What is Electrophysiology?

26 October 2021

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What is Electrophysiology and Its Relation to Heart Health?

Blue Figure with Arms Outstretched and Bright Red Heart - CVRTI Electrophysiology Graphic

We all know the feeling of our heart racing or fluttering as we get excited, nervous, or stressed. But what is going on in the heart to get a heart rhythm? The heart contracts and expands to pump blood through the body using an electrical stimulus that starts in the heart’s sinoatrial node. That electrical stimulus travels through the four chambers of the heart to give the heart the ability to pump blood. Electrophysiology is the study of the electrical patterns in the heart. Electrophysiologists are doctors who specialize in the heart’s electrical patterns and most commonly treat patients with heart arrhythmias.

An Overview of Electrophysiological Research, Heart Arrhythmias, and Atrial Fibrillation

Arrhythmias are any problems with the heartbeat. Arrhythmias can feel like the heart fluttered, skipped a beat, suddenly started racing, or is beating very slow. These sensations can normally occur when experiencing different emotions. But most commonly for arrhythmia patients, this occurs because of a disruption in the heart’s electrical pathway.

When the electrical stimulus in the heart does not follow the correct electrical pathway through the heart, the heart contracts and expands either too rapidly or slowly, causing blood to flow improperly or back into the heart. The disruption in the electrical stimulus’s pathway is the cause of the arrhythmia. What can happen over time with repeated arrhythmias is that the heart cannot pump as effectively, resulting in less blood flow throughout the body. Electrophysiologists are concerned with arrhythmias when they happen unexpectedly and frequently. Not all arrhythmias are a concern, and some can be considered harmless. The earlier the diagnosis of arrhythmia, the better the outcomes for the patient. Arrhythmias can damage or weaken the heart and the heart’s ability to pump blood. Treatment options for arrhythmias can help control the occurrence of the arrhythmia or prevent damage to the heart.

Electrophysiology and Atrial Fibrillation

Specifically, electrophysiologists are concerned with patients who experience atrial fibrillation. Atrial fibrillation (also known as AFib) is an arrhythmia where the chambers of the heart begin to rapidly beat and look like they are quivering. Blood can get unexpectedly pushed into the atria of the heart. The trapped blood can lead to blood clots or strokes. Atrial fibrillation is a severe worldwide disorder and is expected to affect around 40 million people. Early diagnosis of is vital to ensure successful outcomes.

What is an Electrophysiology Study of the Heart?

Electrophysiologists conduct an electrophysiology study on patients to diagnose arrhythmias and atrial fibrillation. As part of the diagnosis, electrophysiologists will pinpoint where the electrical pattern is getting disrupted in the heart. From the study results, the electrophysiologist will be able to determine if medications, ablation therapy, or routine monitoring are needed to treat the patient. Even with electrophysiology studies, arrhythmias can be difficult to diagnose. Patients undergoing an electrophysiology study are often not experiencing constant arrhythmias. However, early diagnosis and treatment of arrhythmias are essential to ensure no further damage to the heart.

CVRTI’s Research in Electrophysiology & Abnormal Heart Rhythms

At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), researchers are committed to learning how to better understand the heart’s electrical patterns. There has been a long-standing focus on cardiac rhythm and its disorders since the foundation of the institute. The CVRTI is exploring new technologies to better diagnose and help patients who suffer from arrhythmias and other heart rhythm disorders. CVRTI researchers have changed the landscape of electrophysiology by understanding how cardiac bioelectricity creates the electrocardiographic signal, both in health and disease and deciphering how ion channels and transporters create the heartbeat and become altered. CVRTI researchers are dedicated to the study of the genomic basis of inherited arrhythmia syndromes and studying how risk factors, such as obesity , affect arrhythmia incidence and mortality. Finally, the structural basis of atrial fibrillation , the most common rhythm disorders, is being elucidated by pioneering imaging studies . In all, the CVRTI continues to lead the way in electrophysiological reasearch and understanding how rhythm disorders develop and creating tools to study and treat these in patients.

CVRTI researchers are also learning the ion channels that generate electrical signals in the heart have other roles as well. Ion channels can regulate mitochondria , which is the power center of each muscle cell, as well as cell organization . Also, the proteins that organize ion channels can be used to rescue failing heart muscle as well as help clinicians quantify the extent of heart muscle failure . The more we learn about ion channel, the better our understanding that these basic building blocks are not just important for the heart’s electrical system, but for heart function as well.

What is Cardiac Arrhythmia?

16 September 2021

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What is Cardiac Arrhythmia?

Heart with Blue EKG Lines Behind - CVRTI Cardiac Arrhythmia Blog Image

The heart’s primary function is to pump blood throughout the body. This is done by an electrical connection that originates from the sinoatrial node (SA node). The electrical impulse begins at the SA node travels throughout the heart. The electrical impulse travels along a pathway through the heart to create the heart’s movement. The movement or pumping is what allows the blood to flow in and out of the heart in the appropriate direction. A disturbance in that electrical pathway can impact the heart’s ability to pump blood or heart rate. Changes to the heart’s electrical impulses result in irregular heartbeat / heart rhythm or cardiac arrhythmias.

Types of Cardiac Arrhythmia

Cardiac arrhythmias are any type of irregularity in heart rhythm which results in a change in heart rate. Arrhythmias are classified by the impact they have on heart rate and where the heart they originate:

Tachycardia

A cardiac arrhythmia that creates a faster than usual heart rate.

Bradycardia

Arrhythmias create slower than resting heart rates.

Are Arrhythmias a Symptom of Heart Failure?

Arrhythmias can also impact heart rate as a flutter in heart rate or premature heartbeat. Patients describe these arrhythmias like the heart skipped a beat. Tachycardia and bradycardia arrhythmias are not necessarily a sign of heart disease or heart failure because daily activity such as exercise, stress, meditation, and sleep can cause heart rates to go above or below resting.

Physician’s Evaluation of Arrhythmias

When physicians suspect a patient is having abnormal cardiac arrhythmias, they will evaluate first whether those are tachycardia or bradycardia arrhythmias. Once that is established, then physicians will evaluate where in the heart the arrhythmia is originating. The heart is split into four chambers, with two ventricles and two atria. Tachycardia arrhythmias can originate in the ventricles or the atria. Bradycardia arrhythmias typically occur at the nodes of the heart.

Common Symptoms Patients Experience

Fast heart rates are not always a sign of concern because it is normal to feel like your heart is beating rapidly during intense exercise or to feel your heart rate go down while preparing for bed. Patients who may have more arrhythmias might feel fluttering in their chest, chest pain, or unexplained shortness of breath. Outside of chest concerns, arrhythmia patients may have heightened anxiety, unexplained fatigue, fainting or feelings of fainting, lightheadedness, or unexplained sweating.

During regular routine examinations, physicians may diagnose a heart arrhythmia without the patient feeling any physical symptoms. Because arrhythmias can happen at any time, physicians may ask patients to wear a heart monitor like a Holter monitor for a few days. Some physicians may order tests like an electrocardiogram, tilt-table test, cardiac MRI to evaluate the patient’s heart health.

When Patients Should Seek Treatment

Some cardiac arrhythmias may resolve themselves on their own or may pass quickly. However, patients at risk for arrhythmia or who are experiencing arrhythmias should seek medical attention immediately. So arrhythmias, like ventricular fibrillation arrhythmia, can be deadly. In ventricular fibrillation arrhythmia, the heart will quiver making it ineffective in pumping blood, resulting in blood not getting distributed throughout the body, and vital organs will get damaged quickly without blood. Complications from arrhythmias can include cardiac arrest, stroke, or heart failure.

Common Causes of Arrhythmia

Anything that causes a disruption in the heart’s electrical pathway can result in cardiac arrhythmia. Research indicates that patients with substance abuse disorders, high caffeine usage, alcohol abuse, heart-related conditions (heart disease, heart attack, high blood pressure, electrolyte imbalance), diabetes, history of smoking, obesity, or high stress are at risk for cardiac arrhythmias. Patients at risk for arrhythmia should follow recommendations for good heart health.

Cardiac Arrhythmia Prevention

Any activity that is designed to maintain heart health is an excellent activity to prevent cardiac arrhythmias. Patients should have a diet with healthy fats and lean protein. Cardiac arrhythmia is often not seen in physically fit adults with normal heart function but can be present in structurally normal hearts. To prevent arrhythmia, patients should limit substances such as cigarettes, alcohol, caffeine, and drugs. Stress is a significant risk factor for cardiac arrhythmias, so stress and anger management is critical lifestyle to prevent arrhythmias.

Cardiovascular Research and Training Institute

Researchers at the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI) are studying what can impact the heart’s electrical patterns and how to best diagnose, maintain, and treat cardiac arrhythmias. The CVRTI is committed to better understanding how to maintain a healthy heart and improve heart health outcomes. Investigators are studying the mechanisms underlying atrial fibrillation and ablation techniques with the goal of improving ablation outcomes . They are also studying techniques to terminate left threatening arrhythmias without the need for shocking the heart. The genetic basis for some of these arrhythmias is also being investigated. Research at CVRTI will change the standard of care & treatment for cardiac arrhythmia patients.

Contact CVRTI for heart matters and to learn more about ongoing research for cardiac arrhythmia.

What is Sudden Cardiac Death?

26 August 2021

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Sudden Cardiac Death Causes, Symptoms and Treatments (SCD)

Blue Heart Image Representing Sudden Cardiac Death

Sudden cardiac death (SCD) is a heart arrhythmia condition when the heart abruptly stops functioning, leading to a halting of breathing and consciousness, resulting in death. SCD is one of the most significant causes of natural deaths globally. Annually, just over 300,000 US adult deaths are a result of sudden cardiac death. Roughly half of all cardiovascular disease deaths are from SCD.

SCD is caused by a sudden cardiac arrest. Sudden cardiac arrest is the result of abnormal function of the heart’s electrical system, causing the heart to suddenly beat too fast or without synchrony, impairing the heart’s ability to sufficiently pump blood. Thus, sudden altered electrical activity in the heart results in a lack of blood flow throughout the body, causing brain and other organ damage, and can result in death.

SCD is difficult to diagnose and prevent because it is hard to predict when a patient will experience arrhythmia. Further, many patients are unaware they are at risk for sudden cardiac arrest because there may not have clear symptoms of an underlying disease or cardiomyopathy.

Treatment for Sudden Cardiac Arrest

The few moments immediately after the onset of sudden cardiac arrest are the most crucial because without treatment, the risk of survival decreases. Without treatment in the first few minutes of sudden cardiac arrest, blood will not reach the brain and ultimately be followed by sudden death. During a sudden cardiac arrest, patients will need cardiopulmonary resuscitation (CPR) and defibrillation treatment to help keep blood flowing through the body. Once hospitalized, core temperature of patients is decreased (therapeutic hypothermia) to reduce the risk of brain injury and medications to control the arrhythmia. Survivors of sudden cardiac arrest may receive an implantable cardioverter-defibrillator (ICD) (see Preventing Sudden Cardiac Death below).

Common Causes of Sudden Cardiac Arrest

SCD is caused by arrhythmias in the heart. Cardiac Arrhythmias are abnormal heart rhythms. The most common arrhythmia associated with Sudden Cardiac Death is ventricular fibrillation. These cardiac arrhythmias are rapid-firing impulses from the lower chambers of the heart (ventricles). Because of the rapid irregular beating of the ventricles, blood is unable to flow out of the heart. Sudden cardiac arrest presents differently in patients because there are many different causes.

Patients who have previously experienced a heart attack or have coronary artery disease are at high risk for a sudden cardiac arrest. Also, a subset of otherwise healthy individuals has a genetic defect that leads to Sudden Cardiac Death, so people with a family history of SCD may be at high risk.

Symptoms of Sudden Cardiac Arrest

There are no clear symptoms that indicate if a patient is at risk for sudden cardiac arrest. However, individuals with coronary artery disease or heart attack victims should stay educated on sudden cardiac arrest so they can notice any potential changes to their heart rhythm and discuss treatment options with their doctors.

Prior to a sudden cardiac arrest episode, patients may have discomfort in their chest, body weakness, shorter breathing patterns, and palpitations. During a sudden cardiac arrest, patients might feel like their heart is racing or feel dizzy, but the majority of patients do not have any prior symptoms. Signs that a person might be experiencing sudden cardiac arrest are immediately and unexpectedly collapsing, fainting or no pulse, not breathing, and loss of consciousness.

Prevention Sudden Cardiac Death

If a patient is in sudden cardiac arrest, the use of CPR and a defibrillator are the best options to restore the heart’s electrical pattern.

The best sudden cardiac arrest prevention option is for patients at high risk (post-heart attack, known coronary artery disease, known inherited arrhythmia disorders) to discuss potential treatment strategies with their cardiologists. For very high-risk SCD patients, an implantable cardioverter-defibrillator (ICD) is an option. ICD is a small implantable device that is designed to correct irregular heart rhythm by detecting and correcting fast heart rates through the delivery of a powerful electric shock. Additionally, some anti-arrhythmic medications have success in reducing sudden cardiac death.

Cardiovascular Research and Training Institute Sudden Cardiac Arrest Death & Heart Disease (Cardiomyopathy) Research Performed at CVRTI

At the Cardiovascular Research & Training Institute (CVRTI), researchers are interested in understanding the genetic basis for sudden cardiac death disorders and the fundamental mechanisms that trigger the initiation of abnormal heart rhythms in order to prevent Sudden Cardiac Death.

Using Utah’s one-of-its-kind genealogical resource linked to medical records, the Utah Population Database (UPDB), CVRTI investigators are discovering new genes that predispose to Sudden Cardiac Death. By taking a sample of blood, CVRTI investigators can create patient-specific stem cells that can be coaxed into beating heart cells in a dish, so-called induced pluripotent stem cell-derived cardiomyocytes. CVRTI investigators are at the forefront of these new technologies, leveraging them to better understand who is at risk for a Sudden Death disorder, how the abnormal heart rhythms start and how to design new therapies for sudden cardiac arrest.

Continued Research As It Relates to The Heart and Other Organs

Further along the translational spectrum, other CVRTI investigators are exploring how to limit brain and other organ damage once blood flow is stopped. New molecules discovered at the CVRTI have shown promise in reducing the damage to cells from low blood flow (ischemia). Just like therapeutic hypothermia, these agents could be used to reduce catastrophic organ loss once low blood flow has been identified and corrected.

What is Congestive Heart Failure and How is it Treated?

30 June 2021

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What is Congestive Heart Failure and How is it Treated?

Body Skeleton with Red Heart Inside - Heart Failure Symptoms Graphic

Heart failure, also known as congestive heart failure (CHF), is a disease state that covers any reason why the heart is not pumping blood efficiently. Chronic heart failure is a chronic condition that gets worse with time. The heart pumps blood throughout the body to meet the body’s demand for blood and oxygen. During heart failure, the heart cannot pump as much blood throughout the body and tries to compensate for less blood by beating faster, enlarging, and withholding blood from less vital organs. When the body’s cells don’t receive enough blood, everyday activities can suddenly become very challenging and can result in extreme fatigue, shortness of breath, or coughing.

Common Causes of Congestive Heart Failure

Heart failure usually results from other conditions that weaken the heart muscle. Some of the more prevalent conditions causing heart failure include coronary artery disease (atherosclerosis), high blood pressure, and previous heart attacks. Other causes include faulty heart valves, cardiomyopathy (damage to the heart muscle), myocarditis (inflammation of the heart muscle), heart defects at birth, abnormal heart rhythms, and even other chronic diseases such as HIV, diabetes, or thyroid disorders. Lifestyle plays a big role in the risk of heart failure as well. Obesity, alcohol use, tobacco, and certain medications increase the risk of heart failure

Heart Failure Symptoms

Symptoms of Congestive Heart Failure Ranging from Mild to Severe

Heart failure symptoms present as a function of the heart disease severity, ranging from mild to severe cases. Mild symptoms of heart failure include dry, hacking coughs, worsening shortness of breath with activity, increased swelling of legs, feet, and ankles, sudden weight gain, discomfort or swelling in the abdomen, and a hard time falling asleep. Severe symptoms are escalated versions of these symptoms with the addition of possible dizziness, confusion, sadness or depression, loss of appetite, and an inability to lie flat

Measuring Congestive Heart Failure

A quantitative measure of heart muscle failure is the ejection fraction, the amount of blood pumped out of the left ventricle as a fraction of the amount of blood in the left ventricle. It measures how efficient the ventricle is at emptying itself and deploying blood to the rest of the body. Borderline ejection fractions have a value of 41-49%, where symptoms are noticeable during activity. Reduced ejection fractions are less than 40%, where symptoms may be noticeable during rest. Tracking symptoms are very important to managing and improving the quality of life and the ejection fraction associated with congestive heart failure. Shortness of breath, heart rate, daily weight, swelling, blood pressure, and impaired thinking are all important symptoms to track when managing heart When managing heart muscle failure.

Preventing Heart Failure

Prevent Congestive Heart Failure and Heart Disease Through a Balanced Diet

Good lifestyle choices can prevent the onset of heart failure or help mitigate the symptoms for patients with chronic heart failure. Alcohol and tobacco use is a significant risk factor that results in arterial damage. Limiting this, including even secondhand smoke, goes a long way in avoiding congestive heart failure. Prototypical heart-healthy foods and a balanced diet can supplement the limiting of vices. Some of these foods include lean protein (chicken and fish), fruits and vegetables, foods low in saturated fat, trans fat, sugar, and sodium, and good fats like olive oil, fish, and avocados.

Learn to manage your lifestyle to prevent heart failure

Managing and monitoring your weight through a good diet and regular exercise is critical for maintaining good heart health. Finally, in instances where individuals have conditions that weaken the heart, it is important that they adhere to their existing treatment program. Treating underlying risk factors such as high cholesterol and blood pressure has been shown to prevent heart problems such as attacks and coronary artery disease – two of the primary drivers of heart failure.

Congestive Heart Failure Treatment

Heart Failure Treatment for Heart Disease Patients Is Usually a Combination of Lifestyle Choice Changes and Prescribed Medication

Treatment for heart failure is usually a combination of lifestyle choice changes and a doctor’s prescribed medication. Medications are prescribed to a patient based on the type of heart muscle failure and severity. Common medications include

Types of Treatment for Congestive Heart Failure

Angiotensin-converting enzyme (ACE) inhibitors, Beta-blockers: (beta-blockers and ACE inhibitors are usually taken together to protect the heart and slow chronic heart failure progression), diuretics, and Mineralocorticoid/aldosterone receptor antagonists (MRAs) (diuretics and MRAs help with fluid retention). Individuals with heart failure find themselves on a variety of drugs to ensure that the heart muscle failure doesn’t worsen and prevent normal daily functioning

Cardiovascular Research & Training Institute

At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), researchers are interested in how cardiac muscle biology relates to the mechanistic basis of heart failure(HF). The CVRTI is committed to focusing on learning what drives heart muscle failure and how best to treat it. Researchers are working on changing the standard of care for HF patients through drug therapy, gene therapy and therapeutic devices. Specifically, CVRTI investigators are trying to understand how the failing heart can recover in order to improve outcomes for HF patients. Our investigators are focused on identifying cellular and molecular targets to develop new therapeutic tools for myocardial recovery. They also evaluate myocardial ultrastructure, microstructure, and function in normal, diseased, and aged hearts. Preserving and optimizing the cellular cytoskeleton and the mitochondrial function in the failing heart are major research interests of our investigators. With these research programs in place, the CVRTI is committed to improve how acute and chronic heart failure patients are diagnosed and treated.