Irregular Heart Rhythms and Seizures

I'm going to drop this into my blog so I can find it. Last week I had a continuous heart monitor implanted to see if the heart rhythm was causing seizures or the other way around. Here's what I found although there is no good way to cite the source, as it has none but several articles, which actually includes one about dogs, another about epilepsy. That's why I don't like AI.

Irregular Heart Rhythms and Seizures

Irregular heart rhythms (arrhythmias) and focal seizures are two distinct medical conditions that can occur independently or in conjunction with each other. Here’s a summary of their relationship and key points:

Arrhythmias: Abnormal heart rhythms that can be too fast (tachycardia), too slow (bradycardia), or irregular (atrial fibrillation, ventricular tachycardia, etc.)

Can be caused by various factors, including heart disease, electrolyte imbalances, medications, and genetic conditions 

May lead to symptoms such as palpitations, dizziness, fainting, or chest pain

Focal Seizures: Type of seizure characterized by abnormal electrical activity in a specific part of the brain (focal onset)

Typically involves involuntary motor movements or sensory disturbances limited to one side of the body or a specific area

Can be caused by various factors, including brain lesions, infections, or genetic conditions

May be accompanied by symptoms such as numbness, tingling, or weakness

Connection between Arrhythmias and Focal Seizures: Seizures can increase the risk of arrhythmias, particularly in individuals with underlying heart conditions

Seizure medications may also contribute to arrhythmias as a side effect

In some cases, arrhythmias can precede or coincide with seizures, making it challenging to distinguish between the two conditions

The autonomic nervous system (ANS), which regulates heart rate and blood pressure, can be affected by both arrhythmias and seizures

Clinical Significance: Accurate diagnosis and treatment of both arrhythmias and focal seizures are crucial to prevent complications and improve patient outcomes

Monitoring of heart rhythm and electroencephalogram (EEG) recordings can help identify the presence of arrhythmias and seizures

Treatment may involve medications, implantable devices (e.g., pacemakers, implantable cardioverter defibrillators), or surgical interventions, depending on the underlying causes and severity of the conditions

Key Takeaways: Irregular heart rhythms and focal seizures can occur independently or in conjunction with each other

Seizures can increase the risk of arrhythmias, and seizure medications may contribute to arrhythmias as a side effect

Accurate diagnosis and treatment of both conditions are essential to prevent complications and improve patient outcomes

Monitoring of heart rhythm and EEG recordings can help identify the presence of arrhythmias and seizures [This is the Medtronic device I have now.  It is NOT a pacemaker.]

New treatment for A-fib

“Scientists at The Ohio State University Wexner Medical Center also discovered that atrial fibrillation drivers don’t always have the shape of a closed loop but may instead consist of “hubs” where the electrical activity of atrial fibrillation is multiplied much like a small tornado. The study results were reported in The Journal of the American Heart Association.

“Thinking of atrial fibrillation drivers as hubs may change the way we interpret mapping results of the heart to identify these drivers. Finding these reentrant atrial fibrillation drivers is key for doing targeted ablation and successfully treating AFib,” said Vadim Fedorov, professor of physiology and cell biology at the Ohio State College of Medicine and lead author of the study.

At least 2.7 million Americans live with atrial fibrillation, with some suffering from persistent atrial fibrillation that lasts for longer than seven days at a time. When medications don’t work, physicians use ablation.”

https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/ohio-state-research-pinpoints-heart-condition

Why an echocardiogram?

Bob was taken to the ER last night after a week or two if discomfort, and in my non-medical opinion, his primary care physician dropping the ball.  If this were ordinary times he probably would have seen her as soon as he felt shortness of breath.  A call back after his EKG on Tuesday might have helped his anxiety.   It was determined he was in A-fib, and this morning he had an echo.  So I looked that up, and this is what Sanjay Gupta says about that, and why those with a-fib should have one.

“It is painless, harmless, readily available in most hospitals and can give a large amount of very useful information about the structure and function of the heart.

As atrial fibrillation can be caused by a structural problem with the heart such as heart valve disease or heart muscle weakness, the echo can help to elucidate the underlying cause of the AF.

Secondly, the echo can help assess the size of the atria. If the atria look very enlarged then it makes it more unlikely that the heart can be restored to a normal rhythm.

Thirdly, one important risk factor for strokes in patients with AF is the presence of heart failure. The echo can easily identify if the heart is weak and therefore help with risk assessment.

Fourthly, sometimes when the heart rate is excessively fast due to AF and not adequately controlled, the heart itself can start weakening. This is called a tachycardia-induced cardiomyopathy. The echo can identify a tachycardia induced cardiomyopathy and therefore guide appropriate treatment. The good news is that with appropriate rate control treatment, a tachycardia induced cardiomyopathy can easily be reversed.

Finally, some heart rhythm control medications such as Flecainide should not be used in patients with structural heart disease. A normal echocardiogram is reassuring with this regard and allows such medications to be used.”

https://drsanjayguptacardiologist.com/blog/why-everyone-with-afib-should-have-an-echocardiogram/

Coffee vs. Chocolate for caffeine

Woot! “A typical cacao bean contains less than 1/20th of the caffeine present in coffee . . .” Caffeine Content

According to Livestrong.com dark chocolate has heart and blood pressure benefits:

Health Benefits of Dark Chocolate

. . .  dark chocolate, which is packed with antioxidants known as flavanols. These antioxidants help the body's cells resist damage. Specifically, flavanols are believed to improve vascular health by lowering blood pressure and improving blood flow to the brain and heart. Flavanols can also help blood platelets be less sticky so that they don't form clots as easily. The higher the cacao content, the more flavanols the chocolate will contain. When choosing a dark chocolate, look for a high cacao content with the least amount of sugar or other ingredients that add calories.

According to the Live Well web site by Jillian

Caffeine in Coffee

Eight ounces of generic brewed coffee averages 95 milligrams of caffeine, according to the National Nutrient Database. The range is 102 to 200 milligrams. A 16-ounce cup of coffee -- the “grande” or medium size in most coffee shops -- contains 200 to 300 milligrams of caffeine. A coffee shop’s standard 1-ounce shot of espresso averages 75 milligrams of caffeine, while generic brewed espresso averages 40 milligrams. A 16-ounce vanilla latte contains 150 milligrams of caffeine.

Decaffeinated Coffee

Decaffeinated coffee does contain some caffeine. In a study published in the October 2006 issue of the "Journal of Analytical Toxicology," University of Florida researchers found that 16-ounce cups of brewed regular decaffeinated coffee, a medium coffee at most coffee shops, contained anywhere from 3 to 13.9 milligrams of caffeine.

Caffeine in Chocolate

A 1-ounce square of unsweetened baking chocolate contains 23 milligrams of caffeine. A large 3.5-ounce bar of very dark chocolate, which contains 70 percent to 85 percent cocoa, averages 80 milligrams of caffeine. Regular dark chocolate, with 50 percent to 69 percent cocoa, contains around 70 milligrams in a 3.5-ounce bar. The same amount of plain milk chocolate contains 20 milligrams of caffeine. Hot cocoa averages 9 milligrams of caffeine per 8-ounce cup.

From comments at Jillian’s site.

“Journal of Chromatographic Science, Vol. 46, pp 892-899 (2008)

Standard Reference Material 2384 Baking Chocolate from the National Institute of Standards & Technology (Gaithersburg, MD), 90 % cocoa solids, was determined to have 26 mg/g (2.6% by weight) theobromine and 2.4 mg/g caffeine.

Food Research International, Vol 42, pp 707–716 (2009)

Chocolate with 60% cocoa solids (from a leading Croatian chocolate manufacturer) was determined to have 9 mg/g (0.9% by weight) theobromine and 0.8 mg/g caffeine.

Even taking the lower, latter figure for caffeine content, this translates into 23 mg of caffeine in 1 oz (28.35 g) of chocolate containing 60% cocoa solids (e.g. bittersweet baking chocolate). “

Like everything else on the internet, people disagree on the amount of caffeine in chocolate—some claiming there is none naturally, that it is added.

Q. How much caffeine is in Chocolate?

A. The small amount of caffeine present in chocolate occurs naturally in the cocoa bean, unlike the caffeine in soft caffeine drinks which is added during the manufacturing process.

Here caffeine are some comparisons that may be helpful:

Coffee 8 fl. oz. 65-120 mg

Cola-type soft drinks 12 oz. 30-55 mg

Milk Chocolate 1 oz. 5-10 mg

Dark Chocolate 1.4 oz. 7-50 mg

The amounts of caffeine in specific HERSHEY'S chocolate products are listed on the Chocolate Products Caffeine page.

Maybe I’ll go with this explanation:

“Chocolate derived from cocoa beans is a weak stimulant. It contains two stimulating methylxanthines (a class of alkaloid molecules), a significant amount of theobromine (and theophylline) and a small amount of caffeine. The slight stimulatory effect of chocolate is it seems as much due to the combination of theobromine and theophylline than caffeine.

Generally, caffeine and theobromine have very different effects on different people. Theobromine is relatively mild and helps elevate serotonin levels producing a really nice side effect of feeling good over a longer period of time. Caffeine is a stronger stimulant and acts relatively quickly as a wake-up drug. Compared to the caffeine, the theobromine has about one-quarter the stimulating power.

However, chocolate contains too little of these compounds to create a similar effect to portion equal to coffee. A typical cacao bean contains less than 1/20th of the caffeine present in coffee (from zero to 1000 parts per million of caffeine per bean).”

 

Not what I wanted to read the day after Thanksgiving

My daughter’s Thanksgiving Day pies—cherry, apple and pumpkin. She always decorates with little cut outs from the pastry.

I've had A-fib (atrial fibrillation) as long as I can remember, but wasn't diagnosed until 1996. I was on medication for awhile, then had an ablation (the cause turned out to be an extra circuit), then for a decade didn't use meds, then it began kicking in more frequently, and recently I returned to medications to control the rhythm and slow down my heart and a blood thinner in case a clot develops (the biggest risk for A-fib is a stroke). The Nov. 30 JAMA reports that losing weight is important in reducing A-fib, which would account for the increase in symptoms and the 30 lbs I've added in the last 4 years. This is not what I wanted to know the day after Thanksgiving with the frig loaded with left overs, including 3 kinds of pie.

http://jama.jamanetwork.com/article.aspx?articleid=1779533

Wired and transmitting

The heart monitor I’ve been wearing since September 16  apparently transmitted something I was ignoring, the doctor was contacted by the company, and then I was called about 7 p.m. Wednesday evening and told to go to the ER. Isn't technology amazing--all sorts of things going on behind our backs we don't know about!

I'm home now--released from the hospital late yesterday afternoon. When the cardiologist walked in with the flock of young docs in training, I'd already heard the discussion held outside my room. I don't know how often Huffington Post is listed in the record as a possible cause of heart problems, but it's in mine. Because of the medical school down the road at OSU, you see a lot of doctors coming through the ranks. They all seemed to know what Facebook and blogging are.

I met the most interesting people--asked most of the staff who had the time how long they'd been working at Riverside, career goals, etc. The woman cleaning my room turned out to be a former neighbor in the 1970s when we lived on Abington Rd. One guy had changed careers from real estate after the 2008 downturn; he began in a very low level job (which he hated) and kept applying within as jobs opened up. The echocardiogram guy had relocated from Cleveland where there were many med tech schools but no jobs, and we had a good laugh about Columbus residents and the first snow flake to fly.

One lady doctor looked to me to be 15, so I just had to ask--she was 28. One lady intern had the most fabulous bedside manner and special touch, that I hope she's around the next time I need her.  And I got to give my name and birthdate at least 30 times. 

The food was excellent—fresh and tasted “homemade”--and you could order any time.  All the staff seemed to have special training in being friendly.  When I raised the blind, I looked down on the new addition to the hospital.  It is always expanding.

“Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body. During atrial fibrillation, the heart's two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart. Atrial fibrillation symptoms include heart palpitations, shortness of breath and weakness. “ http://www.mayoclinic.com/health/atrial-fibrillation/DS00291

Healthcare Costlier All Around for Afib Patients - in Clinical Context, Strokes from MedPage Today

I had no idea that A-fib was so expensive! Atrial fibrillation patients are generally sicker than those who don't have atrial fibrillation which apparently accounts for the higher costs. According to this article

Treating patients with atrial fibrillation costs the U.S. an estimated $26 billion more per year than treating patients who don't have the condition, researchers reported after extrapolating 2008 data for 2010.

Total direct medical costs were estimated to be 73% higher in atrial fibrillation patients than in matched control subjects, representing a net incremental cost of $8,705 per patient per year, according to Michael H. Kim, MD, from Northwestern University in Chicago, and colleagues.

The estimated annual cost included $6 billion related directly to atrial fibrillation, $9.9 billion for cardiovascular risk factors or disease, and $10.1 billion for noncardiovascular medical problems, according to the study published online in Circulation: Cardiovascular Quality and Outcomes.

Medical News: Healthcare Costlier All Around for Afib Patients - in Clinical Context, Strokes from MedPage Today

A sadness too big to measure

I was delighted to run into my old art class buddy at the book shop today. The class dissolved about 3 years ago, and so the three of us who used to go to lunch together, or enjoy an occasional afternoon movie or art show, had lost touch. After the hug--No, she wasn't painting anymore, Yes, her husband was doing better, and did I know her 52 year old daughter died this summer. I almost couldn't catch my breath. They were preparing to go spend a few days with her, to provide transportation to and from surgery, and keep her company, and then got the call. Irregular heart rate--I think she'd been scheduled for an ablation. My friend had returned to the central Ohio area over 30 years ago to care for her own mother, and I think she had some comfort as she entered her 80s that her daughter was just in the next state. Now it's the numbing grief plus the insecurity. All the whys and what ifs. They will be moving to Pennsylvania to be nearer their son.

Fast and fluttery are more serious than slow. If like me, you've always had an irregular heart rate (shortness of breath, fatigue, dizziness and lightheadedness), and you've learned to live with it, or just wait till it goes away, it's not a heart attack you need to fear, but a stroke. I'm always surprised when I read that A-fib is not life threatening; it certainly was for my friend's daughter. When the rhythym is restored and the electrical charge reconnects, there may be a clot waiting to be pushed through.

This chance encounter today was a kick in the pants for me to have mine checked again. Technically, my ablation didn't work--all the pulmonary veins around my heart had been doing it wrong so long, they just ignored the fact that the extra circuit was dead and gone. It's time to stick that 30-day monitor back on. Yuk.

1402 Amen! shouted the lawyers

Of course. They get 1/3 of the Vioxx settlement. Although I know it will be appealed.

And let's hope those lawyers will personally never need a life changing, disease fighting drug or technology developed by the U.S. pharmaceutical industry. It is a very risky area to invest in--as a retiree, I'll probably look for something safer, something less identified with miracles that can never backfire.

The Vioxx case involved a man who had undiagnosed arrhythmia and died. "The pathologist who performed Ernst's autopsy testified during the trial that a blood clot likely caused the arrhythmia and a subsequent fatal heart attack. The pathologist could not offer 100% certainty that there was a blood clot (not found during the autopsy) or heart attack. The jury demonstrated by its verdict that it believed the theory that a blood clot caused the arrhythmia and that Merck and Vioxx were liable."

Well, let me weigh-in with something that IS 100% certain. I've had arrhythmia all my life and it was NEVER found until 1996 when feeling light-headed, I walked a mile to the clinic from my office at OSU and was immediately put in a wheelchair and pushed through a construction zone to the emergency room and admitted. In order to be diagnosed, you have to be having an episode during a doctor's visit. That was my third or fourth incident that day and I guess I was just tired of grabbing a wall every time I stood up. I'd never reported it because I've only been me, and I assumed everyone's heart raced after eating peanut butter, or remembering an auto accident, or chatting in a nice restaurant, or walking into the stacks to reshelve an armload of journals. I thought the room went black for everyone when changing positions suddenly. It was never picked up in check-ups, in pregnancy and labor, or in my only surgery.

After several days of testing at the OSU Hospital the diagnosis was "idiopathic atrial fibrillation." That means, "we don't know why you have a heart rate that some times is 50 and sometimes is 300." But they didn't even tell me the worst part. A nurse friend visited me in the hospital and told me I could have died any number of times, or had a serious stroke. The blood pools, then builds up and splashes on through--sometimes in a clot.

After 5 years of medications to control my heart rate, and a generation of heart research and new technology (paid for by investors and inventors in our health care companies), it was determined I had an extra circuit in my heart, fluttering there trying to join the party redirecting the electrical impulses to nowhere land. It was zapped in 2002, and I went on new and different meds including coumadin, because although the circuit was gone, the pulmonary veins around my heart didn't know the ship had left the dock and continued to flutter and cause problems. They needed to be retrained, and the meds were for that. About 18 months ago those meds (developed by a pharmaceutical company), were discontinued.

Jane Galt and Dr. Sanity comment.