preventing Arrhythmias
Structure important for ___________
 Congenital defects - are they preventable?
Unfortunately not
 Damage to heart - is it preventable?
YES!!!!


What is a risk factor?
Preventing Arrhythmias

Cardiac Risk Factors
 Smoking
 High
cholesterol
 High blood pressure
 Diabetes/Obesity
 Age
 Gender

Eliminate these factors,
your risk of damaging the
heart goes down!
What Sara wants you to know…
Hypertrophic
Cardiomyopathy
(HCM)
Lifestyle Changes
Prevention
Let’s review, what is HCM again?
What are the
differences
between a
normal heart and
one with HCM?
In Hypertrophic Cardiomyopathy…
1.
Asymmetric
myocardium
thickening
(especially in
septum)

Decreased filling
High outflow velocity
High pressure
Difficulty breathing



In Hypertrophic Cardiomyopathy…
2.
Abnormal
growth of
muscle fibers

Messy
conduction
Arrhythmias

Since HCM is genetic, there aren’t
good treatments for it.
Making lifestyle changes is very important…
Children experience slow growth because the
body uses up all of its calories compensating for
the heart’s hard work.
HIGH calorie, LOW fat, LOW sodium diet with
lots of fluids is important!
What about physical activity?
Vigorous activities should be avoided but
moving around is EXTREMELY important.
How does HCM affect social life?


Teachers/nurses should be aware of condition in
school
Occupation should have low physical demand
Support Groups:
www.childrenscardiomyopathy.org/site/listserve.php
What can we do to catch a problem
early on?

Look at family history
 Problems?
Consider
genetic screening

Blood pressure checks
every 2 years
 120/80
mm Hg or less is
GREAT

Cholesterol checks every
5 years
 Total
should be less than
200 mg/dL
THANK YOU!
Any questions?