Understanding the irregular patterns of heart arrhythmia
Charlie Hildestad didn’t feel well during a preseason run with other members of the Illinois Wesleyan University lacrosse team. But the 19-year-old kept running, completing seven of 10 laps. He then left the campus field, entered a nearby restroom and fainted.
Hildestad, a graduate of Saint Viator High School in Arlington Heights, received emergency room care for the fall 2018 incident and learned he likely had a type of arrhythmia, a condition in which the heart beats with an irregular or abnormal rhythm. He’d had flare-ups before in which he had vomited but not fainted.
“I thought maybe I was just out of shape or hadn’t eaten enough that day,” Hildestad says.
Taking matters to heart
Cardiac electrophysiologist Mark Metzl, MD, of NorthShore University HealthSystem, diagnosed Hildestad with supraventricular tachycardia (SVT), a faster than normal heartbeat that begins above the heart’s two lower chambers.
Reaching a diagnosis had been complicated because Hildestad’s heart rate would return to normal after he fainted or vomited. But Metzl made the diagnosis with the aid of an unusual tool: a specially equipped Apple Watch Series 4.
Hildestad wore a KardiaBand, which replaced the wristband on his Apple Watch. When he felt an abnormal heartbeat coming on, he could press the Apple Watch’s Digital Crown to produce an electrocardiogram (ECG) to accurately reflect what was occurring.
Normal resting heart rates for adults are between 60 and 100 beats per minute. Highly trained athletes may have resting heart rates below 60.
The first episode Hildestad had after donning the watch generated an ECG that revealed a heart rate of 276.
Arrhythmias occur when the electrical impulses that coordinate heartbeats don’t work properly, causing the heart to beat too quickly, too slowly or irregularly. It’s important to diagnose arrhythmias promptly, for the sake of the heart and other organs.
“When the heart doesn’t beat properly, it can’t pump blood effectively. When the heart doesn’t pump blood effectively, the lungs, brain and all other organs can’t work properly and may shut down or be damaged,” according to the American Heart Association (AHA).
Types of arrhythmias
An arrhythmia may or may not cause any signs or symptoms and might only be discovered during a routine physical with a primary care provider, says Christopher Henry, MD, a cardiac electrophysiologist with Northwest Community Healthcare. Diagnostic tests and treatments vary depending on the patient, symptoms and medical conditions.
There are several types of arrhythmias. Tachycardia is a heartbeat that is too fast, and a bradycardia is one that is too slow. Irregular heartbeats are called fibrillations, such as atrial fibrillation (AFib) and ventricular fibrillation. When a single heartbeat occurs earlier than normal, it’s called a premature contraction.
AFib is the most common arrhythmia;the AHA estimates that it affects between 2.7 million and 6.1 million Americans. The number of cases is increasing each year as people live longer, notes Roderick Tung, MD, associate professor of medicine and medical director of the Center for Arrhythmia Care at UChicago Medicine’s Heart and Vascular Center.
Arrhythmias occur when the electrical impulses that coordinate heartbeats don’t work properly, causing the heart to beat too quickly, too slowly
Among the risk factors for AFib are advanced age, binge drinking, high blood pressure, sleep apnea, diabetes and underlying heart disease. However, some people who lead healthy lives and have no other medical conditions, including athletes, develop AFib.
Prevention is possible, and the AHA calls for a heart-healthy lifestyle to reduce the risk for AFib. “Among the best preventive steps against AFib are to remain lean and to not smoke,” Tung adds.
Sometimes arrhythmias can cause heart palpitations, which feel like a pounding or racing heart.
Palpitations that quickly dissipate are probably nothing to worry about, medical experts say. However, if they continue or are accompanied by dizziness, fainting, chest pain or shortness of breath, seek immediate medical attention.
The emergency department at Northwest Community Hospital frequently sees patients experiencing heart palpitations, says emergency medicine physician Jon Garlovsky, DO.
“It’s important to tell emergency medical staff when the palpitations started, what they felt like, how long they lasted and if they are still occurring,” Garlovsky says. While heart palpitations can be caused by arrhythmia, they can also be related to thyroid disease, pregnancy, low blood pressure, anemia and anxiety disorder, among other conditions.
Technology and treatment
The AHA says implantable cardioverter defibrillators (ICDs) are useful in preventing sudden death in patients with known sustained ventricular tachycardia or fibrillation.
“Studies have shown ICDs to have a role in preventing cardiac arrest in high-risk patients who haven’t had, but are at risk for, life-threatening ventricular arrhythmias,” the AHA says. Newer-generation ICDs can also serve as a pacemaker to stimulate the heart to beat if the heart rate is too slow.
Pacemakers and defibrillators are considerably smaller and safer than they used to be, Henry says. “As an example, a leadless pacemaker is currently available that is about the size of a large pill. It gets implanted directly into the heart via blood vessels from the groin.”
Hildestad underwent a cardiac ablation, which scars the small areas of heart tissue that trigger or sustain an abnormal heart rhythm, returning it to normal.
In spring 2019, he returned to his attack position with the Illinois Wesleyan Titans lacrosse team without worry of a flare-up, fainting or vomiting.
“Charlie is cured and no longer needs to see me or any other cardiologist,” Metzl says. “We are able to treat over 90% of patients with SVT with successful ablation.”
Ablation can be used for AFib too, with success rates of 70% to 80%, Metzl says. “We don’t really like to say the word ‘cured’ for patients with AFib because the long-term success rates from ablation are not yet greater than 90%,” he says.
Hildestad, a business administration major and computer science minor at Illinois Wesleyan, says he felt “relief and happiness” after finding a cure for his particular arrhythmia.
“I no longer had to worry when I laced my cleats up,” says Hildestad, who was happy to return to sports. “I had finally found an answer to my issue.”