High blood pressure, high cholesterol level and family history are not the only things that can cause heart attacks. Arrhythmia and muscle dysfunctions also can cause heart attacks, fainting spells and death.
Most people who have a heart rhythm problem experience symptoms, such as fainting, months before they have a heart attack or die, said Dr. Masood Akhtar, an electrophysiologist with Wisconsin Electrophysiology Group.
Akhtar practices mostly at Aurora Sinai Medical Center and St. Luke’s Medical Center, but he and the Wisconsin Electrophysiology Group serve all southeastern Wisconsin hospitals.
The general public does not realize the seriousness or recognize the symptoms of a heart rhythm problem because pulmonary disease and corroded artery issues get more media attention, Akhtar said.
Benign rhythm problems can be treated and in some cases cured, he said. Highly malignant heart rhythm problems can be treated to prevent a future heart attack that would normally result in death, Akhtar said.
Akhtar is one of the most experienced electrophysiologists in the country and brought the specialty to Wisconsin. He heads Wisconsin Electrophysiology Group, an operation consisting of nine electrophysiologists with private offices at St. Luke’s Medical Center and Aurora Sinai Medical Center. The organization is the largest group of electrophysiologists in the nation and the only accredited electrophysiology program in the state, Akhtar said.
The most common symptom of a malignant heart rhythm problem is sudden death because of a lack of prior knowledge about the rhythm of the heart, Akhtar said.
"In 10 years, this will be common knowledge because half of cardiac problems are rhythm problems," Akhtar said. "The No. 1 killer is heart disease, and half of those people die from rhythm problems, which is about 300,000 per year."
The second most common symptom of a rhythm problem is a fainting spell. Nearly 1 million Americans per year experience fainting spells, Akhtar said.
The definition of fainting is also misunderstood by most people who have not had any experience with a cardiologist or electrophysiologist.
When an individual has a medically-termed fainting spell, the person loses consciousness. If the person does not wake up, he or she is considered to be in a coma, Akhtar said.
What most people think is a fainting spell, when consciousness is not lost, is merely a loss of balance and does not qualify as a fainting spell medically, Akhtar said. That is not a concern of the electricity flow within the heart, he said.
Fainting spells, when a person loses consciousness, are a direct result of the electricity in the heart malfunctioning and have long disproved the theory that fainting is a result of a neurological disorder, Akhtar said.
When a person really does faint, it could be a serious warning sign.
"If you have a rhythm problem and you faint, and the rhythm problem is not recognized, the sudden death probability is 25 percent for that person within the next 12 months," Akhtar said.
The functionality of the heart depends on the electrical current that spontaneously sparks in a corner of the right upper chamber of the heart.
"The signal goes through the right and left upper chambers like a ripple in a pond," Akhtar said. "Then between
the upper and lower chambers there is a natural insulation so the electricity cannot jump. It is a wiring cable created by nature that picks up
a signal."
There are hundreds of varieties of chaotic rhythm problems, Akhtar said, and the job of the electrophysiologist is to determine what point in the sequence of events the electrical current is short-circuiting.
Having a heart rhythm problem can only be fatal if a patient or a doctor who is not a specialist in electrophysiology or cardiology does not recognize the seriousness of the symptoms, Akhtar said.
"If you have a fainting spell, you go to a primary care physician and you are not sent to a cardiologist or neurologist, you are out of the loop," Akhtar said. "We only see 20 percent of people who have rhythm problems. The other 80 percent are the people out there who don’t know they have rhythm problems, their doctors don’t know and they don’t have the resources to find out."
For frequent fainters and people who have had a cardiac arrest, an electrophysiologist can implant an internal defibrillator in the patient’s chest. The internal defibrillator is equivalent to a rescue squad in your chest, Akhtar said, and more than 100,000 are implanted in patients nationally per year.
A defibrillator monitors the pace of the heart, and if the heart is beating too slowly or too quickly, the defibrillator shocks a patient with up to 700 volts to steady the beat, Akhtar said.
Karla Schmitz, 31, of Oshkosh, had a heart attack as the result of a viral infection when she was just 21 years old. Schmitz has been a patient at St. Luke’s and Aurora Sinai for 10 years since her internal defibrillator and pacemaker were originally implanted in Madison.
She had an ablation procedure that ceased her natural electric current, making her pacemaker-dependant, and a defibrillator was implanted to control her heart’s speed in beats per minute, Schmitz said.
"The analogy they told me was that it is as if you have your car on cruise control at 60 mph. The pacemaker is the cruise control and does not let you go below 60 mph," Schmitz said. "But anytime you are going downhill, your car can speed up. If it speeds up to a point, like when you are exercising and your heart rate is too fast, the defibrillator shocks your heart to bring it back to the normal speed."
The shock provides a jolt to her body, Schmitz said, and afterward she knows she is awake and OK.
"There is a constant mental awareness that you always have (a defibrillator and pacemaker)," Schmitz said. "At first it was more like, ‘Why me?’ And then it shocks you a few times, and you realize you would normally be dead. It takes a while to transition from, ‘Why me?’ to ‘Thank God.’"
Lives can be saved if people know the warning signs and know how to help someone who was in cardiac arrest, Akhtar said.
"After a heart attack or heart surgery, a lot of people live 20 or 30 years afterward with a good quality of life," Akhtar said. "No one thinks they have a problem, and then suddenly they collapse and die. But if you go back in history, you might find out that the person saw someone a few months ago after a fainting spell. You need to figure out that this is a serious problem because you are not going to have another chance."
April 15, 2005, Small Business Times, Milwaukee, WI
