Butterflies in Your Chest?

Murielle Case:

 

 

Murielle

 

Case History:

 

 

Murielle is a 71-year-old French Canadian woman who has been complaining of increased shortness of Breath and chest pain during her morning walks around  the park. And cleaning the second floor has become increasingly difficult because she gets winded climbing the stairs.  She is upset she can no longer wear her favorite shoes because her ankles are too swollen. Murielle has also had trouble falling asleep at night because of her shortness of breath and a feeling of “butterflies running around in her chest”. Muriel has been smoking 1 pack/day for approximately 45 years. For the last 10 years she has smoked only socially (she claims) 3 cigarettes per week, and she drinks 2-3 glasses/wine per day. Murielle also has a past history of heart disease. Approximately 3 years ago while she was cleaning her house became dizzy and then had no recollection of where she was for approximately 4 hours.

 

 

 

 

What is wrong with Murielle?

 

 

 

–DO NOT SCROLL DOWN UNTIL YOU HAVE FINISHED THE CASE–

 

 

 

Original Poem:

 

 

Butterflies:

 

Fluttering, flapping inside a chest

Not free, but trapped, confined

Why can’t I be like the rest?

Can’t fly, can’t live—Fall behind

The cocoon grows with age

Instead of going away

Too tired to leave the cage

The wind is gone—I am in dismay

Erratic as the evening thunderstorm

Confused as the morning fog

What has happened to my form?

Cannot function with a missing cog

But I am not alone

Others pool around me

Disrupting the flow, let out a groan

Fear a never-ending diastole

 

 

 

Poll:

 

 

 

Do you have any family members with Atrial Fibrillation?

 

 

 

What do we need to know in order to help Murielle?

 

 

 

The Heart:

 

 

 

Conducting System & ECG:

 

Video-

 

 

 

What’s ECG?

 

 

 

Electrocardiography is the process of recording the electrical activity of the heart over a period of time using electrodes placed on a patient’s body. These electrodes detect the tiny electrical changes on the skin that arise from the heart muscle depolarizing during each heartbeat.

 

 

 

ecg_normal_sinus_rhythm

 

 

 

Normal rhythm produces four entities — a P wave, a QRS complex, a T wave, and a U wave — that each have a fairly unique pattern.

 

 

  • The P wave represents atrial depolarization.
  • The QRS complex represents ventricular depolarization.
  • The T wave represents ventricular repolarization.
  • The U wave represents papillary muscle repolarization.

 

 

 

Murielle had Atrial Fibrillation (AFib). What is That?

 

 

AFib is an arrhythmia, which is a malfunction of the heart’s electrical system which causes an irregular heartbeat. This occurs specifically in your heart’s atriums, preventing them from completely contracting–Instead, they fibrillate, hence the name Atrial Fibrillation

 

 

 

The Difference Between a Normal Heart and One With AFib-

AFib

Notice its erratic rhythm of the heart with AFib— The little bumps between each R wave,  this is the atrium fibrillating, and the R waves are closer together because the heart is beating faster to try and compensate for the inefficiency of the fibrillation.

 

 

Murielle’s ECG-

EKG

Again you can see the bumps between each R wave, and the R waves are closer together, meaning she has a quicker heartbeat. Looking at the ECG is one of the easiest methods of identifying AFib.

 

 

 

Try This ECG Game and See If You Can Find The Patient With an Arrhythmia:

http://www.nobelprize.org/educational/medicine/ecg/ecg.html

 

Which patient has an arrhythmia?

 

 

 

Signs and Symptoms:

 

 

Based on Murielle’s symptoms, what do you think the symptoms of AFib are?

 

 

 

–DO NOT SCROLL DOWN UNTIL YOU HAVE FINISHED THE MULTIPLE CHOICE–

 

 

 

AFib Symptoms

This image shows some of the symptoms of AFib (Dizziness/faintness, irregular heartbeat, shortness of breath, and chest pain). These symptoms can be easy to mistake for something else or wave off, but they should not be!

 

 

Diapositive1_71

This chart shows the prevalence of certain symptoms in people who have AFib, this can range from multiple per person, to none at all

 

 

 

AFibIntro

 

 

 

The Largest Risk of AFib is Stroke:

 

 

 

5xStroke

Women with AFib are are at greater risk of stroke and of dying than men with AFib

 

 

 

1in6

 

 

 

How?

 

 

AFib

This image shows how AFib can lead to stroke through the formation of blood pools which become blood clots and travel to the brain blocking circulation, causing a stroke. Which is a serious, serious risk– can lead to disability, paralysis, loss of independence, or even death.

 

 

Stroke Diagram AF

This image diagrams the process of AFib leading to stroke on a larger scale

 

 

Risk of AFib:

 

 

Which of these do you think increases the risk of AFib, based on what you saw in Murielle?

 

 

–DO NOT SCROLL DOWN UNTIL YOU HAVE FINISHED THE MULTIPLE CHOICE–

 

 

 

AFib Risks

These are some of the examples of things that will increase your risk of developing AFib. AFib is also the most common complication after heart surgery (20-30% of people who are recovering)

 

 

age-increase-afib-figure

This chart shows the increased risk of developing AFib that comes from advancing age ranging from less than 2% to over 10%, with Men being at higher risk.

 

 

 

AFib-Infographic

Or in other words, AFib’s prevalence rises from 4% of 60+ year-olds to 10% of 80+ year-olds

 

 

 

 

Check Out this Website For More Information:

http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AFib-Awareness_UCM_476637_SubHomePage.jsp

 

 

 

Community Impact:

 

 

Worldwide Impact:

AFib Worldwide

AFib is a growing problem Worldwide, however, the US and Europe are the most affected by it.

 

 

 

F3.large

The chart above shows the speed at which the population with AFib is increasing in comparison to the general population, and it demonstrates vividly that AFib is growing at an alarmingly quicker rate than our own population to become a larger and larger segment of the population, and a larger and larger problem.

 

 

 

afib_map_us

Looking at AFib in the US, it is much more prevalent on the Eastern side of the country, specifically the North East, which is where I live

 

 

 

Westport CT Survey

This is a survey I took at my school in Westport, CT. A combined 14% of students know someone with AFib, much higher than the average 2%. This is in part due to its higher prevalence in North Eastern US, but also due to not all cases of AFib being reported. Because AFib may not have any symptoms, or they may be minor on their own people may assume that it is not a big issue and do not treat it. Even my mother has talked about having palpitations yet does nothing about it. Although AFib may not have an immediate effect on these people’s lives, it puts them at great risk (5x) for stroke, which could lead from anything as serious as paralysis to death.

 

 

AFib has a largely negative effect on quality of life:

Screen Shot 2016-04-25 at 1.06.57 AM

 

Because of the negative effect AFib has on quality of life, and the risks of stroke and heart failure that come with it; it should most definitely be treated, not ignored!

 

 

But How Do We Treat AFib?

 

 

 

Current Treatment:

 

 

 

Goal:

 

 

-To reset your heart’s rhythm or control its rate

-And to prevent blood clots

 

 

Resetting Your Heart’s Rhythm:

 

 

  • Electrical cardioversion- An electrical shock is delivered to your heart through paddles or patches placed on your chest, which stops your heart’s electrical activity momentarily

 

  • Cardioversion with drugs- Medications called anti-arrhythmics help restore normal sinus rhythm (intravenous or oral)

 

 

Maintaining a Normal Heart Rhythm:

 

 

Anti-arrhythmic medications that could be prescribed include

 

  • Dofetilide (Tikosyn)
  • Flecainide
  • Propafenone (Rythmol)
  • Amiodarone (Cordarone, Pacerone)
  • Sotalol (Betapace, Sorine)

 

 

Side Effects:

 

  • Nausea
  • Dizziness
  • Fatigue

 

 

Heart Rate Control:

 

 

Medications may be prescribed to control heart rate, such as:

 

  • Digoxin (Lanoxin)
  • Calcium channel blockers
  • Beta blockers

 

Beta blockers may cause side effects such as worsening heart failure and low blood pressure (hypotension)

 

 

Catheter and Surgical Procedures:

 

 

Catheter Ablation-

 

Atrial fibrillation is caused by rapidly discharging triggers, or “hot spots.” These hot spots are like abnormal pacemaker cells that fire so rapidly that the upper chambers of your heart quiver instead of beating efficiently. In catheter ablation, a doctor inserts long, thin tubes (catheters) into your groin and guides them through blood vessels to your heart. Electrodes at the catheter tips can use various methods to scar the tissue so that the erratic signals are normalized. This corrects the arrhythmia without the need for medications or implantable devices.

 

 

 

mcdc7_catheter-ablation-atrial-fibrillation

 

 

 

Surgical Maze Procedure-

 

The maze procedure is conducted during an open-heart surgery. Doctors create a pattern of scar tissue to interfere with the stray electrical impulses that cause atrial fibrillation, using various techniques such as precise incisions, radiofrequency, or cryotherapy. Although these procedures have a high success rate, atrial fibrillation may recur. Catheter ablation or other treatment may be used if atrial fibrillation recurs. Because the surgical maze procedure requires open-heart surgery, it’s generally reserved for those who don’t respond to other treatments or in cases where it can be done during other necessary heart surgeries, such as coronary artery bypass surgery or heart valve repair.

 

 

Atrioventricular (AV) Node Ablation-

 

If medications or other forms of catheter ablation are unsuccessful, or if there are side effects or if you are not a good candidate for other procedures, AV node ablation is another option. In this procedure, radiofrequency energy is applied to the pathway connecting the upper chambers (atria) and lower chambers (ventricles) of your heart (AV node) through a catheter to destroy this small area of tissue. This prevents the atria from sending electrical impulses to the ventricles. However, the atria continue to fibrillate. A pacemaker is then implanted to keep the ventricles beating properly. After AV node ablation,  blood-thinning medications will need to be administered to reduce the risk of stroke because the heart rhythm is still atrial fibrillation.

 

 

 

mcdc7_av-node-ablation

 

 

 

Preventing Blood Clots:

 

 

Atrial fibrillation along with certain treatments for atrial fibrillation put the patient at especially high risk of blood clots that can lead to stroke. The risk increases if another heart disease is present along with atrial fibrillation. Your doctor may prescribe blood-thinning medications (anticoagulants) such as:

 

  • Warfarin (Coumadin, Jantoven)- Powerful medication; may cause dangerous bleeding; regular blood tests
  • Dabigatran (Pradaxa)- Newer; as effective as Warfarin; doesn’t require blood tests; shouldn’t take if have a mechanical heart valve, due to an increased risk of stroke or heart attack;
  • Rivaroxaban (Xarelto)- Newer; as effective as Warfarin; once-daily medication; follow doctor dosing; don’t stop without consulting doctor
  • Apixaban (Eliquis)- Newer; as effective as Warfarin

 

 

More Information on Treatment Here:

http://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/diagnosis-treatment/treatment/txc-20164944

 

 

Are There Better Options?

 

Novel Treatment:

 

 

Stem Cells:

Heart stem cells harvested from patients during coronary artery bypass surgery and are allowed to multiply. Once there were about 1 million of the stem cells per patient, Dr. Bolli’s team in Louisville reintroduce them into the region of the patient’s heart that had been scarred by a heart attack. Heart damage was reversed without dangerous side effects. On average, the stem cell recipients grew the equivalent of 600 million new heart cells, according to Dr. Marban, who used MRI imaging to measure changes. (A major heart attack might kill off 1 billion heart cells.).

 

Stem cell treatment may become applicable to a wide variety of heart problems, including the scarring caused by A-Fib which could help correct the problem long term.

 

 

 

stem-cells-heart

 

 

 

More Information Can Be Found Here:

http://a-fib.com/stem-cells-reverse-heart-damage/

 

 

 

Discussion: (Comment your responses below)

 

 

 

Did you learn anything from this page?

 

What was your favorite part?

 

Let us know your thoughts on future treatments, are stem cells a good path, or should other methods be examined?

 

 

 

THANK YOU!

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