Ask Dr. Zipes
How To: Automated External Defibrillators
By Douglas Zipes, M.D.
From the January/February 2005 Issue
Reader: I travel frequently and have noticed AEDs in many locations like airports and shopping malls. My neighbor told me they are used when someone's heart stops, but I wouldn't know the first thing about how to use one. Where can I get instruction in how to use an AED? Dr. Zipes: AEDs are very simple to use and are designed for individuals with no prior experience to be able to follow simple verbal instructions (given by the device) during the stress of an emergency situation to employ the AED safely and effectively. The Food and Drug Administration has recently approved their sale without the need for a prescription from a physician. The American Heart Association is your best source for additional information.Defibrillator Shocks Reader: Two years ago, my husband had a cardiac arrest while golfing. Thanks to his golfing buddies' quick thinking, CPR, and a cell phone, he survived. The doctor said he had a thickened heart muscle and what he called a cardiomyopathy. He got a defibrillator and has been on pills for his heart rhythm ever since. He had some shocks fight after they put in the defibrillator, but hasn't had any shocks for the last year. He is constantly afraid that he will have another cardiac arrest and get more shocks. The doctor says he is doing fine, but my husband stays up at night worrying about it. Neither of us has had a good night's sleep for many months. Is there any way he can get peace of mind about this? Dr. Zipes: Certain types of cardiomyopathies, such as the kind your husband has (which is probably hypertrophic cardiomyopathy), can cause cardiac arrest. The best protection against dying from this event is the implantable cardioverter defibrillator (ICD). Unfortunately, sometimes the ICD can deliver a shock to a conscious patient, and that certainly is not fun, but it may have saved your husband's life! However, in most instances, your doctor can adjust the ICD and/or use medications to prevent another similar episode. It seems that has been done for your husband, and therefore it is less likely that he will receive another shock while he is conscious. It is most important to remember two things: the ICD is like having an emergency room implanted in your chest and is your best insurance policy against dying suddenly; it is designed to be forgotten about and for the patient to live as normal a life as possible. Try to do just that.Elevated Heart Rate Reader: I am constantly bothered by a fast heart rate. My pulse is always over 100, even when I am resting. I feel jittery all the time and can't sleep at night. When I do get to sleep, I wake up sweating, with my nightclothes drenched. I have lost 20 pounds, even without dieting. My family says I am irritable, but who wouldn't be, the way I feel? I used to love to go to the beach, but now I can't stand the summer weather. Can it be my heart is causing the trouble? Dr. Zipes: Your problems may relate to overactive gland function, most likely the thyroid. You need to consult your doctor, explain your symptoms, and have a thorough evaluation. It is likely that your problem can be diagnosed and treated effectively.Avoiding Blood Tests Reader: I have atrial fibrillation, and the doctor has me on warfarin. I don't like getting blood tests each week. They told me I could cut back to once a month after the level is stabilized, but I don't like getting blood drawn. Why do I need to have thin blood? Is there anything else I can take? Dr. Zipes: Atrial fibrillation can predispose to blood clot formation, which can lead to a stroke. Thinning the blood with warfarin greatly reduces that possibility. Even though warfarin is a bother, such treatment can be lifesaving. New medications are being evaluated that may replace warfarin in the near future, and will not require frequent blood tests.Magnetic Interference Reader: I was attracted to the atrial fibrillation questions about the failure of the cardioversion procedure in the July/August magazine. In 1993, two months after four saphenous cardiografts, I was into atrial fibrillation (AF) and a cardioversion was attempted. I cleared the operating room at 11:00 a.m. and returned to my hospital room with the AF gone. The hospital helped put a heart monitor on my chest midway over the sternum that had three stainless steel wire loops holding the split sternum together. I would estimate the wire loops were not more than a centimeter or two apart from the monitor. About 7:00 p.m. the AF returned, and I was advised to go for a pacer, which was done the next day. Fortunately, that pacer lasted until January of this year. I have a theory about the event, and why it failed. The monitor is actually a radio; electric devices have wires in them that carry electricity; the antenna is in the overhead of the hallway outside the hospital room. Any wire that carries electricity has magnetic forces circumferentially arranged. That magnetic force interfered with the micro electrolytic event that makes a muscle move, and that cardioversion treatment became a failure. Any chance I'm right? And if so, is there a solution? Dr. Zipes: It is very unlikely that the magnetic force you describe caused the atrial fibrillation for several reasons. First, and most important, the skin offers significant resistance to the passage of such electromagnetic forces and protects us from their effects as we stand close to electric sources of all kinds. Second, if such electromagnetic interference (EMI) did occur, it would as likely cause the lower chambers of your heart (ventricles) to fibrillate, and you would have had cardiac arrest from ventricular fibrillation. Third, recurrence of atrial fibrillation after cardioversion is so common, it even has its own initials: ERAF, early recurrence atrial fibrillation. Therefore, what you describe is not at all unusual without having to invoke other causes.
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