The “Befores” and “Afters” of Arrhythmias and Hypertrophic Cardiomyopathy Brought to you by: Andy Lutzkanin Sara 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?

“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 Bradycardia Paroxysmal 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?  Drugs  Surgery  Shock 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  Smoking  High cholesterol  High blood pressure  Diabetes/Obesity  Age  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:

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?