my heartbeat will go on by dr shanta chakrabarti
TRANSCRIPT
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My heartbeat will go on..
Shanta Chakrabar4 MBBS, MD, FRCP(E), FRCPC, FRCPCH, FACC, FHRS Electrophysiology and Congenital Heart Disease Services
St Paul’s Hospital Clinical Assistant Professor Department of Medicine
University of Bri4sh Columbia
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Disclosures
Research grants – Heart and Stroke Founda4on – Providence Health Care – Medtronic Inc – St Jude Medical Inc
objec4ves
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Objec4ves
• Common causes of ‘funny heart beats’ (arrhythmias) in the ACHD popula4on
• When to be worried or concerned • Management of arrhythmias
quiz
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Quiz !!
75 beats /min
20 beats /min
150 beats /min
Is there a problem
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Is there a problem ?
Slow Fast
30% of ACHD pa4ents have significant rhythm problems
Why is there problem
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Why is there a problem ?
Bit complicated
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It’s a bit complicated !
+ rhythm disorders of structurally normal hearts Predic4on
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Can we predict rhythm problems ?
• Age >30 • Valve regurgita4on • Atrial size enlargement • Mul4ple surgeries • Requirement for pacemaker
Heterogenous
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When worry
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When should I be worried ? Slow heart beat
Fast heart beat
Irregular heart beat Loss of consciousness
Fa4gue Dizziness Lack of energy Near fain4ng Fain4ng Difficulty with walking
Palpita4on Heart racing Panic acack Shortness of breath Chest pain Near fain4ng Fain4ng
Ver4go Tunnel vision Spinning Swea4ng Nausea Headache Confusion Skipped beat
Cardiac arrest
Cardiac Output = Stroke Volume x Heart rate
Stroke Volume depends on cardiac contracBlity and Filling pressure and Bme When worry
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When should I be worried ?
• Loss of consciousness • Severe lethargy • Swelling of face and feet
Slow is becer than fast !!
treatment
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Treatment
• Lifestyle changes • Medica4ons • Devices – Pacemaker – Defibrillator
• Electrophysiology Study and abla4on
lifestyle
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Lifestyle
• Weight loss • Recrea4onal use • Exercise • Diet
meds
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Medica4ons : Slow down heart rate or prevent fast heart rate
• Beta blocker : Metoprolol, Bisoprolol • Calcium blocker : Dil4azem, Verapamil • Amiodarone • Digoxin • Sodium blocker : Flecainide , Propafenone • Blood thinners : Aspirin, Warfarin, NOAC
NOAC : Newer Oral An4 Coagulants
Pacemaker
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Pacemaker
ICD
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ICD: Implantable Cardioverter Defibrillator
Endocardial ICD Sub cutaneous ICD
ecg
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ECG
EPS
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Electrophysiology Study
Eps CXR
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Electrophysiology Study
Ab;a4on
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Abla4on
objec4ves
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Tachycardia stops during abla4on
THM
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Take home message
• Arrhythmias are common, mostly benign but may be dangerous
• Slow or fast • Treatable – Medicine – Electrophysiology Study – Pacemaker/ Defibrillator
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Thanks
• Our team – Pa4ents – Nurse educators : Alexia ,
Emma and Bev
– Nurse Specialist : Karen – Physicians : Drs Keiss, Grewal,
Human, Campbell, Gandhi, Leipsic, Ellis, Carere, Dvir, Riahi
– Clinic Staff – Others
QuesBons ?