Winter 2005
The Best Present Ever!

If you have heart disease, you may be on medications and a special diet or exercise program to keep your condition under control. But there's another tool your cardiologist can use to make sure your heart stays healthy: measuring your ejection fraction. Why is this important? Robert Zawadski's story makes it clear.

On Christmas Day 2004, as he and his family were enjoying their holiday meal, 67–year-old Robert Zawadski took a punch to the chest that turned out to be his best Christmas present ever. It was his implantable cardioverter-defibrillator (ICD) firing off a jolt of electricity, because his heart was racing nearly 300 beats per minute.

If it hadn't fired, he would probably have died there at the dinner table. And he hadn't even realized anything was going wrong!

Why did Robert have an ICD? Because after open-heart surgery in the ‘90s, an echocardiogram showed his cardiologist, Zosimo Adefuin, MD, that Robert had a low ejection fraction.

What on Earth is an Ejection Fraction?

It's not as complicated as it sounds. Here's how it works: The two upper chambers of the heart (the atria) receive blood coming in from the body. The two lower chambers (ventricles) pump blood out of the heart. The right ventricle pumps the blood through the lungs for a fresh load of oxygen, then on to the left ventricle. The left ventricle pumps the blood back out to the body: It ejects the blood from the heart.

At least, it ejects most of the blood. There is always some blood left, waiting to go out in the next beat. What's important to know is how much of the blood is successfully ejected each time.

"A healthy heart pumps out at least 55% of the blood with each beat," explains Dr. Adefuin. "If your left ventricle ejection fraction (LVEF) starts falling below 55%, your heart is not pumping effectively."

In 1999, in the wake of his heart attack and surgery, Robert's LVEF measured about 20%. That's why Dr. Adefuin sent Robert to the Electrophysiology Lab at Bridgeport Hospital for high-tech testing of the electrical circuits of his heart. The results showed that Robert's heart had a tendency toward periods of rapid, potentially dangerous rhythms. So the ICD was implanted to protect him, just in case his heart rhythm ever acted up. And for years, Robert's heart behaved properly.

Then came that shocking Christmas present!

Robert knew immediately what had happened. A few minutes after the ICD discharge, he felt fine, so he finished his dinner and enjoyed Christmas with his family. A few days later, he went to Bridgeport Hospital's Pacemaker-Defibrillator Clinic for a checkup.

"We can communicate with the computer in his ICD, using the computer in our defibrillator programmer," explains Meredith Heyde, APRN, a nurse practitioner with specialized training in evaluating pacemaker and defibrillator devices. His ICD, which keeps a log of all events, had recorded not only this firing, but also another one two weeks earlier, while Robert was asleep, which didn't even wake him up. The defibrillator that had been lying quietly in his upper chest for five years had twice been his Christmas angel.

What can those with heart disease take away from Robert Zawadski's story? Understand the importance of ejection fractions, and ask your cardiologist how your LVEF stacks up and whether an ICD would be helpful in protecting your heart. It can be the difference between life and death.