Offbeat: Heart Arrhythmias and Other Heart Issues

Date:
11/19/2009 | 12:00 pm

Cooper Cardiologist Andrea M. Russo, M.D., will answer your questions about heart arrhythmias and other heart issues, as well as the importance of knowing your numbers such as blood pressure and cholesterol. She will address screenings and diagnostic tests you may need, as well as give you tips for making healthy choices.

Dr. Russo is board certified in Cardiovascular Disease, Cardiovascular Electrophysiology, and Internal Medicine. She earned her medical degree from SUNY Upstate Medical Center and completed an internship and residency at Medical College of Pennsylvania. She completed her Cardiovascular Fellowship at Cooper University Hospital. Her special interests are cardiac arrhythmias, catheter ablation therapy for arrhythmias, gender differences in arrhythmia management, implantable device management for heart failure, implantable cardioverter defibrillators/Pacemakers - placement and management, diagnosis and treatment of syncope, and diagnosis and treatment of ventricular tachycardia and sudden cardiac arrest.

 

1. When you can feel your heart beat in your chest is this what is known as palpitations and is this indicative of an arrythmia? 2. What is happening when you lay on your left side and it lowers your heart rate? Thank you. Rosalie from Erial

11/19/2009 12:00:17 PM

Andrea M. Russo, M.D.: "Palpitations" may refer to the feeling of a "strong" heart beat or a "fast" heart beat.  Some patients also refer to "skipped" or "irregular" heart beats.  These symptoms may be related to the normal heart rhythm beating faster, or "extra" beats from the upper or lower chambers of the heart.  On occasion, rapid heart rhythms may be related to abnormal heart rhythms arising from the upper or lower chambers of the heart.  Some of these abnormal heart rhythms may require further treatment.  The first step is to evaluate the symptoms of  "palpitations" by performing some type of monitoring.  This may include a 24 hour monitor ("holter" monitor) or longer monitoring using something called an "event monitor."  This will allow documentation of the cardiac rhythm occurring during symptoms.

Sometimes heart rate changes can be normal.  In particular, during pregnancy, compression on a blood vessel called the "inferior vena cava" may result in a reflex slowing of the heart rate when lying on one side.  In addition, there is also a normal variation of heart rate in otherwise young and healthy individuals called "sinus arrhythmia," which does not require any specific treatment.

I am a 47 yr. old, African American male with several health issues, however I have recently been diagnosed with having only 1 carotid artery. I found out after I passed out and was admitted to the hospital. What do I need to do to prevent future episodes or maintain optimal health? I also do not have a primary doctor and wonder if I need to seek a heart specialist. Thank you for considering my question. Thomas from Camden

11/19/2009 12:02:32 PM

Andrea M. Russo, M.D.: "Passing out" can be due to many types of problems, including heart disease as well as occasionally due to some types of cerebrovascular disease (blockages in the arteries in the neck or brain). Some of these problems may be serious or even life-threatening.

Not only would I recommend that you see a primary care physician, but you will also need to see a doctor who specializes in vascular disease and probably also a neurologist. Please feel free to contact Cooper regarding referral to a primary care physician as well as a cardiologist who specializes in vascular disease or catheterization.

Back in 1989 I was told I had a "long QT" after getting an EKG, and that if I had anesthesia, I should tell the doctor. What is this and do I have to worry? Also, a couple of times doctors have told me that I have a heart murmur but then others don't hear it. I was first told when I was about 7 years old, and then a few years ago, but recently the doctor didn't hear it. Do I or don't I have a murmur? And is that dangerous? Also I have been told I have an enlarged heart, what does this mean? I am a 62 yyear old female, obese, with HTN and high cholesterol, on medicaton to control. Until recently it was being controlled, but my cholesterol has crept up with the good levels decreasing. I try to diet, and have increased my level of exercise, 1-1/2 mile walk daily, and lead a 2x/wk a stretchercise class. Vianne from Berlin

11/19/2009 12:04:56 PM

Andrea M. Russo, M.D.: To answer your first question, a "long QT" is a measurement on the ECG that can be present since birth ("congenital") or can be related to medications or electrolytes (such as potassium or magnesium). The latter is referred to as "acquired" long QT. In some cases, this can run in families or can result in symptoms such as passing out or even dying suddenly. You should see a cardiologist to better evaluate this potential problem.

In reference to your second question, a "murmur" can be heard intermittently and is common in very young children who may sometimes outgrow this finding. However, most adult murmurs are related to heart valve problems, such as heart valve leakiness or valve blockages. On occasion, small holes in the heart may also lead to the finding of a heart murmur. Adult murmurs, particularly those related to heart valve problems, may progress and therefore require further evaluation and therapy. Murmurs can be evaluated by an ultrasound of the heart called an "echocardiogram." Once again, this should be evaluated by a cardiologist. 

Please feel free to call Cooper to obtain a referral to a cardiologist, or ask your primary care physician for a referral. 

1. Explain sinus node dysfunction and the possible future effects if I've been asymptomatic for years. 2. What would you recommend (other than drugs) for someone with low BP, i.e. low 90s over low 60s? I have had one episode 2 years ago of vasovagal syncope. Patti from Washington Township

11/19/2009 12:08:39 PM

Andrea M. Russo, M.D.: 1. "Sinus node dysfunction" or "Sick Sinus Syndrome" is a common disorder that increases in frequency with age, and can lead to abnormally slow heart rates.  Eventually, this may require a permanent pacemaker, particularly if symptoms of lightheadedness, dizziness or passing out develop.  On occasion, pacemakers may be recommended for patients with extremely slow heart rates, even if they do not experience symptoms yet.  Rarely, patients may even die from this problem.  Some medications may also contribute to slowing of the heart rate.  I would recommend that you discuss the details and the diagnosis further with a cardiologist or electrophysiologist (i.e., a cardiologist who specializes in heart rhythm problems), if you have not already done this.

2. "Low BP" as you describe may be normal for some patients, depending on your age and body size.  Your blood pressure is "too low" if it leads to symptoms of lightheadedness, dizziness or passing out, which typically does not occur until the systolic pressures (upper number) get lower than 90 mmHg.  Vasovagal syncope is related to an "imbalance" between the sympathetic nervous system ("adrenalin" system) and parasympathetic system ("vagal" system).  Although increased fluid and salt intake may help to increase intravascular volume and possibly also blood pressure, unfortunately many patients with this syndrome may still require medications to prevent episodes.

I am 78 and work out at the gym three times per week. I have been exercising various things for 28 years (senior softball, 10k races, etc.). Now I start my routine with 30 minute elliptical workout trying for 300 calories, then do five weight exercises three times. I try to keep my heart rate at about 120. Occasionally it races up to 150. I have had stress tests but it never shows up. Should I keep pushing it or should I give up exercising? Frank from Marlton

11/19/2009 12:13:32 PM

Andrea M. Russo, M.D.: Fast heart rates may be due to the "normal rhythm" ("sinus rhythm") or an "abnormal rhythm." Abnormal heart rhythms may result in symptoms of  "palpitations" or a "racing" sensation. The best way to figure this out is to perform some type of heart rhythm monitoring during episodes. Types of monitors include "holter" (24 or 48 hour monitoring) or "event monitors," which allow documentation of the rhythm during symptoms. I would suggest further evaluation through your primary care physician, who may refer you to a cardiologist for this testing.

I have fibromyalgia and lately have been feeling pressure in the left side of my chest. I went to my doctor and got an EKG. She told me that I have a small abnormality but she didn't tell me what it was. I'm 38 years old and 140 pounds. Monday night I felt a numbness on the left side of my face that lasted for about two hours and sometimes I feel an electric sensation going through the left side of my head. I'm a little worried and hope that I can get an answer. Thank you. Wanda from Pennsauken

11/19/2009 12:16:28 PM

Andrea M. Russo, M.D.: There are many types of EKG abnormalities, and some findings may be significant while others are not.  Chest discomfort can be related to a variety of different things, and some of these things may not be related to your heart.  However, all chest discomfort should be discussed with your physician.  In many cases, further evaluation may include testing such as an echo and/or stress test.  The decision regarding what types of tests are indicated will depend on your description, risk factors, and EKG.  I would suggest you discuss this with your primary care physician first, who might also recommend consultation with a cardiologist.

A few week ago I was told by an ER doctor that my heart was slightly enlarged and the artery in my neck was enlarged. You can see palpitations in my right side of my neck beating real fast. I was diagnosed with palpitations. Is this a serious problem? Carolyn from Swedesboro

11/19/2009 12:19:33 PM

Andrea M. Russo, M.D.: "Palpitations" can be related to a variety of different things, including "extra beats" or "rapid beats."  Rapid or fast heart beating can be due to the normal rhythm (sinus rhythm) versus an "abnormal" heart rhythm arising from the upper or lower chambers of the heart. Heart enlargement may be related to a variety of different heart muscle problems, and can sometimes contribute to heart rhythm problems or "palpitations." I would suggest that you see a cardiologist for these symptoms to obtain further evaluation.

I have been diagnosed (2006) via an echocardiogram, with a bicuspid aortic valve. I am now a non-smoker and have a relatively healthy lifestyle. How often should i see a heart specialist and how often should i return for another echo? Martin from Voorhees

11/19/2009 12:23:11 PM

Andrea M. Russo, M.D.: A "biscupid" aortic valve is a congenital problem (present "since birth"). This may eventually progress to valve blockage or valve leakiness, which may require valve replacement in the future. The frequency of cardiology follow-up and echocardiography will depend on the severity of the current problem, as well as the progression in your particular case. Typically, this is followed at least once yearly (or sometimes every 6 months), at least with an office visit and intermittent echoes. If you develop any symptoms of chest pain, shortness of breath, lightheadedness, dizziness, or passing out, you should seek medical attention immediately.

Hi, I will be 65 on the 19th and was born at Cooper Hospital. I have 4 stents, am a diabetic, have IBS, fibromyalgia, asthma and numerous allergies. I take numerous meds. My question is, how do I coordinate a heart-healthy diet and lifestyle with all of my other ailments? I love salads but they do a number on my belly. I was living on Immodium. I had to be on antibiotics because of an infected toe and my podiatrist said it was dangerous to take Immodium at same time, as the waste needs to be removed. Can you help me with a heart-healthy diet that won't interfere with all my other problems? Thank you so much. Joyce from Burlington City

11/19/2009 12:26:28 PM

Andrea M. Russo, M.D.: You are correct to state that it is often difficult, but yet extremely important, to follow a heart healthy diet, particularly with known coronary artery disease and multiple risk factors. This can often be complicated in the setting of multiple allergies, presumably including food allergies, diabetes and recurrent diarrhea. It may be worthwhile meeting with a nutritionist, in addition to your primary care physician and cardiologist, to discuss this further.

What are your thoughts on AICDs in Adult Congenital Heart patients with non-sustained V-tach? Lisa from Blackwood

11/19/2009 12:29:21 PM

Andrea M. Russo, M.D.: Indications for ICDs depend on a variety of factors, include the presense or absence of symptoms, as well as the severity of underlying heart disease.  Symptoms which might suggest arrhythmias include lightheadedness, dizziness, passing out or almost passing out.  For patients who have no symptoms suggesting arrhythmias, ICDs (implantable cardioverter defibrillators) may still sometimes be recommended if the pumping function of the heart (also referred to as "ejection fraction") is very low.  I would suggest you see a cardiologist or electrophysiologist (i.e., cardiologist who specializes in heart rhythm problems) to determine if the person with adult congenital heart disease you are referring to might be a candidate for an ICD.

What can someone, who has recently had congestive heart failure, safely eat; especially considering the sodium issue? I'm afraid to eat almost everything has salt or sodium in it. Doesn't the body need some salt or sodium. Christine from Bellmawr

11/19/2009 12:31:53 PM

Andrea M. Russo, M.D.: Many foods have hidden salt or sodium content.  Some foods are very high in sodium and may contribute to retention of fluid in the body which can worsen congestive heart failure.  Therefore, many patients with heart failure are placed on a diet that is lower in sodium, such as restricting sodium content to 2 grams or sometimes 4 grams per day.  This does not eliminate salt, but just reduces intake.  Examples of some foods that are very high in salt include pickles, potato chips, and canned soups, but there are many other things you may need to avoid.  I would suggest you discuss this with your cardiologist or a nutritionist. 

Dr. Russo, A few years ago, I was diagnosed with PVC's. I had a Holter monitor for 24 hours and was told that I had "hundreds" of PVC's in that 24 hour period. My cardiologist and family doctor assure me that they are benign. Any thoughts? Thank You! Chris from Gloucester Township

11/19/2009 12:41:13 PM

Andrea M. Russo, M.D.: Many patients have "PVCs" or "extra beats" arising from the lower chambers of the heart.  The significance of these extra beats depends on the presence or absence of underlying structural heart disease.  Types of heart disease many include heart muscle weakness (called a cardiomyopathy) heart artery disease, or valve disease.  This may be evaluated with further testing that could include echocardiography (an ultrasound of the heart), stress testing, or even sometimes cardiac catheterization.  The need for any further testing may depend on the presence or absence of symptoms and your ECG.  In many cases, these "extra beats" may occur in the absence of any underlying heart disease and may be "benign."  However, I would suggest evaluation by a cardiologist before assuming this is the case.

I am a 48 year-old woman who is taking bystolic for sinus tachycardia and lots of pvc's(more than 36/minute). I feel much better taking this medicine. Shortness of breath, fatigue, headaches, and palpitations are gone. I thought sinus tachycardia did not require treatment. Do I have an atrial arrhythmia, or ventricular arrhythmia or nothing to worry about? I also take a water pill and an ARB to control my blood pressure. Allie from Cherry Hill

11/19/2009 12:43:13 PM

Andrea M. Russo, M.D.: It is possible that the medication is being used to help with PVCs and symptoms.  There are a variety of different types of abnormal heart rhythms, including atrial tachycardia or or other ventricular arrhythmias that you are referring to.  However, this is determined by looking at the ECG or rhythm strip.  The symptoms you describe could be due to several different types of problems.  I would recommend that you see a cardiologist for further evaluation. 

I have episodic A-fib that is typically two days on, three days off. I barely notice when it is on except for the sense of jitters in my chest. This coumadin thing is getting old and I am only 59. I also have other medications but they have no effect on the problem. What is the best course from here on out? Jay from Cherry Hill

11/19/2009 12:45:01 PM

Andrea M. Russo, M.D.: Atrial fibrillation is a very common arrhythmia in the United States, and can be treated with medications or even a procedure called "catheter ablation," if medications fail or are not tolerated.  Typically, medications are tried first.  In addition to coumadin (which prevents blood clots), medications often include a drug called an "antiarrhythmic drug" to help maintain sinus rhythm.  You should definitely see an electrophysiologist, who is a cardiologist that specializes in heart rhythm problems to determine the best options for your particular case. 

Dear Dr. Russo, I recently had an unsuccessful ablation procedure. It was an "elective" procedure for symptomatic relief that I just couldn't handle anymore after 15 years of these intermitant yet sometimes frequent runs of what NOW appear to be Multiform PVCs. I was wondering, would you consider and is it woth a "2nd" ablation for nuisance epiosodes that come and go but are very uncomfortable when they come? Edward from NJ

11/19/2009 12:51:01 PM

Andrea M. Russo, M.D.: Some types of ablation procedures may require more than one attempt to obtain "cure."  Whether or not a second try is indicated will depend on a variety of different factors including the reason(s) for the unsuccessful procedure.  In some cases, the arrhythmia cannot be brought on in the lab, and therefore the electrophysiologist does not have a good way to localize the source.  Alternatively, arrhythmias may be successfully ablated and then recur, or patients may develop new sources of extra beats.  To determine which possibility is relevant in your particular case, I would recommend you obtain another opinion from an electrophysiologist who specializes in heart rhythm problems or catheter ablation.

I am a 57 year old female with atrial fibulation and recently was hospitalized with congestive heart failure. Was told to watch carefully what mt diet consist of and no salt. doesn't your body need some salt and how much salt is allowed without putting you health in jeopardy. I am suppose to keep me feet elevated when not working, will this help with fluid retention? What else helps with the fluid retention? Chris from Bellmawr

11/19/2009 12:51:37 PM

Andrea M. Russo, M.D.: Congestive heart failure may be due to a variety of different causes, including heart muscle weakness or heart valve problems.  Atrial fibrillation may also worsen symptoms of congestive heart failure.  A reduction in salt or sodium intake is frequently recommended in patients with heart failure because salt helps your body retain water, and this may worsen symptoms of heart failure.  Elevating your legs may also help your body re-distrubute fluid, although a water pill is also often required.  Many foods contain salt and lowering your salt intake will not completely eliminate salt in your diet.  Other medications are also often used to treat heart failure.  The choices of treatment will depend on the severity of your heart problem and the pumping function of your heart (also referred to as "ejection fraction").  In some cases, devices are also implanted to treat heart failure, when medicinces alone do not work.  Controlling atrial fibrillation will also be important, as this could also worsen heart failure symptoms.  I would suggest referral to a cardiologist to determine the best treatment for your particular case.

Andrea M. Russo, M.D. : Thanks to each of our participants today. I hope that I have been able to provide you with information to guide your health care decisions.  The Cooper Heart Institute, where I practice, is the most comprehensive heart care center in southern New Jersey. My colleagues are experts in the treatment of heart disease and leaders in cardiology research. We produce superior outcomes for our cardiology patients, utilizing the latest technology available to pinpoint and treat all types of heart problems.  If we can assist you, please click on the appointment button on this page or call our physician referral staff at 1.800.8.Cooper (1.800.826.6737).

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