The “Befores” and “Afters” of Arrhythmias and Hypertrophic Cardiomyopathy Brought to you by:...

The “Befores” and “Afters” of Arrhythmias and Hypertrophic Cardiomyopathy

Brought to you by:Andy LutzkaninSara Farag

What Andy wants you to know… What is an arrhythmia? What are some warning signs? What are some complications? Two basic types of arrhythmia. How do we doctors treat arrhythmias? What can you do to prevent arrhythmias?

What is an arrhythmia?

What is an arrhythmia?

“Normal cardiac function relies on the flow of electrical impulses through the heart in an exquisitely coordinated fashion.”

Any abnormality in this rhythm of the heart is by definition an arrhythmia.

Symptoms and Signs

What kinds of things did we see with little Jimmy? Rapid heart rate, sweating, restlessnes, difficulty

breathing, passed out

Some others you may see: Dizziness, blurred vision, chest pain, palpitations

(feeling of irregular heartbeats), anxiety

So why are arrhythmias bad?

Every day problems:Uncomfortable, can fall and injure yourself

(what if you are old and frail and you fall?) Longer term problems:

Damage to heart, kidneys, brain, etc.Why?

Worst case scenario:

Ineffective pumping=poor blood flow to organs

Sudden Cardiac Death

Types of Arrhythmias

Junctional Escape Rhythm

Torsades de pointes

Sinus Bradycardia

Ectopic Atrial Tachycardia

Sinus BradycardiaParoxysmal Supraventricular Tachycardias

Atrial Fibrillation

Atrial Flutter

Atrial Premature Beats

Sinus Tachycardia

Sick Sinus Syndrome

Conduction Blocks

Ventricular Premature Beats

Ventricular Tachycardia

Multifocal Atrial Tachycardia

Paroxysmal Reentrant Tachycardias

Ventricular Fibrillation

Ventricular Escape Rhythm

Wolf-Parkinson-White Syndrome

Three Basic Types

Increased Automaticity“Too many chiefs, not enough Indians”Rob’s example: grandma at thanksgiving

Triggered Events - Not important! Reentry

“dog chasing its tail”

“Too many chiefs…”

What normally controls the heart?

SA node is automatic - this is why transplants work

Other parts of heart may become automatic

Recall Rob’s demo with grandma at the Thanksgiving table

“Dog chasing its tail”

Birth defect or damage to heart causes a loop to form in conduction system

Electrical signal will just travel through loop over and over

Loops can be big or small

Great, you have a problem. Now what? What types of treatment are there?

DrugsSurgeryShock the heart (AED or manual defibrillator) Implantable device (defibrillator or pacemaker)

Some important drugs… Epinephrine

aka adrenaline Produced in adrenal glands “fight or flight” response Causes heart to beat stronger and faster

Atropine Originally found in Jimsonweed and deadly nightshade

plants Causes SA node to fire more often Very toxic at high doses - causes ventricular fibrillation

“Individual results may vary…”

Drugs Most have dangerous side effects including causing

new arrhythmias Surgery

Not always useful Can cause further damage

Defibrillators Only fix life threatening situations Can cause further damage Sometimes unable to save

Preventing Arrhythmias

Structure important for ___________ Congenital defects - are they preventable?

Unfortunately not Damage to heart - is it preventable?

YES!!!!

What is a risk factor?

Preventing Arrhythmias Cardiac Risk Factors

SmokingHigh cholesterolHigh blood pressureDiabetes/ObesityAge Gender

Eliminate these factors, your risk of damaging the heart goes down!

What Sara wants you to know…

Hypertrophic Cardiomyopathy

(HCM)

Lifestyle Changes

Prevention

Let’s review, what is HCM again?

What are the differences between a

normal heart and one with HCM?

In Hypertrophic Cardiomyopathy…1. Asymmetric

myocardium thickening (especially in septum)

Decreased filling High outflow velocity High pressure Difficulty breathing

In Hypertrophic Cardiomyopathy…

2. Abnormal growth of muscle fibers

Messy conduction

Arrhythmias

Since HCM is genetic, there aren’t good treatments for it.

Making lifestyle changes is very important…

Children experience slow growth because the body uses up all of its calories compensating for the heart’s hard work.

HIGH calorie, LOW fat, LOW sodium diet with lots of fluids is important!

What about physical activity?

Vigorous activities should be avoided but moving around is EXTREMELY important.

How does HCM affect social life?

Teachers/nurses should be aware of condition in school

Occupation should have low physical demand

Support Groups: www.childrenscardiomyopathy.org/site/listserve.php

What can we do to catch a problem early on? Look at family history

Problems? Consider genetic screening

Blood pressure checks every 2 years 120/80 mm Hg or less is

GREAT Cholesterol checks every

5 years Total should be less than

200 mg/dL

THANK YOU!

Any questions?