On Tuesday evening, April 9, members of the community experienced a comprehensive important lecture from the Navigating the Medical System Lecture Series at Congregation Etz Chaim on the topic of Understanding Heart Arrhythmias, Valve Replacement, and Updates in Treatment. David Slotwiner, MD, FACC, FHRS, Chief of Division of Cardiology and Cardiac Electrophysiology at NewYork-Presbyterian Queens Hospital, and Assistant Professor of Medicine at Weill Cornell, shared lots of valuable information about the latest in treating arrhythmias. He pointed out, “There are a lot of new treatments in arrhythmia and valve replacement.”
He explained in detail how the heart works. He taught how 90 percent of the heart pumping is done by the two bottom chambers of the heart, and that the heart has its own complete electrical system, and there are specialized nerve cells that conduct the heart. The heart should be beating once very second, and it is slower when we are sleeping. Coronary arteries are outside the heart muscle and they supply the heart muscle with its blood supply. Blockage in these is a heart attack. Correction for this type of blockage involves surgery or placement of a stent. This is separate from the electrical system of the heart. Valves ensure that the flow of blood goes in the right direction, and the valves close after blood flows through. They can become too tight or too leaky.
He focused on the electrical system of the heart. An electrocardiogram records the electrical activity of the heart by placing ten stickers on the chest, so the doctor can see the direction of the electricity from many sides. There are two categories of abnormal rhythm. One category is slow abnormal heart rhythms, when the body’s normal pacemaker wears out. Also, the nerves may start to wear out. Symptoms of this problem include fatigue, shortness of breath with exertion, and fainting. Standard treatment is to put in a pacemaker. Now, with modern technology, you can live a totally normal life with a pacemaker. The new type of pacemaker is placed into the heart.
The second type of abnormal heart rhythm is fast abnormal rhythms. These can be from the top chambers to the bottom or from the bottom chambers to the top. Symptoms in the top chambers vary. There can be shortness of breath, chest pain, palpitations, or some people can experience no symptoms. Treatment can include catheter procedures. The bottom chambers are critical to life, so any abnormal rhythm here can be life threatening. The most common one is called cardiac arrest. This is when the electricity of the heart is completely disorganized. He stressed, “There are only two or three minutes to save a life with cardiac arrest. That is why defibrillators should be prominently displayed in public places, and people should be trained how to use them in case of this type of emergency.” Some 50,000 people die from cardiac arrest in the United States each year. Diagnosis for this abnormal rhythm is done with an electrocardiogram. There is also the Holter monitor, which records in 24 hours. This will show if there is any abnormal heart rhythm during this time.
There is a new monitor called a mobile cardiac monitor which is a computer with a transmitter on a patch. It records electrical activity continuously and records it on a cell phone, which is sent to the doctor. It records continuously for 30 days. This is good for less frequent arrhythmias.
Now, there is an implantable heart monitor that has a battery that lasts for three to four years. Every morning, information is sent to the doctor from this monitor. It looks to see if something is abnormal and then starts recording. This is particularly helpful for patients who come in with stroke.
There is another monitor that he encouraged everyone to purchase and it can be obtained without a prescription. It works with any smart phone and it’s called a kardi mobile EKG monitor. Apple has a more expensive version, the Apple series 4 watch, which keeps track of your heart speed, minute to minute. He spoke about new blood thinner medications as well. He said it is important to monitor blood pressure.
Atrial fibrillation is the most common abnormal heart rhythm. At age 70, one in ten people develop this. To reduce the risk of stroke, blood thinners are administered. The new ones, such as Pradaxa, have no side effects. They also don’t need to be monitored as much as Coumadin (warfarin), which was the only treatment before these were developed. Also, Coumadin takes three days to take effect and the new class of blood thinners works right away.
Next, Hafiz Hussain, MD, FACC, FSCAI, RPVI, attending interventional cardiologist, NewYork-Presbyterian Queens, spoke about valve replacement and the newest treatments.
He said that now there is transcatheter aortic valve intervention (TAVI), which involves plastic tubes inserted through the groin or the arm. It is rarely put directly into the heart. This is minimally invasive. The aortic valve of the heart makes sure blood flows in one direction and doesn’t go back. As people age into the 70s, 80s, and 90s, the valve narrows. A diseased valve doesn’t close properly, so blood goes back, and not enough flows back to the body. Aortic valve stenosis symptoms include chest discomfort while walking, shortness of breath, syncope, fatigue, and sudden cardiac arrest. The symptoms are similar to coronary blockages. Diagnosis is performed with transthoracic echocardiogram. The doctor will hear an abnormal sound and send you to a cardiologist. “If the velocity of blood is higher, we know there is a problem.”
Aortic stenosis is a mechanical problem, so it is usually treated with the following possible treatments: open heart surgery to remove the diseased valve and replace it. transcatheter aortic valve intervention (TAVI), or medications. Today, there is amazing technology, so there is just a one-half centimeter incision and the new valve is put in. The valve is made of pig or cow skin and can be put in through the groin or arm, so no open-heart surgery is necessary. Stroke risk is lower without open-heart surgery. “It is a mechanical problem,” he stressed, “so the cure is mechanical.” Medication will not cure it. He shared that NewYork-Presbyterian will be bringing this new procedure to Queens in a few months, and they are the only hospital in Queens that will have this available.
The lecture was followed by a lively question-and-answer session.
By Susie Garber