Heart matters

It is almost Valentine’s Day, what better time to look at matters of the heart? We are all familiar with heart attacks, heart failure and blocked arteries. There are however other heart conditions that are not that well known that we would like to focus on, namely Broken Heart Syndrome, Atrial Fibrillation, and long QT-syndrome.

Broken Heart syndrome

This condition can also be referred to as stress cardiomyopathy or Takobsobu cardiomyopathy. The term “cardiomyopathy” implies that the heart muscle is affected. The onset of stress cardiomyopathy is often triggered by intense emotional or physical stress. It is postulated that an excess of certain hormones called catecholamines induces micro-vessel dysfunction and or a coronary artery spasm. The left ventricle wall (one of the heart chambers’ walls) and apex (tip) of the heart are predominantly affected.

The term Takobsobu is a Japanese term for an octopus trap which is thought to have a similar shape as the ballooning effect at the apex of the heart seen on a cardio echogram in some of these patients. Patients present with symptoms like in a heart attack such as chest pains, fainting or difficulty in breathing. The patient might have an increase in some of the cardiac biomarkers (typically troponin but not creatine kinase) as well as abnormalities on their Electrocardiogram (ECG).

An angiogram will distinguish between coronary artery disease and cardiomyopathy although these two conditions can occur concurrently. Treatment of stress cardiomyopathy is supportive. In some cases, the patients might develop shock or heart failure and are treated according to standard protocols. Typically, patients recover fully with no permanent damage.

Atrial fibrillation

Atrial fibrillation (AF) is a condition where the heart’s rate and rhythm are abnormal. The prevalence of AF increases with age. Most patients with AF also have underlying heart conditions such as hypertension or coronary heart disease or both. AF is classified by the American Heart Association into different groups depending on its frequency of occurrence. It can be paroxysmal, persistent, long-standing, or permanent. It might be that patients with AF have no symptoms and the diagnosis is made incidentally when an ECG is performed at a general check-up. However, the spectrum of associated symptoms can be wide and non-specific, like palpitations, fatigue, dizziness, weakness. In severe cases, the patients can present with fainting (syncope), chest pains, stroke, or heart failure.

The complications because of AF are stroke due to a blood clot and heart failure. In some cases, AF occurs because of another medical condition (after cardiac surgery or a heart attack, overactive thyroid gland), in these instances, the medical conditions should be treated with the AF. The treatment of AF is usually attempted with medications such as a beta blocker or a calcium channel blocker. Cardioversion (controlled shocking of the heart to establish a normal rhythm) can be considered if medication is not successful. Two aspects to consider is the heart rate that needs to be lowered as well as the normal rhythm that needs to be restored. To restore the rhythm long term, percutaneous catheter ablation can be considered. During this procedure, a catheter is inserted in the groin in a blood vessel and moved up to the heart through the heart chamber wall, a controlled “burning” of the area causing the abnormal rhythm is done that will contain the abnormality and prevent it from affecting the rest of the heart. 

Long QT-syndrome

This condition refers to patients who have a dysfunction of the electrical/conduction system of the heart. Once can either be born with this syndrome due to an abnormal gene or develop it due to taking certain medicines or mineral imbalances. A diagnosis is made with an ECG. The ECG print-out records the electrical activity of the heart and results in a typical pattern. If the pattern is abnormal, it can provide us with a clinical diagnosis or suspicion of an abnormality. The ECG pattern is described as a P wave, QRS complex followed by a T wave. All of these represent certain phases of the cardiac cycle and are marked P, Q, R, S, T.

The time between these points can vary in different diseases. If there is a prolongation in the time between the Q and T point, it is referred to as long QT syndrome. In some cases, this syndrome can result in Torsade de Pointes, a certain type of heart rhythm abnormality. The symptoms that might occur in a patient are palpitations, fainting, seizures and in some unfortunate cases, sudden cardiac arrest. Treatment depends on whether you are born with the condition or whether it developed later in life. If you are born with Long QT syndrome, you will need medication called beta-blockers to prevent your heart from beating too fast. It might be necessary to have a pacemaker or a cardioverter fibrillatory implanted to regulate your heart rhythm.

For people who developed long QT syndrome later in life, the treatment might be as easy as stopping medication that caused long QT syndrome, fixing mineral imbalances, in some cases the insertion of a pacemaker or anti-arhythmic medication to control your heart rate. If you are diagnosed with long QT syndrome, you need to be cognisant of medications prescribed as some medication is known to prolong the QT interval and it can lead to adverse effects. If it is suspected that you are born with the condition, it is important to inform family members as it might affect them as well.

Look after your health, by going for an annual checkup, it is wise to request that an ECG is performed during this examination too. In this way one can monitor heart health and, in some cases, identify issues even before we experience any symptoms or complications.

Dr. Janet Strauss is the Chief Operations Officer at Medwell SA – The Home Health Care Specialists.  For more information visit www.medwell.co.za