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.

Syncope — commonly referred to as passing out or fainting — often results from a drop in blood pressure.

Seizures, on the other hand, are caused by abnormal brain activity. The reason behind the abnormal activity may be epilepsy, stroke, cancer or an infection in the brain.

People who pass out as a result of syncope generally recover on their own, and there may be no lasting symptoms. Seizures tend to last longer and often are followed by confusion and extreme fatigue.

“If you lose consciousness, you should talk to your health care provider. Both seizures and syncope can have serious causes and should be checked out,” said Ambica M. Tumkur, M.D., neurologist, Norton Neuroscience Institute.

The difference between syncope and seizure often can be detected by looking at brain waves using an electroencephalogram (EEG). What happened just before the loss of consciousness also can offer clues about the cause.

To function properly, your brain needs blood pumping from the heart as well as controlled electrical signals. When a seizure or syncope occurs, one of these processes is not working the way it should.

About half of syncope cases are caused by a drop in blood pressure. Fainting like this can be caused by stress, such as exposure to injury or blood, fatigue, standing for too long, or being in a hot or crowded place. The loss of consciousness often is preceded by lightheadedness, nausea, feeling warm or cold, sweating, weakness, dizziness, blurred vision or changes in hearing. Syncope also can have more serious causes. These include an irregular heartbeat or issues with blood flow to the brain. 

You should call 911 if the person is not breathing, does not wake up after one minute, has difficulty moving or speaking after waking up, has chest pains or heart palpitations, is injured or fainted while exercising or lying down.

Unlike syncope, seizures happen not from a drop in blood pressure, but because of uncontrolled activity in the brain. The underlying cause can be epilepsy, infection, brain injury, fever, stroke, withdrawal from some drugs, electrolyte imbalances, low blood sugar or sleep deprivation.

Seizures do not always result in a loss of consciousness. They may cause someone to make a noise or cry out when the seizure begins, to bite their tongue or suddenly urinate. Some people report a strange feeling just before the seizure begins, which is sometimes referred to as an “aura.” Seizures can cause convulsions, which usually begins with muscles stiffening and then enters a phase of uncontrolled rhythmic movement. Someone who has a seizure usually has no memory of the experience.

With epilepsy, seizures happen more than once and occur spontaneously, without any apparent cause.

If you see someone having a seizure, get them to the floor if they are not already lying down.  Move hard or sharp objects away from them. Do not try to restrain them and don’t put anything in the person’s mouth.

You should call 911 if it is a person’s first seizure, if the seizure lasts for more than five minutes, seizures happen one after another, the person appears to be choking or having difficulty breathing, the person is injured or the seizure happens in water.

The post Is it syncope or a seizure? Both can cause loss of consciousness appeared first on Norton Healthcare.

The medical term for an abnormally fast heart rate is tachycardia. Two types of tachycardia are supraventricular tachycardia (SVT) and ventricular tachycardia (V-tach). Though the names sound similar, they are very different.

The names describe where the abnormal rhythm begins in the heart.

Ventricular tachycardia begins in the lower two chambers, called ventricles. Supraventricular tachycardia begins in the upper two chambers of the heart, above the ventricles. With either SVT or V-tach, the heart can beat 120 times or more times per minute.

In addition to lightheadedness, SVT and V-tach share other common symptoms, including chest pain, weakness or fatigue, and shortness of breath.

SVT versus V-tach

While SVT is usually harmless, V-tach can be life threatening. V-tach can lead to a dangerous abnormal heartbeat called ventricular fibrillation and cardiac arrest.

“SVT and V-tach can feel the same to patients, but they are very different, and they are treated differently,” said Kent E. Morris, M.D., an electrophysiologist with Norton Heart & Vascular Institute Heart Rhythm Center.

SVT is the result of an abnormal electrical pathway in the heart and can be triggered by stress, drinking alcohol or caffeine, smoking cigarettes or as a side effect to some medications.

V-tach is most commonly related to another cardiovascular condition. Patients with V-tach or more likely to have had a heart attack, , coronary artery disease, an enlarged heart or abnormal heart valves.

An electrophysiologist or other provider can distinguish between SVT and V-tach by looking at an electrocardiogram (EKG), which measures the heart’s electrical signals. Each has a telltale signature.

If your V-tach progresses to ventricular fibrillation, your heart beat can reach 300bpm and you would need medical attention right away.

SVT typically lasts a few minutes but can continue for several hours. With V-tach, episodes are shorter but those lasting more than a few seconds can be life threatening.

Because V-tach is life-threatening, seek medical attention to find out if your racing heartbeat is SVT versus V-tach.

If your heart races more than 30 seconds, you should call 911. You may be experiencing a heart emergency, especially if you have other heart conditions or have other symptoms of heart attack. It is unsafe to drive yourself in a heart emergency, even if you are driving a short distance to the emergency department.

SVT may require no treatment. If you know that you experience SVT, there are also simple techniques you can perform on your own to get your fast heartbeat back to normal. Some common interventions are putting a cold washcloth on your face or holding your breath and bearing down. If you continue to have repeat episodes of SVT, there may be medications or minimally invasive procedures that can be done to help reduce or eliminate your episodes.

Because it is more dangerous, V-tach may require stronger medications called antiarrhythmics or a heart ablation procedure to stop the abnormal electrical signals causing the irregular heartbeat. Some people with V-tach need an implantable device called a cardioverter-defibrillator (ICD), which senses abnormal rhythms and sends out electrical impulses to correct them.

The post Fast heart beat? All about SVT, V-tach and what to do about it 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.

The post Heart palpitations and dizziness could be a sign of ventricular tachycardia appeared first on Norton Healthcare.

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.

The post Cardiac ablation procedure can correct heart rhythm disorders appeared first on Norton Healthcare.

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.

“It’s very rare because of all of these things that have to line up and happen at the exact right time, said Tara U. Mudd, APRN, nurse practitioner with the Norton Heart & Vascular Institute Heart Rhythm Center.

It’s more likely to occur in athletics when a small, hard object like a baseball or hockey puck strikes just above the heart’s location in the chest, according to Tara.

“Those affected by commotio cordis are often younger,” Tara said. “In adults, you have a larger chest size, and it’s much less pliable, offering more protection to the chest cavity.”

Because the first and often only symptom is cardiac arrest, athletic trainers are often the first responders and can administer cardiopulmonary resuscitation (CPR) as well as use an automated external defibrillator (AED) to help restart the heart. Athletic trainers practice regularly to assist with lifesaving first aid.

Survival of commotio cordis has improved dramatically in recent years as CPR training has expanded and AEDs have become more widely available at athletic events.

“If you do not know CPR, learn CPR,” Tara said. “Pay attention to where your AEDs are in any scenario: the grocery store, the airport, your doctor’s office. Just being aware of those things really can help save someone’s life.”

While young athletes can be more susceptible to the condition, it is very rare and any risk of experiencing commotio cordis cannot be predicted and won’t show up on a routine pediatric or other medical exam, according to Soham Dasgupta, M.D., a pediatric cardiologist at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine.

Families don’t need to worry too much about the condition, but should be aware and know what to do in an emergency, according to Dr. Dasgupta.

“It’s all about awareness and having the right tools at the right moment,” he said, referring to CPR and AEDs. “This is an earnest request to all schools to have working AEDs and make sure that there’s someone nearby trained to use an AED.”

The post Commotio cordis is triggered by a unique sequence of events appeared first on Norton Healthcare.

Telehealth is a good solution for established patients who simply need to do an annual or twice-yearly check-in with a physician. For newer patients, it can be more of a challenge, however it is easier to do an online or telehealth visit to assess the patient’s condition before moving to an in-person appointment.

Patients can use a smartphone, laptop or desktop with a webcam, or even a tablet. This can be a great situation for older patients who don’t mind not having to leave home to go to the doctor. You may contact your provider’s office to see if scheduling a telehealth visit is possible. Once your provider’s office schedules the appointment for you, you will access your video visit by signing in to MyNortonChart and clicking on the Appointments tab.

Please note that this is different from Norton eCare, which is a self-scheduled service offered for minor illnesses. If you don’t have a MyNortonChart account, sign up at NortonHealthcare.com/MyNortonChart. More information on accessing your video visit may be found here.

For patients with pacemakers or other cardiac devices, follow-up appointments routinely are done remotely. The device sends reports to the physician’s office, where it is read and checked for issues.

If a patient needs a heart rhythm analysis, for instance, there are a number of options, including mobile outpatient cardiac telemetry.

“The patient wears a monitor that they can put on and wear anywhere from one to 30 days, and it sends information back to our office,” Dr. Morris said.

These devices use cellular-connected technology to send almost real-time data. There are some commercially available gadgets that can provide information as well, such as the Apple Watch or Kardia, which takes a medical-grade electrocardiogram (EKG) anywhere you are.

“While these are not substitutes for the full 12-lead EKG we do in the office, they can give us some good data,” Dr. Morris said.

The post Visit the cardiologist from your living room appeared first on Norton Healthcare.

“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?”

The post Cardiac electrophysiologist has heart-care roots appeared first on Norton Healthcare.