Diplomate, Board Certification of Emergency Medicine
There is so much to talk about in the heart, but we will
confine ourselves to the rhythm. Rhythm is the electrical
impulse that spreads through the heart and causes the
contraction of the heart. The heart, as you know, has four
chambers. The top two are the atria (one is called an atrium)
and the two bottom ones are the ventricles and they are much
bigger. These bottom chambers must provide the push to pump
the blood all the way through the body. The electricity
originates in the atrium and causes it to contract before
spreading to the bottom chamber and causing it to contract.
The two contractions are the bump-bump we hear when we listen
to the heart. Want to see these electrical impulses? Do an
EKG and you will see them.
Sometimes there are problems. In young people, sometimes a
focus in the heart goes wild and gives abnormally high heart
rates. Higher heart rates are expected during exercise,
dehydration, stress or fever, but some heart rates are too
high and very uncomfortable. Maneuvers to lower heart rate
such as massaging the neck or giving very short-acting drugs
can control these events. If they recur, the focus can be
identified on studies and the area ablated, or burnt, so
there is no more trouble from them. Sometimes there is more
than just a small focus, but a whole piece of tissue which
short circuits. This can be Wolff Parkinson White disease,
and it requires special treatment as regular slowing drugs
may cause more of a short circuit.
Sometimes one reads about unfortunate events of young people
dying suddenly. Rhythm can be the problem in two cases called
Brugada syndrome and Long QT syndrome. Both of these are
readily diagnosed from an EKG and run in families. Young
people who faint usually have nothing seriously wrong, but an
EKG should always be done to rule these problems out.
Slow rhythm can be a problem in the aged but is very common
in athletes. Pregnant women and babies have higher heart
rates. Medications can lower heart rates although there are
some that increase them. Check with your doctor.
Thyroid not working? This will affect your heart rate as
well. So you see it isn't always so simple; each case must be
looked at individually. Next week we will discuss adult
problems. Write me in care of the Yated.
Winter is upon us and don't forget immunizations. I have seen
many sorry parents who did not give their children the
chicken pox and hepatitis A vaccination. These two diseases
are rampant in Israel and prevention is the best strategy.
GlaxoSmithKline is the sponsor of this column.
