heart conditions

What’s Causing Your Leg Pain? – Join Us for a Live Web Chat!

PAD Live ChatPeripheral artery disease (PAD) is a commonly undiagnosed disease affecting about 8.5 million Americans. Symptoms vary from cramping in the lower extremities, as well as pain or tiredness in leg or hip muscles. According to the American Heart Association, many people mistake the symptoms of PAD for something else, which is why it can easily go undiagnosed. Having the correct diagnosis is important because people with PAD are at a higher risk of heart attack or stroke, and if untreated, PAD can lead to gangrene and amputation.

Many people think their leg pain is due to arthritis, sciatica or just a part of aging. People with diabetes may even confuse PAD pain with a neuropathy, a common diabetic symptom that causes a burning or painful discomfort of the feet or thighs. It is important to know that, while PAD is potentially life-threatening, it can be managed or even reversed with proper care. If you’re having any kind of recurring pain, talk to your healthcare professional.

Join me on Tuesday, March 24, at 12:00 p.m. for an interactive web chat entitled “What’s causing your leg pain?” Dr. Robertson will be available to answer questions and discuss various topics about PAD, including symptoms, diagnosis and misdiagnosis, prevention and treatment.

During this interactive web chat, you’ll be able to ask questions and get real-time answers from our Emory Healthcare professional.

Register now for our March 24 chat at emoryhealthcare.org/mdchats.

About Dr. Robertson

Gregory Robertson, MDGreg Robertson, MD, is the chief of the Emory Heart and Vascular Clinic at Johns Creek. At the Emory Johns Creek Hospital he is chief of cardiology and the medical director of the Cardiac Catheterization laboratory and interventional program. He is board certified in Vascular Medicine, Endovascular Medicine, Interventional Cardiology and Cardiovascular Medicine.

Dr. Robertson’s research has had a focus on the development of new technologies and techniques to treat blocked leg arteries in patients with peripheral arterial disease, helping patients walk farther and prevent limb amputation in diabetic patients. While in the San Francisco Bay Area for 16 years before moving to Atlanta, he practiced with the well-known medical device inventor Dr. John Simpson, whose development teams invented the atherectomy procedure and the first percutaneous arterial closure device. Atherectomy is a procedure which allows the physician to remove plaque in blocked arteries without major surgery. His newest project is with Dr. Simpson’s invention of the Avinger Ocelot and Pantheris devices which open blocked arteries using smart laser imaging.

Dr. Robertson’s clinical expertise is oriented on performing minimally-invasive procedures to avoid major surgery. He has developed many of the vascular programs at the new Emory Johns Creek Hospital including 1) carotid artery stenting, 2) percutaneous repair of abdominal aortic aneurysms and 3) limb preservation for those at risk of limb amputation. He has also developed the cardiac intervention programs for emergency heart attack victims and elective procedures to include PCI and PFO/ASD closure.

Takeaways from Dr. Hoskins’ Arrhythmia Live Chat

arryhthmia live chatThanks to everyone who joined us Tuesday, February 24 for the live online chat entitled “Irregular Heart Beat: Is it normal?,” hosted by Emory Arrhythmia Center physician Michael Hoskins, MD.

Because arrhythmias are common in young- and middle-aged adults, it is important to understand the symptoms. Some arrhythmias are relatively harmless, but others can be fatal if not treated. Dr. Hoskins provided answers to questions about the diagnosis and treatment of heart rhythm disorders, as well as tips of how to deal with an episode of irregular heart beats. Check out the conversation by viewing the chat transcript! Here are just a few highlights from the chat:

Question: I have observed that during some of these episodes my blood pressure is really low and it has been recognized that sometimes my oxygen level is low during the night. could this be causing my arrhythmias? I do have trouble breathing through a deviated nostril.

Michael Hoskins, MDDr. Hoskins: A common condition associated with arrhythmias is sleep apnea. This can be caused by a deviated septum and can cause difficulty breathing and low oxygen levels at night. It sounds like you may benefit from a sleep apnea evaluation.


Question: I have been advised that I am a candidate for ablation for my a-fib. What are the options offered by Emory and how do I become educated about the options?

Michael Hoskins, MDDr. Hoskins: Ablation and medications are both treatment options for atrial fibrillation. It’s important to tailor that therapy to each specific patient. I would encourage you to schedule a visit with one of our arrhythmia specialists.


Question: Most irregular heartbeats do resolve within a few beats. If they don’t resolve for a longer period of time, a person would go to the emergency room, right? Or should that person wait for other symptoms, (dizziness or something else).

Michael Hoskins, MDDr. Hoskins: Some arrhythmias are more dangerous than others. We often encourage patients to call their doctor before going to the ER if it has been determined that their particular arrhythmia isn’t life threatening. However, certain arrhythmias need immediate attention and are best handled in the ER. If your arrhythmia is accompanied by severe chest pain, shortness of breath or loss of consciousness, you should consider calling 9-1-1.

If you missed this chat, be sure to check out the full list of questions and answers on the web transcript. For more information or to request an appointment to be screened for a heart rhythm disorder, visit emoryhealthcare.org/arrhythmia.

If you have additional questions for Dr. Hoskins, feel free to leave a comment in our comments area below.



How an Irregular Heartbeat Can Increase Your Risk of Stroke

Irregular HeartbeatAtrial fibrillation (AF) is the most common arrhythmia seen by physicians. AF is a condition in which the two of the heart’s four chambers beat irregularly. According to the American Heart Association, the risk of stroke is 5 times higher in patients diagnosed with AF because of an increased risk for clots in the heart chambers.

Depending on a patient’s age and other clinical risk factors for stroke, a scoring system is typically generated that will help classify that patient’s stroke risk. Patients with one or more risk factors for stroke are usually advised to take blood thinners for stroke prevention. Warfarin (or Coumadin) and other newer agents Pradaxa®, Xarelto® or Eliquis®  are proven therapies for stroke prevention in AF patients. All of these medications have proven to be safe and effective. Nevertheless, some patients may not tolerate these medications or could develop bleeding complications. In that case, a new option for stroke prevention has been studied and is awaiting FDA approval.

This new therapy is called the “Watchman” device. This device is delivered via a minimally invasive procedure (entry via the femoral vein) into the left atrium. In the left atrium this device is used to cover the left atrial appendage. X-Ray and echocardiography are used to guide this procedure. The left atrial appendage is a structure in the left atrium, or left heart chamber, that has a “cul-de-sac” shape and is responsible for the majority of clot formation in patients with non-valvular AF.

Emory Electrophysiologists have participated in the original studies of the “Watchman” device, which may lead to FDA approval. To schedule an appointment with an Emory Electrophysiologist, please call 404-778-7777 or visit emoryhealthcare.org/arrhythmia.

About Dr. El-Chami

Mikhael El Chami, MDMikhael El-Chami, MD, is an Assistant Professor of Medicine at Emory University and is the director of the arrhythmia clinic at Emory University Hospital Midtown.

Dr. El-Chami received his undergraduate and doctorate of medicine degree at the American University of Beirut in Lebanon. Following his internship and residency at Emory University School of Medicine in Atlanta, he was selected to be a chief medical resident at Emory University Hospital Midtown. After completion of his Chief Residency he also finished a cardiology and cardiac electrophysiology fellowship at Emory. He has been an Emory Faculty member since 2008. He is a Fellow of the American College of Cardiology and the Heart Rhythm Society, as well as an Alpha Omega Alpha honor medical society member.

Dr. El-Chami’s professional interests involve the treatment of heart rhythm disorders and prevention of sudden cardiac death. He has had numerous publications in the field of electrophysiology and continues to be involved in research on a number of studies related to atrial fibrillation and management of heart failure through device therapy.

Cutting-Edge Therapies for Hypertrophic Cardiomyopathy (HCM)

Hypertrophic cardiomyopathy Hypertrophic cardiomyopathy (HCM) is the most common monogenetic cardiovascular disorder occurring in about 1 per 500 people in the general population. Approaches to the treatment of HCM vary considerably depending on how the patient is affected. At Emory Healthcare, we are fortunate to have true experts capable of providing state-of-art therapies which range from genetic counseling or simple life-style adjustments to cardiac transplantation. Patients at risk for sudden cardiac death receive life-saving cardiac defibrillators. Those with drug-refractory symptoms due to obstruction of outflow from the heart receive septal reduction either by open heart surgery or by catheter ablation. The Emory Hypertrophic Cardiomyopathy Center is a regional and national center of excellence capable of addressing the full range of challenges in the patient with HCM.

For more information about programs that make up the Emory Heart & Vascular Center, visit emoryhealthcare.org/heart.

About John Douglas, MD

John Douglas, MDDr. John Douglas is an interventional cardiologist at the Emory Heart & Vascular Center. He is also a Professor of Medicine at Emory University School of Medicine and Director of the Interventional Cardiology Fellowship Program. He is one of the most tenured Emory cardiologists, beginning his career in 1974. He has been recognized in America’s Top Doctors, Atlanta’s Top Doctors and The Best Doctors in America.

Advancing Patient-Centered Cardiac Care

Patient Centered Cardiac CareOne of the chief goals of quality healthcare, as defined by the Institute of Medicine, is to provide patient-centered care. Doing so requires “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” (Institute of Medicine, 2001). As patients know, this kind of care doesn’t always happen. Providing patient-centered care requires effective communication and a trusting relationship. It also requires high-quality evidence regarding what forms of treatment are most likely to advance patients’ goals.

Emory has placed patient and family centered care at the top of the list of priorities and is taking important steps to make this happen. The Patient and Family Advisor program, for example, has created a way for patients and families to be “at the table” in important discussions about the way that care is delivered within our system. The clinicians at the Emory Heart & Vascular Center are active participants in helping to transform care at Emory and are committed to working with our patients to provide them with care that is most consistent with their goals. My colleague Dr. Cassimatis, for example, recently wrote on this blog a very helpful set of tips that will help patients to get the most out of their visit and ensure that their questions are answered. Emory cardiologists are committed to answering these questions and to working with patients and their family members to make decisions that are often complex.

Emory cardiologists are also actively conducting research to advance the mission of patient-centered care. Emory physicians are studying how our patients want us to communicate with them about research studies for which they might be eligible. Emory physicians are studying what information is most important to patients undergoing evaluation and treatment for severe heart failure. And Emory physicians are studying the role of new tools for communicating with patients about the risks and benefits of cardiac procedures. These are just a few examples of the ways that Emory physicians and researchers are helping to improve communication and facilitate the kind of trusting relationship that is essential to effective patient-centered care.

Because no decision can adequately reflect patients’ values without evidences, Emory doctors are also at the forefront of conducting clinical research studies that are essential to address many of the pressing problems that patients face. It is only through well-done research that we will have the information our current and future patients need to make decisions that are consistent with their goals.

In all of these ways, the clinicians at the Emory Heart & Vascular Center are committed to ensuring, and to helping other doctors ensure, that patients’ decisions match their values as much as possible.

If you have feedback or suggestions on how to improve patient-centered care at Emory Healthcare, please let us know by leaving a comment below. To make an appointment with an Emory cardiologist or cardiovascular specialist, please call 404-778-7777.

About Dr. Dickert

Neal Dickert, MD, PhDNeal Dickert, MD, PhD is Assistant Professor of Medicine in the Division of Cardiology. He also holds a secondary appointment in the Department of Epidemiology at the Rollins School of Public Health and is a senior faculty fellow at the Emory Center for Ethics. He also serves as associate program director for the cardiology fellowship program. Dr. Dickert received his MD from the Johns Hopkins University School of Medicine and PhD from the Johns Hopkins Bloomberg School of Public Health. Dr. Dickert is board-certified in cardiology and internal medicine. Clinically, Dr. Dickert practices in the Emory University Hospital and Atlanta VA Medical Center Cardiac Care Units. Dr. Dickert’s research focuses on ethical issues relevant to cardiology practice and clinical research.

Emory Offers State-of-the-Art Therapies for Heart Rhythm Disorders

heart rhythm therapyHeart rhythm disorders (arrhythmias) are common medical problems that affect millions of Americans each year. Treatments for arrhythmias vary from simple medications to specialized procedures depending on the needs of a particular patient. Fortunately, due to rapidly advancing technology, available therapies are quickly changing.

As one of the premier medical research centers in the Southeast, Emory offers some of the most cutting-edge treatments available for a wide variety of heart rhythm disorders. Highlighted below are just a few of these new advances:

Wireless pacemakers

The world’s smallest pacemakers are being implanted at Emory as part of an ongoing clinical trial. The Micra leadless pacemaker is an investigational device that is about one-tenth the size of a standard pacemaker. This device is approximately the length of a paperclip and round, like a capsule. This capsule contains all of the components of the pacemaker including the battery, and eliminates the need for the wire that is part of a standard pacemaker system.

One of the key benefits of the Micra pacemaker is that fact that it is implanted using a catheter through a vein in the front of the leg. The device is inserted directly into the heart. This process is generally quicker than a standard pacemaker procedure, and avoids the need for a surgical incision. Patients who have slow heart rates with weakness, lightheadedness, or fainting may be candidates for the Micra pacemaker clinical trial. Emory is the only center in Georgia that is participating in this trial.

Subcutaneous defibrillators

Defibrillators are devices that are designed to detect and treat life-threatening heart rhythm abnormalities. They are traditionally inserted under the skin in the patient’s shoulder, with a wire (or “lead”) that travels through a vein into the heart. While these devices have proven very effective, the presence of a defibrillator lead within the bloodstream may be associated with certain long-term complications. These may include infection or scarring of the blood vessel.

The subcutaneous defibrillator is a new type of device that is placed under the skin just like a standard defibrillator. However, this new device has a lead that travels just under the skin without having to be inserted through a blood vessel. This reduces the risks associated with infection.

Cryoablation for atrial fibrillation

Atrial fibrillation is the most common heart rhythm disorder, and can be treated in a variety of ways depending on the needs of the patient. One treatment option for this arrhythmia is catheter ablation. Traditionally, ablation for atrial fibrillation involves heating, or cauterizing, certain cells involved in the generation of atrial fibrillation. One new technique that has become available in the past several years is cryoablation. This therapy involves freezing cells with a super-cooled balloon that is positioned inside the heart with the use of a catheter. Cryoablation has the potential to be quicker than standard ablation, while having similar safety and effectiveness.

Ongoing clinical trials

Emory offers several clinical trials for patients who suffer from heart rhythm disorders. These trials represent opportunities to participate in the use of cutting-edge treatments that may not be available elsewhere. To learn more about ongoing heart rhythm clinical trials at Emory, please contact:

Emory University Hospital: Janice Parrott, 404-712-5592, jparrot@emory.edu
Emory University Hospital Midtown: Paige Smith, 404-686-7992, pfsmith@emory.edu
Emory St. Joesph’s Hospital: Cindy Barnes, 678-843-6093, cynthia.barnes@emory.edu

About Dr. Hoskins

Michael Hoskins, MDMichael Hoskins, MD, is an assistant professor of medicine and electrophysiologist who practices primarily at Emory University Hospital. Dr. Hoskins received his medical degree from the Medical College of Wisconsin in Milwaukee, after which he completed his residency in internal medicine at Emory. He was chief resident in Internal Medicine from 2005 to 2006. He then completed fellowships in cardiology and electrophysiology, also at Emory, and has been practicing here since 2010. He specializes in treating cardiac arrhythmias, focusing on ablation of arrhythmias and implantation and management of pacemakers and defibrillators.

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Atrial Fibrillation and New Anticoagulation Medications

AnticoagulantsAtrial Fibrillation is a very common heart rhythm disorder that may affect patients of all ages. Typically, this type of heart arrhythmia causes symptoms including palpitations, chest pain, dizziness or shortness of breath. However, it is important to note that this disorder can sometimes (especially in the elderly) be present without any symptoms whatsoever. While this arrhythmia is often associated with other heart conditions (valve problems, hypertension, coronary artery disease, congestive heart failure), in many patients, there is nothing else wrong with the heart. Patients with atrial fibrillation or atrial flutter and 1 or more risk factors for stroke such as simply being older than 65, having diabetes or hypertension, having a history of heart failure or prior mini-strokes are often prescribed anticoagulant drugs to prevent a stroke. For decades, physicians have prescribed Coumadin (warfarin) to reduce the risk. Importantly, aspirin is not nearly as effective as Coumadin in reducing the risk of stroke in patients with atrial fibrillation and is not considered an anticoagulant.

Patients taking Coumadin require blood tests every 4-8 weeks to monitor the proper dose to be sure the drug is effective and to reduce the risk of bleeding. Certain foods can reduce the effectiveness of the drug (such as leafy greens or spinach) and often medications can interact with Coumadin that potentially increase the risk of bleeding (especially certain antibiotics). Despite these drawbacks, Coumadin has effectively been utilized for decades to reduce the risk of stroke in patients with atrial fibrillation.

In the past 5 years, newer anticoagulants have been approved by the FDA for reducing the risk of stroke in patients with atrial fibrillation. These include Pradaxa, Xaelto and Eliquis. Drugs such as Clopidogrel (Plavix) are not used for this purpose and like aspirin are antiplatelet drugs used for other purposes. These newer anticoagulants have the advantage of not requiring blood tests to monitor their efficacy and they have fewer interactions with foods and other medications. Large clinical trials have been performed for each of the above newer anticoagulants and 3 drugs have been tests in head to head comparisons with Coumadin for efficacy and bleeding complications. The trials have demonstrated that all of the newer agents are at least as effective as Coumadin without a significant increase in bleeding risk. Despite the fact that all the newer agents do not have an antidote (such as vitamin K or plasma) in patients who are bleeding, this has not translated into a significant increase in bleeding risk in the large trials, and therefore, is why they have been approved by the FDA.

That being said, all anticoagulants carry a risk of bleeding and the decision to use Coumadin or any of the newer drugs is a decision requiring close consultation and discussion with your physician. It is important to promptly notify your physicians if you have had atrial fibrillation, are not taking an anticoagulant and you have any symptoms of a mini-stroke, even if the symptoms resolve on their own.

It is also important to note that all of the above also applies to patients with atrial flutter, another arrhythmia similar to atrial fibrillation. The above does not apply to patients with palpitations and tachycardia unless atrial fibrillation or atrial flutter has been confirmed with an EKG.

If you have symptoms that suggest you might have episodes of atrial fibrillation or you have already been diagnosed with an arrhythmia and wish to discuss the use of Coumadin or any of the newer agents, you can contact your existing cardiologist, or call HealthConnection at 404-778-7777 to make an appointment with an Emory cardiologist near you.

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Understanding Peripheral Vascular Disease

PVDDo you experience painful muscle cramps in your hips, thighs or calves when moving around? You may be surprised to learn that this is the primary symptom of peripheral vascular disease (PVD). PVD is defined as diseases of the arteries outside of the heart and brain. PVD is a term used interchangeably with peripheral artery disease, or PAD, but PVD encompasses diseases of the arteries AND veins.

Arteries move blood away from the heart, and PAD typically involves the narrowing of the arteries that transport blood to the arms and legs. Veins take the blood back to the heart and generally don’t get narrowed with cholesterol, but rather develop another very common condition called chronic venous insufficiency (varicose veins).

PAD – Arteries

Many patients go undiagnosed because the symptoms can be attributed to something else, such as arthritis, a neuropathy or normal stiffness that occurs with aging. Patients with PAD may also experience numbness, weakness or coldness in one or both legs. Often the symptoms come on slowly and the patient starts altering their life style and become more sedentary.

On the other hand, at least half of people who suffer from PAD have no signs or indications at all. Risk factors for PAD include aging, personal or family history, cardiovascular disease or stroke. Controllable risk factors include:

  • Cigarette smoking
  • Obesity
  • Diabetes mellitus
  • Physical inactivity
  • High blood cholesterol
  • High blood pressure Renal failure

Chronic Venous Insufficiency

This is more common than PAD and may start at an early age. The symptoms of this may include any one or more of the following: legs feeling heavy or tired especially at the end of the day, mild swelling of ankles, severe cramps at night time, restless legs, itching of legs, or formation of visible veins on the leg. In severe cases the skin around the ankle area may get darker in color and sores may form, generally above the ankle, which are slow to heal.

Some of the risk factors include age, family history of varicose veins, obesity, standing for long periods on hard surfaces and history of blood clots or phlebitis in the leg.

If you have any of the above symptoms or would like to discuss your risk factors, talk to your healthcare provider. PVD diagnosis begins with a physical examination.

At Emory, treatment of PVD is a combined effort within the Emory Heart & Vascular Center, the Division of Vascular Surgery and Endovascular Therapy and Interventional Radiology. To make an appointment, call 404-778-7777.

About Khusrow Niazi, MD

Khusrow Niazi, MDDr. Niazi specializes in interventional cardiology, carotid artery disease, peripheral artery disease and venous disease of the legs. He has been practicing at Emory since 2003. He has been involved in many trials in treating blockages in the carotid arteries and leg arteries with less invasive options. Dr. Niazi is involved in trials focused on the removal of plaque from the leg arteries with less invasive methods. He also has treated many patients with chronic venous insufficiency and varicose veins.

What Is Supraventricular Tachycardia (SVT) and Does It Require Treatment?

SVT heartSupraventricular tachycardia (SVT), also referred to as paroxysmal SVT or PSVT, is a type of abnormal heart rhythm (arrhythmia) in which the heart beats too fast. When the heart beats too fast, it may not function effectively, resulting in less oxygen-rich blood reaching the tissues throughout the body. SVT often starts and ends suddenly, and may not be associated with any symptoms. However, many people do experience symptoms as a result of SVT, including palpitations (rapid, noticeable heartbeats), dizziness, fainting, shortness of breath and chest pain (angina).

In most cases, SVT occurs because of a malfunction of the heart’s electrical system. The heart is made up of two upper chambers (atria) and two lower chambers (ventricles). In a normal heartbeat, an electrical impulse originates from an area in the right atrium called the sinus node. This impulse travels first to the atria, causing them to contract and pump blood into the ventricles. The electrical impulse then continues along its circuit to the atrioventricular (AV) node, where it pauses to allow the ventricles to fill with blood. Finally, the impulse reaches the ventricles, signaling them to contract and pump blood out to the lungs and the body. In SVT, the electrical malfunction occurs at some point before the electrical signal reaches the ventricles.

Common types of SVT include:

  • Atrial fibrillation (A-fib) is a type of tachycardia that occurs when multiple circuits of disorganized electrical activity in the atria replace the organized electrical activity that is normally generated by the heart. The result is fibrillation (quivering) of the atria instead of regular heartbeats.
  • Atrioventricular (AV) node re-entry tachycardia (AVNRT) is the most common form of SVT. Patients with this arrhythmia do not have structural problems with their heart, but have two pathways that can channel impulses to and from the AV node. Under certain conditions, usually following a premature beat, these pathways can form an electrical circuit, which starts a rapid heart rhythm.
  • Wolff-Parkinson-White syndrome (WPW) is an arrhythmia caused by an extra electrical pathway from the atria to the ventricles. Although some people with WPW do not have any symptoms, others experience palpitations, dizziness and angina. Rarely, WPW can be life threatening.

SVT often first occurs in children and young adults. Many controllable factors can increase the risk of SVT episodes, including stress and anxiety, certain medications, excessive alcohol or caffeine consumption, smoking and the use of illegal stimulants such as cocaine.

Otherwise healthy individuals experiencing SVT without significant symptoms may not require any treatment. However, if you have an underlying related health condition or significant symptoms, treatment may be necessary. This may take the form of medication therapy, pacemaker implantation or cardiac ablation, in which radiofrequency energy is used to destroy very tiny areas of tissue that give rise to abnormal electrical signals.

Emory’s Arrhythmia treatment program is one of the most comprehensive and innovative clinics for heart rhythm disorders in the country. In addition to offering state-of-the-art care for the full range of heart rhythm disorders, we also operate heart rhythm screening clinics at a number of locations throughout the Atlanta area. If you have experienced an irregular heartbeat, palpitations, a racing heartbeat or other troubling heart irregularities, we recommend that you schedule an appointment with one of our specialty-trained nurse practitioners, who will begin a comprehensive screening evaluation to determine whether you need follow-up care with an electrophysiologist.

About Dr. DeLurgio

David DeLurgio, MDDavid DeLurgio, MD , is a professor of medicine at Emory University School of Medicine and director of Electrophysiology at Emory Saint Joseph’s Hospital. Dr. DeLurgio earned his medical degree from the University of California Los Angeles School of Medicine, where he also completed his residency and fellowship training. He joined Emory Healthcare in 1996 and served as the director of the Arrhythmia Center and Electrophysiology Lab at Emory University Hospital Midtown before relocating to Emory Saint Joseph’s Hospital.

About Emory’s Arrhythmia Center

Emory’s Arrhythmia Center is one of the most comprehensive and innovative clinics for heart rhythm disorders in the country. Our electrophysiologists have been pioneers in shaping treatment options for patients with arrhythmias such as atrial fibrillation, as well as for those with congestive heart disease. Our specialized electrophysiology (EP) labs host state-of-the-art equipment, including computerized three-dimensional mapping systems to assist with the ablation of complex arrhythmias, and an excimer laser system to perform pacemaker and defibrillator lead extractions.

Patients with devices, whether implanted at Emory or elsewhere, have access to Emory’s comprehensive follow-up care. Patients benefit from remote monitoring, quarterly atrial fibrillation support groups and 24-hour implantable cardiac device (ICD) and pacemaker monitoring services. Inpatient telemetry and coronary care units, as well as outpatient care and educational support of patients with pacemakers and ICDs, complete Emory’s comprehensive range of arrhythmia treatments and services.

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What Is Bradycardia and Why Does It Occur?

bradycardiaBradycardia is the medical term for a heart rate that is too slow — specifically, a heart rate less than 60 beats per minute in adults. However, under some circumstances, a heart rate less than 60 beats per minute is perfectly healthy and not a cause for intervention. For instance, a resting heart rate below 60 beats per minute in a person who is physically fit may be normal, and it can be normal for the heart rate to dip below 60 beats per minute in some older adults and in anyone during sleep.

The heart consists of two upper chambers (atria) and two lower chambers (ventricles). In a normal heartbeat, an electrical impulse originates from an area in the right atrium called the sinus node. This impulse travels first to the atria, causing them to contract and pump blood into the ventricles. The electrical impulse then continues along its circuit to the ventricles, signaling them to contract and pump blood out to the lungs and the body.

In bradycardia, there is a problem with this electrical impulse. For instance, it may trigger the atria to contract, but not reach the ventricles to signal their contraction (heart block), or the signal may travel too slowly along its pathway through the heart. As a result, the heart may not pump enough blood out to the body, which can cause a range of symptoms, such as dizziness, fatigue, shortness of breath, chest pain (angina), lightheadedness and fainting. In severe cases, bradycardia can even lead to cardiac arrest.

Problems with the heart’s electrical system can have many causes, including damage to the heart muscle related to aging or heart disease, an imbalance of electrolytes in the body, the use of certain medications, hypothyroidism, sleep apnea, high blood pressure and underlying heart conditions, including congenital defects.

If your doctor determines that bradycardia occurs as a result of an underlying condition, such as high blood pressure, hypothyroidism or sleep apnea, the first step will generally be to treat the underlying condition to see if this corrects the slow heart rate. If medications you take may be causing your bradycardia, you doctor may adjust or change your medication regimen. If these approaches do not resolve your bradycardia, your doctor may recommend the implantation of a pacemaker to help the heart maintain a healthy rate.

If you experience symptoms of bradycardia or any other abnormal heart rhythm, you can visit one of Emory’s new heart rhythm screening clinics located throughout the Atlanta area to determine if your condition is serious.

About Dr. Patel

Anshul M. Patel, MDAnshul Patel, MD , is an assistant professor of medicine and electrophysiologist who practices primarily at Emory Saint Joseph’s Hospital. He graduated magna cum laude from Harvard College and received his medical degree from the Johns Hopkins University School of Medicine. Dr. Patel completed his internship, residency and cardiology training at Massachusetts General Hospital and Harvard Medical School, where he also completed a fellowship in cardiac electrophysiology. He specializes in pacemaker and defibrillator implantation, as well as catheter ablation, with a particular interest in atrial fibrillation and ventricular arrhythmias.

About Emory’s Arrhythmia Center

Emory’s Arrhythmia Center is one of the most comprehensive and innovative clinics for heart rhythm disorders in the country. Our electrophysiologists have been pioneers in shaping treatment options for patients with arrhythmias such as atrial fibrillation, as well as for those with congestive heart disease. Our specialized electrophysiology (EP) labs host state-of-the-art equipment, including computerized three-dimensional mapping systems to assist with the ablation of complex arrhythmias, and an excimer laser system to perform pacemaker and defibrillator lead extractions.

Patients with devices, whether implanted at Emory or elsewhere, have access to Emory’s comprehensive follow-up care. Patients benefit from remote monitoring, quarterly atrial fibrillation support groups and 24-hour implantable cardiac device (ICD) and pacemaker monitoring services. Inpatient telemetry and coronary care units, as well as outpatient care and educational support of patients with pacemakers and ICDs, complete Emory’s comprehensive range of arrhythmia treatments and services.

Related Links