Winter 2005
Multi-Tasking the Heart

What do you do when your heart beats too fast, too slow, and not in sync? When you've had two heart attacks, and you've developed congestive heart failure? You go to the Electrophysiology Lab at Bridgeport Hospital to find out what's going on!

"I'm the only male left among my siblings," says Paul Augustine. The family history of heart disease has claimed four brothers and also affects a sister. And it's almost claimed him—four times. He's grateful that recent advances in cardiac technology have kept him going strong.

Back in 1975, Paul was only 40 when, after a softball game, he felt "a little heaviness in my left arm." He would have ignored it. It was his wife, Marlyn, who made him go to Bridgeport Hospital, where he learned he'd just had a heart attack.

Prompt treatment, plus cardiac rehabilitation, saved his heart and his life.

Ten years later, after a second heart attack, Paul came to Bridgeport Hospital, where expert cardiothoracic surgeons bypassed four blocked arteries so blood could flow to his heart muscle. Once again, his life was saved.

In 1999, Paul suffered fainting spells, breathlessness, and weakness in the legs. "These are among the symptoms of congestive heart failure, or CHF," says Paul's cardiologist, Ahmed Jamshidi, MD, who has been protecting and watching over Paul's heart for more than thirty years now. "Congestive heart failure, a common outcome of heart disease, is when the heart is too weak to pump enough blood to the body's organs."

Dr. Jamshidi was very concerned that the CHF would lead to a life-threatening arrhythmia, so he asked Craig McPherson, MD, director of Cardiac Electrophysiology at Bridgeport Hospital, to evaluate the electrical function of Paul's heart.

In the Electrophysiology Lab, Dr. McPherson found that Paul's heart had no hidden, life-threatening rhythm tendencies. However, it was prone to heart block—an abnormally slow heartbeat—so Paul needed a pacemaker. (See "What's in a Word?")

For several years after his pacemaker was implanted, Paul felt pretty good again. Then in 2003 the old weakness and breathlessness came back. "I'd walk up seven or eight steps and have to rest," Paul says. "I couldn't walk even 50 feet without stopping to catch my breath." And now, his heart was in such poor shape, Dr. Jamshidi told him he had two choices:

  1. a heart transplant, or
  2. replacement of his pacemaker with a new kind of device: a biventricular implantable cardioverter defibrillator, or ICD. (See "What's in a Word?")

Hoping to avoid a transplant, Paul came again to Bridgeport Hospital's Electrophysiology Lab to undergo more testing of his heart's electrical system. These sophisticated tests demonstrated two problems:

  • First, in the time since his previous tests, his heart had developed a tendency to go into ventricular tachycardia (a rapid, potentially fatal cardiac rhythm in the ventricles—the lower chambers of the heart). His pacemaker was not designed to protect him from such a calamity.
  • Second, the right and left ventricles were out of sync—not working together to pump blood out of the heart. The fact that his pacemaker could be connected only to the right ventricle was actually interfering with the spread of electricity through the two pumping chambers.

The news was good: no transplant! Dr. McPherson agreed with Dr. Jamshidi that a biventricular ICD would solve both problems. "This multi-tasking device does more than prevent a slow heartbeat," he explains. "When the fast heartbeat occurs the ICD can also shock the heart back to a normal rhythm. It also can be connected to a wire that leads to the left ventricle. This meant the new device could synchronize the contraction of the two ventricles for a more effective heartbeat. In fact," adds Dr. McPherson, "this new type of biventricular (right and left ventricle) pacing is referred to as ‘resynchronization therapy.'"

The morning after his biventricular ICD was implanted, Paul went home breathing easier. Within weeks, he was feeling stronger and healthier than he had in years.

"The difference between the old pacemaker and the new bivent," he says, referring to his new device as if it were an old friend, "is like night and day. I can go up a flight of stairs without thinking about it. I can walk half a mile at a time. I can do many of the things I had cautiously stayed away from before, like climbing hills and working in the yard."

What advice does Paul Augustine have for others who find themselves feeling faint, weak, and breathless? Take it seriously, and go straight to the experts. "When it comes to your heart" — he shakes a finger — "don't fool around!"