By Judah Berman
This past summer I had the opportunity and privilege to shadow an interventional cardiologist. During my month following the doctor, I saw many routine cases. Some cases include tachycardias (fast heart beat), nose bleeds, and thickening heart valves (which open and close to pump blood in and out of the heart). These conditions required anything from simple medication to complete replacement. One patient even had an arrhythmia that we fixed by depolarizing the heart for one beat (remember, the heart is an electric machine, so you can reboot it by stopping it for a split second). However, in my last week we witnessed an incredible case that was easily fixable, yet extremely rare.
A young male walked into the clinic after a scare the previous night. During a vigorous and intense game of basketball, his heart rate spiked to high rates, something normal when engaged in such strenuous activity. However, after he had slowed down to stop playing, and even fully calmed down, his heart continued to beat at an abnormally high rate. He reported to us that his heart was still beating fast when he got home, where they called an ambulance which was able to administer a medication that helped bring down his heart rate. The medical report said that his heart had been beating at nearly 180 beats per minute (bpm) for 45 minutes. This was quite the interesting case, and the doctor I shadowed was eager to show me this one. He took one look at the EKG (Electrocardiogram) chart which maps out a single heartbeat, grinned, and explained to me that by looking at the specific distances between points in the EKG, he could tell it was Wolff-Parkinson-White Disease (WPW).
The heart has three nerves, two on the left side and one on the right. These nerves respond to signaling levels in the blood and tell the heart to speed up or slow down. When one runs, the adrenaline level in the blood increases and this tells the heart to beat faster. Someone with WPW Disease is born with a fourth nerve. When the heart reaches a certain high point of beats-per-minute, the fourth nerve begins to act as a closed circuit. On a micro level, this means that the beat of the heart triggers the fourth nerve, which in turn tells the heart to beat again, and the cycle repeats. On a macro level, this means the heart is stuck in a very fast loop until the individual receives medication or some other intervention. This explains the young man’s extremely prolonged tachycardia. As I said earlier, there is an easy fix.
Medicine today tends to stray away from open heart surgery as long as it’s not absolutely necessary, and for good reason. Those types of surgeries, no matter how small, require intense preparation and carry many risks. In this case of WPW, surgery is not needed. Instead, interventional cardiologists use catheters placed through arteries. In this case, the cardiologists placed a catheter into the femoral artery, which is located in the leg. From there, the catheter makes its way up through the arteries to the heart. Attached to this catheter is a small device that emits a radio frequency. The catheter is positioned over the extra nerve, and then administers a quick moment of radio frequency at the precise moment when the heart beats and the nerve comes up and touches the cathode. The frequency ablates (kills) the nerve cells of this extra nerve, and cures the patient 90% of the time. Without the extra fourth nerve, the heart continues to beat as normal.
I was unable to watch this procedure as it occurred several days after I finished shadowing the physician. However, it was extremely interesting to learn about this disease, and leaves me with a question. How many different abnormalities are truly out there in the medical field? And what can we do to treat them all?
Until next time,
Judah Berman