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1-800-675-6368Comprehensive care for heart rhythm disorders
Riverside providers comprehensive care for patients experiencing heart rhythm issues, offering diagnosis, management, interventional services and cardiac surgery. Our team is led by board-certified cardiac electrophysiologists – cardiologists with specialized training in the heart’s electrical system. From the clinic to the interventional lab, our entire team is committed to caring for patients with heart rhythm disorders.
The heart’s electrical system controls its heartbeat and rhythm. Electrical impulses coordinate the four chambers of the heart to beat in a specific sequence and manner. When the heart beats as it should, it is in normal sinus rhythm, named after the sinus node, the heart’s natural pacemaker. Problems with this electrical system can cause the heart’s chambers to beat irregularly or out of sync, affecting its ability to pump blood efficiently.
When the heart’s rhythm is off, it may struggle to pump enough blood and oxygen to the brain and other organs. Alternatively, it may work too hard, potentially damaging the heart muscle.
Electrical system issues are relatively common. Researchers estimate that between 2-5% of people have an irregular heartbeat or arrhythmia. This percentage rises with age, as arrhythmias are more prevalent in individuals over 65. The most common type of arrhythmia is atrial fibrillation, or AFib.
The signs on an irregular heartbeat, also known as an arrhythmias, can be similar to other heart problems. The symptoms you experience depend on the type of arrhythmias you have.
Additionally, some arrhythmias can also make your heart skip beats or start its beat from the wrong part of the heart.
This is when your heart beats too slowly, fewer than 60 beats per minute.
Symptoms may include:
• Fatigue
• Feeling lightheaded or dizzy
• Fainting (also called syncope)
• Shortness of breath
• Trouble thinking clearly or remembering things
Common Arrhythmias include:
• Sick sinus syndrome
• Conduction bloc
There are different types of diagnostic tests a physician may order to diagnose an arrythmia. Some are very simple and can be done in an office setting. Other tests need to be done in the cardiac catheterization lab.
• Recording Heart Rhythms (ECG, EKG, Holter Monitor, Event Recorders, Implantable Loop Recorder)
• Echocardiogram
• Cardiac Stress Test
• Electrophysiology Study
As irregular heart rhythms are often caused by heart disease, a provider may ask the patient to make some lifestyle changes that contribute to and exacerbate cardiovascular disease. These may include:
• Stop Smoking
• Get more exercise
• If they are diabetic work to have tighter management of their HbA1c
• Maintain a healthy weight
• Eat a heart healthy diet, especially limiting salt, caffeine and alcohol
• Find ways to reduce stress
• Get enough restful sleep
The provider may prescribe different medications to manage symptoms, treat irregular heartbeats and prevent dangerous side effects. The physician may also prescribe medications to manage other aspects of cardiovascular disease. Individuals should be careful to take all medications as prescribed and never stop taking something without talking to the provider.
There are several main categories of medications often used. Some medications may work in multiple ways:
• Blood thinners, also called anticoagulants: These medications help prevent blood clots and stroke, which is a common side effect of some arrythmias, including AFib.
• Antiarrhythmic medications: There are different categories of antiarrhythmic medications that are classified based on the mechanism they use, such as impacting how sodium, potassium or calcium is absorbed within the heart or vessels. These are often used to slow down the heart rate.
Some antiarrhythmic medications, such as dofetilide (also called Tikosyn) an sotalol, have to be started while the patient is admitted to the hospital in order to monitor their heart. For this medication, patients are usually admitted for 3 – 4 days to be sure there are no negative side effects and to determine the correct dose.
• Calcium channel blockers, also called calcium antagonists: These are often used to treat arrythmias as well as angina (chest pain) and high blood pressure (hypertension)
• Beta blockers: These medications decrease the heart rate and the cardiac output, or amount of blood pumped through the heart. These medications are often prescribed for people with high blood pressure as well as for arrythmias and chest pain (angina).
This procedure, performed in the cardiac catheterization lab, uses cold (cryoablation) or heat (radiofrequency ablation) to treat the area of the heart causing the irregular heart rhythm. A tiny catheter is inserted into a blood vessel and then guided up to the heart using an x-ray screen. The physician conducts an electrophysiology study and identifies the exact location in the heart that is producing too much electricity and disrupting the normal process. Once identified, this location is intentionally scarred using either heat or cold at the end of the catheter. This scarring keeps that portion of the heart tissue from over-producing the electrical charge.
This outpatient procedure is used to reset the heart to its normal rhythm.
Patients are lightly sedated for this procedure. In other words, they are given medicine to make them sleep, but they do not undergo general anesthesia. While patients are asleep, the physician shocks the heart to return it to normal rhythm, also called normal sinus rhythm. This is usually with controlled, low-energy electrical shocks, but it can be done with medications.
From the outside, it looks like defibrillation when electrical shocks are used in an emergency situations like cardiac arrest, but it is slightly different. With cardioversion, the shocks are at a lower energy level and usually delivered with applied electrodes.
The short-term effectiveness of cardioversion is very high, and most patients return to a normal rhythm. Patients are usually prescribed medications to help them stay in a normal rhythm after the procedure.
Long term, many patients experience a return of their irregular heart rhythm at 6 months to 1 year after the procedure. But some patients are able to remain in the normal rhythm following the procedure.
Pacemakers
Pacemakers are small devices implanted into the chest that manages a patient’s irregular heartbeat. These are most often used to manage the arrythmias causing slow heartbeats.
Implanted Cardioverter Defibrillators (ICDs)
These are small devices that are implanted in the chest to help patients who have life-threatening arrythmias. These can be caused by a heart attack, cardiac arrest of other forms of cardiovascular disease. ICDs monitor and track heart rates and can deliver shocks if the heart is too rapid or out of rhythm. Some versions also work as pacemakers as well and can help speed up slow rhythms.
Implanted Loop Recorders
These can record the rhythm for up to three years, which can help identify the type of irregular heartbeat for patients who are suspected of having an arrhythmia but haven’t been able to capture it on an EKG or Holter Monitor test.
Atrial fibrillation (AFib) increases the risk of stroke. This is because the way the heart contracts in AFib can lead to blood clots forming in the area of the heart known as the left atrial appendage. If these clots form and then become loose, they can immediately block the blood flow to the brain, causing a stroke. This is why most people with AFib are on blood thinners, also called anticoagulants. For patients unable to stay on blood thinning medications, having a small device, known as the WATCHMAN™ device, implanted to block that tiny portion of the heart can work to prevent strokes. Learn more about the WATCHMAN™ implant here.
Riverside Cardiology Specialists – Newport News
500 J. Clyde Morris Blvd., Annex Building 1st Floor
Newport News, VA 23601
757-594-2074
Riverside Cardiology Specialists – Gloucester
7544 Hospital Drive, Building A, Suite 202
Gloucester, VA 23061
757-594-2074