Posts Tagged ‘heart conditions’

A Look at Causes & Diagnosis of Atrial Fibrillation (A-fib)


In our last post, Dr. Langberg defined Atrial Fibrillation, or A-fib, as the quivering of the two upper chambers of the heart resulting from disorganized electrical activity, and the most common heart rhythm conditions requiring treatment. Together, Emory University Hospital and Emory University Hospital Midtown perform more than 3,600 electrophysiology procedures per year, including diagnosis and treatment procedures for A-fib. In this post, I’ll examine causes of A-fib and discuss how we diagnose it.

It’s crucial that we identify potential causes of A-fib in order to determine the best approach to treatment. Although we can’t always find the specific trigger, certain pre-existing heart and lung conditions are the most common causes. These conditions include:

–      Thyroid conditions

–      Obesity

–      Obstructive sleep apnea

–      Hypertension (high blood pressure)

–      Coronary artery disease

–      Heart valve disease

–      Heart surgery

–      Chronic lung disease

–      Heart failure

–      Cardiomyopathy (disease in which the heart muscle is weakened)

–      Congenital heart disease

–      Pulmonary embolism (blood clot to the lungs)

Less common causes of A-Fib include hyperthyroidism, pericarditis and viral infections.

In at least 10% of cases, we’re unable to find underlying heart disease or lung conditions. In these instances, A-fib may be related to alcohol, excessive caffeine use, stress, certain drugs, electrolyte or metabolic imbalances, or severe infections. It’s important to note that the risk of A-fib increases with age, particularly after age 60.

Next—how do we diagnose Atrial Fibrillation? There are a variety of methods, but our initial diagnosis begins with a conversation. We ask you about your medical history, including your health habits and symptoms, which may include fatigue, palpitations, chest discomfort, shortness of breath, or dizziness. We also ask about your family history, and then perform physical exams and conduct appropriate tests and procedures. One of the most useful tests is an electrocardiogram (EKG), a painless procedure that records the heart’s electrical activity. With an EKG, we can determine how fast your heart is beating, whether its rhythm is steady or irregular, how strong the electrical signals are when they pass through your heart, as well as how long it takes these signals to reach each section of your heart.

In our next Heart & Vascular post, we’ll explore treatment options for A-Fib at Emory, including innovative therapies and clinical trials.

For more information about the Emory Atrial Fibrillation Program, or to schedule an appointment, please call Emory HealthConnectionSM at 404-778-7777 or 1-800-75-EMORY.

Are you concerned that you may have A-fib? If you have questions or comments about A-fib diagnosis, please let me know in the comments section below.

About Michael Lloyd, MD:

Dr. Lloyd began practicing medicine at Emory in 2007—he specializes in Internal Medicine, Cardiology, and Cardiac Electrophysiology. His areas of clinical interest and research include arrhythmias, electrophysiology lab, and pacemaker. Dr. Lloyd’s organizational leadership memberships include the American College of Cardiology, the American Heart Association, and the Heart Rhythm Society.

Take a Tour of the Cardiac Rehabilitation Center at Emory

In this post, I’d like to introduce you to the Cardiac Rehabilitation Center at Emory Healthcare. The facility offers state-of-the-art amenities, panoramic views, and experienced staff to care for patients following heart attacks, open heart surgery, angioplasty, and stent placement.

Our mission is to help reduce risk factors for heart disease through exercise, education, and support. If you’d like to visit us in person, please call 404-778-2850 to arrange a site visit. We’re available Monday through Friday (except on major holidays) and are located within the Earle B. and Stephanie Blomeyer Fitness Center at 1525 Clifton Road NE in Atlanta. We’ll help you to identify your risk factors and generate a plan to make you healthier.

Here, you can join me on a virtual tour to learn more about what we can offer patients as they recover from heart procedures:

If you have any questions or comments about our facility, please feel free to let me know in the comments section.

What is Aortic Stenosis?

The word Aortic is derived from aorta, the main artery that pumps blood to the body from the heart. Additionally, the Greek translation of narrow is stenos.  In aortic stenosis, the aortic valve narrows, restricting blood flow from the heart to the body.

Most people are born with three leaflets of tissue over each artery that open and close as the heart beats. If someone is born with two leaflets, they may have premature narrowing of the valve. People with three valves often do not develop aortic stenosis until their 70s or 80s. Unfortunately, we can expect an increase in patients with aortic stenosis as baby boomers approach this age.

Common symptoms of aortic stenosis include:

–        Shortness of breath

–        Chest pain (often increasing with activity)

–        Fainting

–        Weakness

So, what is the science behind these symptoms? Simply put, as the aortic valve narrows, pressure increases inside the left heart ventricle. The left heart ventricle then becomes thicker, decreasing blood flow and causing chest pain. As the pressure continues to rise, blood may back up into the lungs, leading to shortness of breath. If you have a severe form of aortic stenosis, blood may not be able to reach your brain or other parts of your body as easily, causing fainting and weakness.

Typically, diagnosis starts with history-taking and a physical examination. We listen to the heart for a characteristic murmur that signifies a turbulent flow of blood across the narrow valve, and then perform an ultrasound to confirm the diagnosis.

For over 30 years, open heart surgery was the only way to treat aortic stenosis. Emory is the first hospital in the Southeast to study a non-surgical treatment called transcatheter aortic valve implantation.  It involves replacement of the narrow valve with a better-functioning synthetic valve from outside the body. We create a small incision in the groin or chest wall and then feed a wire mesh valve through a catheter, or tube, placing it where the new valve is needed. This technique may extend the lives of many people who are too ill or too frail to endure open-heart surgery.

In our next Heart and Vascular blog post, we’ll delve into more detail about procedures and technology surrounding aortic stenosis.

If you’re concerned that you may have aortic stenosis, we strongly encourage you to contact your physician for a physical. If you have further questions or comments regarding aortic stenosis or any other related condition, be sure to let me know in the comments section below.

Peter Block, MD has been practicing at Emory since 2000, where he specializes in internal medicine and cardiology. His areas of interests include angioplasty, cardiovascular disease, arteriosclerosis, and valve disease. Dr. Block’s major and/or recent publications focus on topics such as Equivalence Trials, Images in Clinical Medicine, and Short-Term Folic Acid Supplementation.

Ventricular Assist Devices: Hope for the Broken-Hearted

HeartMate II® LVAD; reprinted with permission from Thoratec Corporation

Many of you are aware of the benefits of heart transplant in patients with advanced heart failure; however, another form of therapy has been quietly emerging as a viable option for patients suffering from this condition.

A ventricular assist device (VAD) is a battery-operated mechanical pump that helps a weakened heart pump blood into the body. Essentially, it takes over the pumping action of the heart and drives blood into the aorta (the large artery that extends from the left ventricle of the heart and into the abdomen) and throughout the body. The device resides both inside and outside of the body, and is operated by an electric motor powered by a battery pack. The controller and batteries are typically worn over the shoulder or around the waist.

In most cases, VADs offer a short-term solution for patients awaiting a suitable donor for a heart transplant, particularly if their medical therapy has failed or if they’ve been hospitalized with end-stage heart failure. According to the United Network for Organ Sharing, over 2,900 Americans are currently awaiting a heart transplant (43 of which are in Georgia).

However, in some cases patients turn to VADs as an alternative to a heart transplant. We refer to this as ‘destination therapy’, meaning that the LVAD serves as a permanent solution for patients with advanced heart failure. Patients who are not heart transplant candidates but who have severe heart failure often pursue this course of treatment.

Ventricular Assist Devices support the left ventricle (LVAD), the right ventricle (RVAD) or both simultaneously (biventricular, or BiVAD). LVADs are used most commonly, and have been in existence for over twenty-five years.

A recent study comparing a new generation LVAD to an older model showed a marked improvement in survival at 2 years (58% vs 25%). In addition, patients reported an improved quality of life. As a result the FDA approved the Heartmate II as destination therapy for patients with end-stage heart failure.

Despite the severity of their illnesses, 70-80% of LVAD patients survive to transplantation.

There are several different types of LVADs, and I’ll go into more detail about specific devices and technology that the Emory Heart and Vascular Center utilizes in a later post. You’ll also hear from two very special patients who have been kind enough to share their stories with us.

Do you have any questions or thoughts about VAD technology or heart conditions in general? If so, please share them with me in the comments.

About Sonjoy Laskar, MD:

Dr. Laskar joined Emory Healthcare in 2005 and has devoted his career to providing direct care to patients with heart failure, heart transplantation and ventricular assist devices, as well as to teaching residents and fellows. He is an active researcher in the areas of echocardiography and ventricular assist devices as destination therapy, and is a member of the American College of Cardiology, Heart Failure Society of America and the International Society of Heart and Lung Transplantation.