Winter 2011
Restoring Ronnie's Rhythm
Restoring Ronnie’s Rhythm

Ronnie Steeves never suspected his breathlessness was related to a heart condition.

As maintenance supervisor at a hydroelectric plant in Monroe, Ronnie Steeves was used to working long days outdoors in all kinds of weather, moving scaffolding and equipment and being on the go. He hadn’t taken a sick day for nearly 12 years. Slowing down wasn’t part of his personality.

So in 2008, at the age of 47, when his energy level suddenly dipped, he noticed—but chose to ignore it. “At first, I didn’t pay much attention to it,” remembers Ronnie, who commutes to work from Orange, where he lives with his wife and teenage children. “I thought I was run down or tired from working too much.” Weeks passed and he tried to get more sleep, but the fatigue didn’t let up. “I tried to shake it off,” he says. “I thought maybe I was out of shape or it was just part of getting older.”

His wife, Lorri, sensed something wasn’t right about her husband’s health. “My wife was on me all the time to see my doctor,” Ronnie says. “I was stubborn about it for a long time. I usually go about once a year anyway, and I had checked out just fine at the last one, so I wasn’t concerned about ‘feeling tired.’” But when Ronnie couldn’t even take a few steps without feeling winded, he knew it was time to see the doctor.

Primary care physician Paris Spanolios, MD, tested Ronnie’s heartbeat in the office. The painless electrocardiogram took just a few minutes. (An electrocardiogram— ECG or EKG—measures the patterns or rhythms of the heart. A doctor can interpret the patterns to diagnose various heart conditions.)

The electrocardiogram results indicated a serious problem with Ronnie’s heart: he had atrial fibrillation (AF) which had triggered congestive heart failure (CHF). (See below: Shortness of Breath, Fatigue and CHF.)

What’s Atrial Fibrillation (AF)?
Affecting millions of adults in the United States, AF is a serious heart condition, resulting in an irregular heartbeat.

Shortness of Breath, Fatigue and CHF

Feeling winded and tired? It could be congestive heart failure (CHF). The first clue for many people with CHF is shortness of breath. This breathlessness is because fluid has backed up into the lungs. Other symptoms include swollen ankles and rapid weight gain (water retention), dizziness and fatigue.

Heart failure is due to either a weak heart muscle that’s not pumping correctly or, as in Ronnie’s case, the heart’s inability to fill its pumping chambers with blood. CHF is caused by a wide variety of heart problems, such as a heart attack, high blood pressure or a heart valve problem.

“If you find yourself out of breath, or if you’re at all worried about your breathing patterns, you should talk to your primary care physician as soon as possible to get checked out,” says cardiologist Edward Tuohy, MD. “If it’s your heart, the sooner the better, so we can get a jump on getting it fixed. Don’t wait.”

Abnormal electrical signals in the heart’s upper collecting chambers cause the heart to quiver and shake, and may affect its ability to pump blood. “Blood pools in the upper chambers of the heart, due to inefficient contractions, and blood clots can form,” says Chief of Cardiology Stuart Zarich, MD. “These clots can travel from the heart to the brain and cause a stroke.” Symptoms of AF often come and go and include dizziness, shortness of breath and palpitations (an unpleasant awareness of the heart beating). Many people with AF also feel very tired. “Additionally, many patients with AF have no symptoms at all,” says Dr. Zarich. “It’s important, therefore, to learn to take your pulse to see if you have an irregular heartbeat or if you are at risk for AF.” (See: Could You Develop AF?)

Treatment
“When my doctor told me I had atrial fibrillation, I got really nervous,” Ronnie admits. “I never thought I’d have a heart problem. Dr. Spanolios answered my questions about what to do next. And when I got home, I also called my sister Eileen, who’s a nurse, to find out more.”

Dr. Spanolios referred Ronnie to cardiologist Edward Tuohy, MD, and cardiac electrophysiologist Murali Chiravuri, MD. They prescribed a combination of treatments to steady the beat of Ronnie’s heart. “Steadying or restoring the heart’s normal rhythm is called cardioversion,” says Dr. Tuohy. “In general, there are two ways to do this: through medication or via a quick electric shock to jolt the heart back into regular rhythm. With most patients, we try medication first, but it depends on the severity of their condition when they are diagnosed.” The electrical cardioversion is done in the Connecticut Cardiac Arrhythmia Center in the Heart Institute at Bridgeport Hospital with the patient under anesthesia (sedation). A cardiologist, nurse and anesthesiologist are at the patient’s side to monitor his or her breathing, blood pressure and heart rhythm during the procedure. “When both treatments are used together, the medications can usually maintain the rhythm the electric cardioversion re-establishes,” he says.

When choosing a cardiologist or cardiothoracic surgeon, be sure to select an expert physician affiliated with Bridgeport Hospital:

Cardiologists
S.M. Yousuf Ali, MD
Doron Amir, MD
Linda Casale, MD
Murali Chiravuri, MD
Mitchell Driesman, MD
Anthony D’Souza, MD
Robert Fishman, MD
Leonid Karpenos, MD
Steven Kunkes, MD
Gilead Lancaster, MD
Michael Logue, MD
Adolfo Luciano, MD
Stephen Marshalko, MD
Craig McPherson, MD
Jay Meizlish, MD
Robert Moskowitz, MD
Randolph Panetta, MD
Edward Pinto, MD
Martin Plavec, MD
Adam Schussheim, MD
Boris Sheynberg, MD
Richard Taikowski, MD
Joseph Tiano, MD
Edward Tuohy, MD
Robert Winslow, MD
Stephen Woodworth, MD
Stuart Zarich, MD
Cardiothoracic Surgeons
Umer Darr, MD
Michael Dewar, MD
M. Clive Robinson, MD
Richard Salzano, MD
Pediatric Cardiologists
Kieve Berkwits, MD
Christa Miliaresis, MD

If you would like more information about, or a referral to, any of these expert physicians, please visit www.bridgeporthospital.org/FindPhysician or call 1-800-794-5013, toll free, 24/7.

The doctors recommended a combination of treatments to regulate Ronnie’s heart rhythm. “For about a year, I was taking three medications daily,” he remembers. “I also had the electrical cardioversion at Bridgeport Hospital three or four times. My heart would hold up for a while, but then it would go back in to AF.”

“The cardioversions would temporarily regulate Ronnie’s heartbeat, but neither electrical nor medical treatment would sustain it for more than a few weeks,” says Dr. Tuohy.

Bridgeport Hospital is the only hospital in the area that provides radiofrequency ablation for cardiac arrhythmias.

To improve Ronnie’s quality of life, his team of cardiac specialists explained a third option: radiofrequency ablation, or RFA.

Radiofrequency Ablation (RFA)
“This minimally invasive procedure is a very effective way to restore a heart’s rhythm,” says Dr. Chiravuri. “If we’ve tried the other methods first and they were not successful, RFA is a viable option.”

During RFA, which is also known as electrophysiology (EPS) ablation, thin flexible tubes (catheters) are threaded into a blood vessel that reaches the heart. A burst of highfrequency electrical energy is delivered to block or redirect the areas of the heart impulse that are causing the irregular heartbeat or rhythm.

On an early Monday morning in May, accompanied by his wife and sisters, Ronnie went to the Heart Institute at Bridgeport Hospital for the RFA procedure.

“I was under anesthesia, so I was sort of out of it, but Dr. Chiravuri and the nursing staff were great. They treated us well, answered our questions and made sure we were comfortable,” says Ronnie. After just one night in the hospital, he was ready to go home. “I noticed a difference right away,” he says. “That morning, the nurses asked me to walk, to prove I was really better,” he says.


Thanks to the experts in the Heart Institute at Bridgeport Hospital, Ronnie Steeves’ heart is back in rhythm.

He was back at work in less than a week. “It was tough to take those few days off to recover—remember, I had perfect attendance—but I knew I had to take it easy,” he says. “Doctor’s orders!”

Back on the Job
Today, Ronnie is grateful to his doctors for fixing his heart. He also thanks his wife for pushing him to get checked.

“When I was first diagnosed, it was difficult to think about my future. I didn’t know what was going on with my heart, and I couldn’t imagine my life changing,” he says. “I am so thankful to my doctors. And, I feel great. I can golf again and walk up stairs without feeling winded. Best of all, I’m back at work!”

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A Fourth Option for Atrial Fibrillation (AF): MiniMaze

Bridgeport Hospital Chief of Cardiothoracic Surgery M. Clive Robinson, MD, is one of only a handful of surgeons in the country who performs an innovative minimally invasive heart procedure called MiniMaze. His experience includes being a preceptor, teaching other surgeons how the MiniMaze can correct atrial fibrillation.

The procedure requires a team of specialists—Dr. Robinson, an electrophysiologist, anesthesiologists, nurses and physician assistants. In the operating room, Dr. Robinson makes several small cuts between a patient’s ribs and inserts a tiny camera to magnify his view of the heart. The electrophysiologist then maps the electrical impulse in the heart to pinpoint the areas where the currents are not flowing properly. Using a specially designed clamp that sends out a radiofrequency current, Dr. Robinson creates lines of scarring (ablations) to block the irregular impulses. As part of the operation, Dr. Robinson also closes off the atrial appendage, a small sac-like structure on the outside of the heart, in which blood collects, so no pooled blood can clot, travel to the brain and cause a stroke.

Could You Develop AF?

According to the American Heart Association, 2.2 million Americans suffer from atrial fibrillation (AF), one of the leading causes of stroke.

Causes include:

  • Age, especially those over age 65
  • High blood pressure
  • Heart disease, including heart attack, valve problems and previous heart surgery
  • Diabetes
  • Alcohol
  • Obesity
If you’re concerned about your risk, speak with your doctor. For an expert physician affiliated with Bridgeport Hospital, please call 1-800-794-5013.