Diplomate, Board Certification of Emergency Medicine
The last thing I want to say is about the most dangerous of
rhythm disturbances. Sometimes -- especially in older
individuals -- there develops a block between the upper and
lower chambers of the heart. This leads to the bottom chamber
beating independently. We call this complete heart block.
This requires a pacemaker, which is basically two wires, one
in each chamber, that are connected to a transmitter that
regulates the heartbeat. Sick Sinus Syndrome is another
common malady that sometimes requires a pacemaker. It is
periods of fast and very slow heart beats.
The pacemaker sits under the skin in the upper chest and is
powered by nuclear energy. It can be deactivated and
reprogrammed by waving special magnets over it and can even
be recharged without ever opening the skin to repair it. They
last for years.
When the bottom chamber of the heart gives the rhythm, it is
often not enough to make the heart beat well and VT or VF
(ventricular tachycardia or ventricular fibrillation) occur.
If they continue they are fatal and this is a cause of sudden
death, often in the setting of a heart attack. If they occur
often but they stop by themselves, one should treat them. To
determine if one has this problem, a holter must be done.
A holter is a 24-hour recording of the rhythms of the heart.
It is done by a simple radio-sized device that a person wears
for twenty-four hours. Usually, a person who suddenly faints
or has palpitations should do this test. To treat this
problem, medications can be given or an ICD can be implanted.
This device looks like a pacemaker, and it gives an
electrical shock to restore normal rhythm if it determines
that a bad rhythm has occurred. Both pacemakers and ICDs are
sensitive to MRI machines and to metal detectors at airports.
Be careful.
Sustained VT and VF can be fatal and CPR must be done
immediately until an electrical shock is given. This can be
lifesaving and has led to not only many courses given to
learn CPR but also to a device called an AED which can give
this shock even in the hands of a layman. These can now be
found in many airlines, airports and in the hands of firemen
and police. The technology is so improving that soon hand-
held AEDs will be available.
On a personal note, long before I was married, my father-in-
law was niftar from a sudden cardiac death and no one
there knew CPR or had a way of giving a shock. Today Hatzolah
units are trained in this and many carry this important
equipment, but precious moments can be lost until they
arrive, so I still believe that this skill should be learned
by everyone. By the way, the old punch to the chest doesn't
do much good in treating this problem. Write me in care of
the Yated.
A message from GlaxoSmithKline, sponsor of this
column. While I do not know how many people would have
use for this drug, I will mention it. Amlarone is a new
medication that is very effective against the most common
disease in the world: malaria. This dangerous disease is
getting more resistant to medications and, while it isn't a
danger in Israel, it can be found in South America and in
Africa (as close as Egypt) and is rampant in Asia.
