The Aveir DR consists of two leadless pacemakers that are implanted into the upper and lower chambers of the heart. The two pacemakers communicate with each other based on the person’s needs to more effectively regulate heart rhythm. 

“A leadless pacemaker is unique technology that was only available for limited types of patients in the past,” said Sofya Kuznetsov, M.D., electrophysiologist, Norton Heart & Vascular Institute Heart Rhythm Center. “The ability to pace upper and lower chambers in sync was only available with conventional transvenous devices.

“The leadless pacemakers are smaller than an AAA battery and can communicate wirelessly with each other to control the heart’s rhythm. They do not require a surgical incision and avoid potential complications associated with conventional pacemaker leads, such as infection or lead fractures. An additional benefit is quicker recovery and fewer mobility restrictions after the procedure.”

Until now, leadless pacemakers have not allowed a dual chamber option, which is needed by nearly 80% of people needing this kind of treatment.

To schedule an appointment with a Norton Heart & Vascular Institute specialist, call (502) 446-6484 (NHVI).

The post Norton Heart & Vascular Institute implants Louisville’s first dual chamber leadless pacemaker appeared first on Norton Healthcare.

When the fast heart rate begins in the upper heart chambers, it is called supraventricular tachycardia (soop-rah-ven-TRICK’-yoo-lar TAK-ih-KAR-dee-ah), also known as SVT. When it starts in the lower chambers, it’s called ventricular tachycardia or VT.

When the heart is beating too fast, it doesn’t have a chance to fill up with blood between beats. As a result, the heart has a hard time pumping enough blood. The reduced blood flow sends less oxygen out to the body, causing lightheadedness or dizziness, chest pain, weakness or fatigue, and shortness of breath.

“Though the symptoms are similar, the outlook is very different for patients with supraventricular tachycardia and those with ventricular tachycardia,” said Hassan Khan, M.D., Ph.D., an electrophysiologist with the Norton Heart & Vascular Institute Heart Rhythm Center. “SVT is usually not serious. VT, on the other hand, can lead to sudden cardiac death and needs to be monitored closely.”

A rapid heartbeat or pounding heart also can be a sign of a panic attack, which should not be taken lightly and warrants medical attention.

A normal resting heart rate is 60 to 100 beats a minute. With SVT and VT, the heart will beat much faster, often in the range of 170 or more beats per minute. SVT, VT and bradycardia (a slow heartbeat) are forms of cardiac arrhythmia or irregular heartbeat. Atrial fibrillation, another heart rhythm disorder, is a form of supraventricular arrhythmia.

Premature beats, or ectopic beats, may feel like your heart skipped a beat. These typically are not a serious medical condition.

Treatment options for arrhythmias depend on your symptoms and the cause of your heart condition. Options include: lifestyle modification, medications and cardiac ablation to interrupt the errant electrical signals causing the irregular heartbeat or a surgically implanted cardioverter defibrillator to reset your heart if you develop a dangerous ventricular arrhythmia episode.

Supraventricular tachycardia

SVT is rare, with 2 in 1000 people estimated to be affected. In a normal heart rhythm, electrical signals follow a specific pathway through the heart, regulating the heart rate and rhythm. However in SVT, abnormal pathways or circuits can form, causing the heart to beat faster than normal.

SVT can affect children or adults, but many people have their first symptoms between the ages of 25 and 40. SVT can be initiated by stress, drinking large amounts of caffeine or alcohol, certain medications, and hormonal imbalances, such as hyperthyroid disorder. In some cases, the cause is not known.

With SVT, the rapid heart rate can occur daily or only once a year. It can be sporadic. SVT typically lasts for a couple of minutes but can last for several hours.

Symptoms of SVT may be difficult to see in infants and very young children. In addition to a rapid pulse, signs of SVT in infants and very young children include sweating, poor feeding and pale skin.

SVT is usually not serious, but it may require treatment. In rare cases, it can cause you to lose consciousness or go into cardiac arrest.

Ventricular tachycardia

VT can occur in an otherwise healthy heart but is usually more common in abnormal heart muscle tissue, which can be result of other cardiovascular issues. These include coronary artery disease, an enlarged heart or abnormal heart valves.

If you’ve had a heart attack or heart surgery, that can contribute to VT. If you’re older or have a family history of cardiac arrhythmia or sudden death you’re also more likely to develop VT.

VT begins in the heart’s lower two chambers, called ventricles. It can be caused in two ways. VT can happen when an abnormal heart circuit within the ventricular muscle becomes triggered, or it can occur when an abnormal ventricular muscle self-activates.

VT is defined as three or more beats in a row at a rate of more than 100 beats per minute. VT that lasts for only a few seconds may not need to be treated. VT that lasts more than a few seconds at a time can become life-threatening.

VT in a structurally normal heart is not serious if the fast heartbeat stops on its own.

When to call a doctor

Call your health care provider if you experience an abnormal heart rhythm or very fast heartbeat for the first time.

With VT, you should call 911 if you feel lightheaded, have chest pain or experience a sustained rapid heartbeat that lasts 30 seconds or more.

With SVT, you should call 911 if you have an episode of SVT that lasts for more than a few minutes or if you also have chest pain, have trouble breathing or are feeling very faint.

If you think your infant or child has SVT, ask your child’s pediatrician about an SVT screening.

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An abnormal heart rhythm doesn’t always require treatment. However, if the arrhythmia is causing significant symptoms or putting your health at risk, an electrophysiologist can help.

One common way electrophysiologists treat heart rhythm disorders is with a minimally invasive procedure called cardiac ablation or catheter ablation.

“Without having to perform open-heart surgery, electrophysiologists use this minimally invasive technique and tools to address the cause of arrhythmias at their source,” said Kent E. Morris, M.D., electrophysiologist with the Norton Heart & Vascular Institute Heart Rhythm Center. “We thread a tiny tube, or catheter, through a blood vessel and up to the heart, where we apply either heat or cold, depending on the situation, to small areas of heart tissue to block abnormal electrical signals that is causing the arrythmia.”

The heart uses electrical impulses to control the timing of your heartbeats. The tiny scars created by cardiac ablation block the electrical impulse causing the arrhythmia. By blocking these abnormal electrical signals at their source, electrophysiologists can restore a normal heart rhythm.

Catheter ablation can be used to treat a wide range of arrhythmias, including supraventricular tachycardia (SVT), atrial fibrillation (A-fib), atrial flutter, ventricular tachycardia (VT) and premature ventricular contractions (PVCs).

Preparing for cardiac ablation

Before the heart ablation procedure, you will be given medication to sedate you and make you sleepy. These medications are meant to reduce your anxiety and relieve your discomfort.

The cardiac ablation procedure typically takes from one to four hours, but sometimes can take longer. After the procedure you will need to lie still in recovery for several hours to decrease the risk of bleeding.

You may go home the same day or spend the night in the hospital for monitoring. You likely will feel some soreness after the procedure but typically can resume normal activities in a few days.

Other treatments for arrhythmia

Medications also can be used to treat heart arrhythmia.

With tachycardia, an electrophysiologist may prescribe a type of medication called a beta blocker or a calcium channel blocker to slow down your heart and restore a normal rhythm.

For A-fib, quivering or irregular heartbeat, or atrial flutter, a similar heart rhythm disorder, you may receive a blood thinner to prevent blood clots and reduce the risk of stroke, and heart rate-controlling medications such as beta blockers or calcium channel blockers, which both slow the heart rate.

One cause of a fast heart rate is supraventricular tachycardia or SVT, which can cause the heart to beat from 150 to 200 beats a minute. SVT occurs when the fast heart rate begins in the upper chambers.

If you have a known diagnosis of SVT, you may be able to stop this by doing something called a vagal or Valsalva maneuver. You may be able to stop an abnormal heart rhythm simply by coughing, holding your breath and straining, dunking your face in ice water, or putting a cold towel on your face. Patients should only try this technique if they have a known diagnosis of SVT.

A procedure called cardioversion also can restore your normal heart rhythm for atrial fibrillation and also in more arrhythmias including ventricular tachycardia (VT), where a fast heart rate begins in the lower chambers of the heart.

During a cardioversion procedure, an electrophysiologist delivers a shock to your heart through paddles or a patch on your chest. This shock essentially can “reset” the electrical impulse in your heart.

Implantable devices  can also be use to monitor for or correct an arrhythmia.

An implantable loop recorder is a small device the size of a paper clip that can be implanted under the skin on the chest wall to monitor your heart rhythm for evidence of any abnormal rhythm.

A pacemaker can correct a slow heart rhythm. An electrophysiologist typically implants the pacemaker through the vein under the collarbone, with wires running to the heart. If the heart beats too slow or stops, the pacemaker can send a tiny electrical signal to stimulate the heart. There are also newer “leadless” pacemakers that can be implanted through a vein in the leg. These are small devices that sit only inside the heart and do not have any wires attached.

An implantable cardioverter-defibrillator (ICD) is designed to correct a dangerous potentially life threatening fast heart rhythms that originate in the bottom of the heart. Like the pacemaker, it is typically powered by a device implanted near the collarbone. If the ICD detects an abnormal fast rhythm, it sends out a shock to reset the heart’s rhythm to normal to prevent you from dying from the abnormal rhythms.

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Call 911 if your blue fingernails are accompanied by any of the following symptoms:

• Shortness of breath or difficulty breathing
• Chest pain
• Sweating
• Dizziness, lightheadedness or fainting

Fingernails are good for scratching itches, but they are also a window into your health. If the skin under your fingernails has a blue or purple tinge, you might need to see a health care provider or a heart specialist.

Why are my nails blue?

The medical term for blue nail beds is cyanosis. Cyanosis can occur when there is not enough oxygen circulating in the bloodstream, or circulation is poor. Oxygenated blood is red, while blood depleted of oxygen has a blue hue.

What causes blue nails?

There are several reasons your nails could be blue, including heart conditions. Sometimes a heart murmur will cause blue nail beds. When a health-care provider listens to your heart and hears a certain swooshing sound, it’s an indication that the blood is flowing through the heart abnormally.

Heart murmurs can be innocent, or harmless. But murmurs also can be an indication of a structural heart condition such as a hole between two or more of the heart’s chambers — atrial septal defect or ventricular septal defect. While this defect is present at birth, patients can grow into middle age with little or no symptoms. Many aren’t even aware they have the condition.

Other causes of heart murmurs include:

• Anemia affecting the thickness of the blood and blood flow
• Carcinoid heart disease, a slow-growing tumor that can affect the heart’s valves
• Endocarditis, an infection that harms heart valves
• A faulty heart valve that isn’t closing all the way or is stiff, allowing blood to flow in the wrong direction
• Hyperthyroidism (an overactive thyroid) resulting in a rapid heartbeat and a murmur
• Hypertrophic cardiomyopathy, which makes your heart muscle thicker and stiffer

Another cause of cyanosis could be cold temperatures that can make blood vessels constrict, resulting in fingers and toes taking on a blue tint.

“This will go away when you warm up,” said Tara U. Mudd, APRN, nurse practitioner with Norton Heart & Vascular Institute. “Numbness and tingling when you’re cold is common, and as long as it stops when you go inside or get warm, it’s not a concern.”

When should I see a doctor?

“If you have blue nails, call your health care provider,” Tara said. “Evaluation may include using a device called a pulse oximeter, which measures the amount of oxygen in your blood. Your provider may use this data to help diagnose the underlying cause of your cyanosis and recommend treatment options.”

If your blue nail beds are caused by a serious heart issue, your physician may refer you to the Norton Heart & Vascular Institute Structural Heart Program, which brings together the talents of cardiothoracic surgeons, interventional cardiologists and imaging cardiologists to one location on the Norton Audubon Hospital campus. With the input and viewpoints of many specialties, each patient gets a customized treatment plan.

The post Why are my nail beds blue? appeared first on Norton Healthcare.

His cardiac device had to be programmed into an MRI-safe mode before he went into the MRI tube, but rather than do it in person and add a possible risk of exposure to the coronavirus, a device manufacturer representative programmed the  device remotely.

Norton Healthcare became one of the first health care organizations in the country to utilize remote device programming to minimize patient exposure.

“If you didn’t tell the patient it was being done remotely, they wouldn’t know the difference,”  said Dr. Belker, 86 and a retired Louisville urologist.

Because MRIs rely on powerful magnets and radio waves to create detailed pictures of organs and tissues in the body, cardiac devices need to be put in a safe mode during the imaging.

“It was no different than ordinarily, except the (device representative) was sitting 20 feet away. He could have been in another building, and it wouldn’t have been any different,” Dr. Belker said.

Keeping the device representative in a different room not only was a good precaution, but also conserved the use of personal protective equipment, which was in short supply nationally at the time.

According to Dr. Belker, remote programming of the device would make it easier for patients with pacemakers and defibrillators to be scheduled on any day of the week rather than only when the technician can be present.

The ability to reprogram devices isn’t particularly new, but there hadn’t been a need for remote control until the coronavirus pandemic happened. Controlling the cardiac device remotely is somewhat like a computer help desk taking control of your computer temporarily to fix a problem.

In the past, patients with pacemakers or defibrillators were excluded from having an MRI because of concerns the powerful magnets and radiofrequency might harm or in some way disrupt the device, possibly triggering a rapid heart rate.

Cardiac devices have been redesigned so they are safe for MRIs. Now, prior to an MRI, patients simply have their devices reprogrammed to an MRI-safe mode before entering the MRI room.

After the imaging procedure, a technician restores the device’s normal settings.

An estimated 12% to 16% of people with implanted cardiac devices will need an MRI at some point during the year.

Norton Heart & Vascular Institute physicians use devices like the one in Dr. Belker to send information like heart rate and blood pressure to providers. Readings that are outside the normal range result in an immediate call to adjust medications or diet, or make other changes.

The post Innovative care to help make patients safer appeared first on Norton Healthcare.

The honor of chair was bestowed on Joseph A. Lash, M.D., cardiologist and medical director of the institute. Hunt presented him with a special lab coat with his new title as Rounsavall Family Foundation endowed chair. Dr. Lash has been practicing cardiology in Louisville for 29 years and has served as medical director of Norton Heart & Vascular Institute since 2011.

“By endowing the chair, it will help to advance even further the team-based and passionate care provided at Norton Heart & Vascular Institute through support of its leadership,” Hunt said. “It’s only fitting to expand upon the great work already being done by recognizing Dr. Lash as chair.”

Norton Heart & Vascular Institute is the area’s leading provider of cardiovascular care, from general cardiology to subspecialty care that includes vascular surgery, thoracic surgery, cardiac surgery, electrophysiology, advanced heart failure and interventional cardiology.

The team at Norton Healthcare is committed to helping prevent and treat heart disease. According to the Centers for Disease Control and Prevention, every 1 out of 4 deaths in the U. S. is due to heart disease, making it the No. 1 killer of both men and women. Nationally, the rate of heart disease is 324.3 per 100,000 people, while Kentucky is higher at 387.2. Nearly half of all Americans have at least one of the three risk factors for developing heart disease: high blood pressure, high cholesterol and smoking.

Norton Healthcare continues to expand its heart care services, recently growing and adding programs, including an Atrial Fibrillation (A-fib) Program and an Advanced Heart Failure and Recovery Program, along with recruiting additional cardiologists and subspecialists to help more patients with heart and vascular disease live their best lives.

Several recent awards and accreditations affirm the quality of care provided by Norton Heart & Vascular Institute:

• The American Heart Association Regional Trailblazer Award for excellence in pioneering a regional network of heart attack care
• American College of Cardiology (ACC) accreditation of Norton Hospital and Norton Audubon Hospital for excellence in A-fib and electrophysiology care
• Recertification of all Norton Healthcare adult-service hospitals as Chest Pain Centers by the ACC
• Most recently, Norton Audubon Hospital was awarded the ACC’s HeartCARE Center of Excellence — the top level of accreditation for excellence in heart and vascular care. Norton Audubon Hospital is the first and only hospital in Louisville to achieve this prestigious national distinction.

To maintain a level of excellence in heart and vascular care takes a continued focus on expanding services, implementing the latest in technology and creating spaces that help facilitate care that is focused on the patient.

“Being the health care leader for this community comes with a great responsibility. And that responsibility means continually advancing heart and vascular care, both through the medical care we deliver and easier access to leading medicine,” said Russell F. Cox, Norton Healthcare president and CEO. “This takes an unwavering commitment from our many providers, team members, administrators, board members and community.

“We are truly blessed by the commitment of time and the financial support that Hunt Rounsavall gives to Norton Healthcare in order to help us best serve our patients and their families.”

Jon Cooper, chief administrative officer for Norton Audubon Hospital, outlined significant changes coming to the heart and vascular program at Norton Audubon Hospital, which include:

• Growing the Advanced Heart Failure and Recovery Program to include a ventricular assist device (VAD) program for patients with late-stage heart failure.
• Renovating cardiac intensive care unit rooms to facilitate the high level of advanced care needed while creating private spaces for patients and their families
• Adding a fourth cardiac catheterization lab
• Installing a second electrophysiology suite
• Upgrading diagnostic imaging to include best-in-class computed tomography (CT) and magnetic resonance imaging (MRI) capabilities
• Relocating and consolidating key heart and vascular offices and services to the west side of the campus to create easy access and a common point of entry. Major elements include:
  • Outpatient services to be relocated include all heart and vascular providers (cardiology, vascular, heart failure, cardiothoracic surgeons), cardiac and pulmonary rehabilitation, as well as all heart failure services.
  • Hospital-based services also will be consolidated on the west side of the campus, including the heart and vascular center, nuclear medicine, electrophysiology and cardiac catheterization.
  • Creation of a cardiovascular resource center will help patients with education, resources and support needed when facing cardiovascular disease.

“Norton Audubon Hospital has a long history of providing innovative heart care. We are excited to begin our next chapter, which is focused on the hearts of our patients and their families, and continuing on our path of excellence,” Jon said.

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“I saw how grateful her patients were. Some of them became her lifelong friends,” said Dr. Kuznetsov, a cardiac electrophysiologist with Norton Heart & Vascular Institute Heart Rhythm Center.

As an electrophysiologist, Dr. Kuznetsov diagnoses and treats heart rhythm issues. These include heart palpitations, atrial flutter and fibrillation, and heart arrhythmias — conditions related to the electrical activities in the heart.

To correct or prevent arrhythmias, she can implant devices like a pacemaker or implantable cardioverter defibrillator (ICD), or she can perform an ablation procedure.

“A lot of things we do give patients immediate relief,” Dr. Kuznetsov said. “The best moments are when they come to you after a procedure and say, ‘I’m feeling so much better.’”

Dr. Kuznetsov moved to Louisville in 2002 from Ulyanovsk, a medium-sized Russian city best known as Lenin’s birthplace. She attended the University of Louisville for her undergraduate and medical school education.

Dr.  Kuznetsov then did her medical residency at the University of Chicago, Illinois, and training in cardiology and electrophysiology at Case Western Reserve University in Cleveland, Ohio.

A Love of Cardiology and a Chance to Be Closer to Family

“I always knew I wanted to go into medicine and cardiology,” Dr. Kuznetsov said.

She became interested in electrophysiology in college, when she worked monitoring cardiac telemetry — remote readings from patients’ hearts — looking for arrhythmias. In medical school, Dr. Kuznetsov knew she’d found her specialty when she shadowed an electrophysiologist.

After working briefly in Owensboro, she returned to Louisville and Norton Heart & Vascular Institute Heart Rhythm Center, the leading provider of comprehensive care for patients in Louisville and Southern Indiana with arrhythmias and other irregular heartbeat conditions.

When she moved back to Louisville, Dr. Kuznetsov found a home in the same neighborhood as her sister, a dentist who also works in Louisville. Dr. Kuznetsov’s mother has retired from medicine. Her father is in construction, remodeling houses.

“I get to spend a lot of time with family. Family is important to me,” she said. “I see my parents a couple of times a week.”

Involving Patients in Their Care

The mother of a 4-year-old son, Dr. Kuznetsov likes being outdoors and enjoys music. She is an avid piano player. Dr. Kuznetsov also enjoys traveling both in and outside the United States.

“I love my work. I love treating patients. I like spending time with my family. Having the balance of rewarding work and helping people and spending time with family is really great,” she said.

Dr. Kuznetsov said it’s important to involve patients in their own care.

“They need to understand what they have and the options for treatment. They have to be part of the decision-making process,” Dr. Kuznetsov said. “People are different in how aggressive they want to be, so the approach to every patient is different, not only what their condition is but what approach they want to take.”

Dr. Kuznetsov said her motivation is simple: “How can I make my patients feel better?”

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