Latest news with #arrhythmia
CBS News
a day ago
- Health
- CBS News
A woman's heart suddenly stopped. Two passing nurses saved her life.
Merryl Hoffman knew she was taking good care of her heart. The 63-year-old attorney didn't smoke or drink, and she was an avid hiker who used to run marathons and other distance races. In her 40s, she had been diagnosed with a leaky mitral valve and underwent surgery to repair it. Every year since, she has seen a cardiologist to check her heart and its function. The reports always came back clear. When Hoffman left her apartment on Manhattan's Upper East Side on Oct. 23, 2025, her heart was the last thing on her mind. She was saddled with her work bag and purse, hightailing it to the subway station so she could make it to work on time. That's when her memory of the day ends. Shortly into her walk, Hoffman experienced a sudden cardiac arrest. Her heart stopped beating. She collapsed to the ground. Doctors later told her it was a severe arrhythmia that could have been fatal — if not for where Hoffman fell. Hoffman had collapsed outside Memorial Sloan Kettering Cancer Center's Breast and Imaging Center, about two and a half blocks from her subway station. A patient care technician and a passing runner immediately rushed to her aid. Then, Memorial Sloan Kettering nurses Sabrina Castle and Gianna Formisano stumbled upon the scene while walking to work. "We were so shocked. When we were walking up, people were like 'Nurses, nurses!' We didn't know what we were walking into," Formisano said. "People were grabbing our coffee, taking our bags. It was out of a movie, the way that they were like 'Oh, thank God you're here.'" Sabrina Castle and Gianna Formisano outside the Memorial Sloan Kettering Cancer Center. Memorial Sloan Kettering "They absolutely saved my life" Formisano and Castle took over performing CPR, keeping Hoffman's heart manually beating. She didn't have a pulse, and she had hit her head when she collapsed. The nurses also instructed one of the other bystanders to call an ambulance. Early CPR increases survival for patients in cardiac arrest by "at least two or three fold," said Dr. Jessica Hennessey, a cardiologist at NewYork-Presbyterian/Columbia University Irving Medical Center. Early CPR means that blood flow to the brain and heart continues, preserving the health of those organs. Bystanders in a medical emergency should call 911 and immediately start CPR, Hennessey advised. CPR can be done with mouth-to-mouth or with just chest compressions, Hennessey said. After five minutes that "felt like forever," the ambulance arrived, Formisano said. Castle and Formisano helped the EMTs load Hoffman into the ambulance. Then, she was taken to NewYork-Presbyterian's cardiac care unit for further treatment. For the small crowd, the day carried on. Castle and Formisano headed to work. After a few hours, they called NewYork-Presbyterian to see if they could find out more about Hoffman's status. They went to the hospital and spoke to a nurse there. "She was like, 'You got her back. She's intubated, she's alive, you saved her life,'" Castle recalled. Hoffman was still unconscious. She told CBS News that she didn't wake up until five days after the collapse. Her family told her that she had been rushed into surgery. Doctors told her that her heart had stopped for several minutes -- and the actions of Castle, Formisano and other bystanders had saved her. "Without them, I was told, there was no doubt I would have died or been brain dead," Hoffman said. "They absolutely saved my life." Hoffman had an implantable cardioverter-defibrillator placed in her chest to prevent further cardiac arrests. The device shocks the heart if it detects an irregular heartbeat. She also began cardiac rehabilitation. Shortly after, she returned to work. Life began to get back to normal but one question was constantly at the back of her mind: Who had helped save her? A chance reunion While in cardiac rehabilitation, Hoffman found herself telling the story of the strangers who had helped her. A physiologist there overheard her talking about it and thought the story sounded familiar. His girlfriend was friends with two nurses who had helped a woman matching Hoffman's description. After some back and forth, the physiologist connected Hoffman with Castle and Formisano. The trio immediately made plans to get dinner. Hoffman's husband joined them for the meal. There, the nurses were able to fill in the gaps of the October morning when Hoffman collapsed. Sabrina Castle, Merryl Hoffman and Gianna Formisano at the site where Hoffman collapsed. Sabrina Castle and Gianna Formisano "It was very jarring, when they gave my husband and I the blow-by-blow of that morning. There were things we did not know," Hoffman said. "It was pretty incredible." Since that dinner, the women have stayed in touch. Recently, Castle and Formisano even passed Hoffman on the same block where she had collapsed. The three took a photo at the site. "We were like, 'Wow, this is really crazy,'" Formisano said. "'We're running into you on the same spot, on your way to work, on our way to work, but now you're alive and well and in a much different state than when we met you the first time.'"
Health Line
21-05-2025
- Health
- Health Line
What You Need to Know About Abnormal Heart Rhythms
An abnormal heart rhythm is when your heart beats too fast, too slow, or irregularly. It's also called an arrhythmia. Your heart contains a complex system of valves, nodes, and chambers. They control how and when blood is pumped throughout your body. If these are disrupted, damaged, or compromised, it can change your heart rate or rhythm. Arrhythmias can cause no symptoms, or you may feel some symptoms. They may include: discomfort fluttering or pounding in your chest pain in your chest shortness of breath lightheadedness fatigue fainting Not all arrhythmias are life threatening or cause health complications. But to be safe, you should report any abnormal heart rhythm to a doctor. The types of abnormal heart rhythms The most common types of abnormal heart rhythms include: Tachycardia Tachycardia means that your heart is beating too fast. For example, a typical heart beats 60 to 100 times per minute in adults. Tachycardia is any resting heart rate over 100 beats per minute (bpm). There are three subtypes of tachycardia: Sinus tachycardia: This is an increased heart rate that can occur in response to exercise, pain, dehydration, excitement, fever, or illness. With sinus tachycardia, your heartbeat returns to its usual rate once you get better or become calm. Supraventricular tachycardia: Supraventricular tachycardia originates in the upper chambers of your heart, known as the atria. Ventricular tachycardia: Ventricular tachycardia is a very fast heart rate that occurs in the lower chambers, known as the ventricles. Atrial fibrillation This disorganized heart rhythm occurs in the upper chambers of your heart. It's the most common arrhythmia. Atrial fibrillation, or AFib, occurs when many unstable electrical impulses misfire, causing your atria to quiver erratically. AFib causes your heart to beat irregularly and can increase your heart rate to 80 to 180 bpm, which is much faster than the typical 60 to 100 bpm. Atrial flutter An atrial flutter typically occurs in the right atrium, one of your heart's two upper chambers. It may occur in the left atrium as well. Atrial flutter is a type of arrhythmia that originates in the atrium and results in rapid atrial rhythm. It's due to an abnormal circuit of electrical activity. In atrial flutter, your heart's overall rhythm can be regular, but your heart rate is often fast. Atrial flutter also increases your risk of stroke. Bradycardia If you have bradycardia, you have a slow heart rate (less than 60 bpm). Bradycardia generally occurs when the electrical signals traveling from the atria to the ventricles become disrupted. Some athletes have slower heart rates because they're in excellent physical condition, which isn't usually due to a heart problem. Bradycardia can result from: medications, including certain blood pressure and antiarrhythmic medications hypothyroidism hypothermia other heart conditions Ventricular fibrillation Ventricular fibrillation is a life threatening arrhythmia in which the ventricles beat rapidly and erratically. This impairs the flow of blood from your heart and leads to cardiac arrest. It's a serious condition that results in death if not immediately treated with defibrillation. Premature contractions A premature contraction is a beat that occurs early. It can occur in the atrium (premature atrial contraction) or in the ventricle (premature ventricular contraction). In either case, when feeling your pulse, it may feel as though your heart pauses or skips a beat. What are the symptoms of abnormal heart rhythms? If you have an abnormal heart rhythm, you may experience some or all of these symptoms: feeling faint, dizzy, or lightheaded shortness of breath irregular pulse or heart palpitations chest pain pale skin sweating fainting fatigue What causes abnormal heart rhythms? Several factors may cause an abnormal heart rhythm. These can include: High blood pressure High blood pressure means too much force is required to push the blood through your blood vessels. It creates more resistance to blood flow and can affect how your heart works. Over time, high blood pressure can lead to heart disease. Coronary heart disease Coronary heart disease is a serious heart problem that occurs when cholesterol and other deposits block your coronary arteries. This plaque prevents oxygen and essential nutrients from reaching your heart. Heart conditions or damage to the heart A heart condition or an injury to your heart can lead you to develop an atypical heart rate. Some of these conditions may have other symptoms as well. They may include: changes in your heart's muscle after illness or injury healing after heart surgery structural abnormalities of your heart heart failure, which happens when your heart can't pump an adequate amount of blood damage to your heart after a heart attack Medications Some medications or substances may cause your heart rate to change. Medications that may cause your heart rate to increase include: caffeine nicotine decongestants, such as phenylephrine or pseudoephedrine amphetamines, which are drugs that stimulate the brain asthma medications, such as an albuterol inhaler other recreational drugs, such as cocaine Medications that can cause your heart rate to decrease may include: beta-blockers, which treat high blood pressure calcium channel blockers certain antiarrhythmic medications, such as digoxin and amiodarone, clonidine, and donepezil Anxiety or emotional distress Anxiety or other emotional distress can increase your heart rate as part of your body's fight-or-flight response. This can cause sinus tachycardia. You may feel heart palpitations. Your accelerated heart rate typically slows once you calm down. Illness or fever Having an illness or fever may temporarily cause sinus tachycardia. This may temporarily raise your heart rate. Once your illness resolves, your heart rate typically returns to its normal rate. Other causes Other factors can also cause alterations in your heart's rhythm. These can include: pain electrolyte imbalances, such as low potassium, calcium, and magnesium sleep apnea blood clots anemia hypothyroidism other health conditions What are the risk factors for abnormal heart rhythms? The risks for arrhythmia can include: smoking previous heart conditions, or a family history of heart conditions diabetes stress being overweight being physically inactive a diet high in fats and cholesterol high blood pressure or other health problems drinking alcohol in excess drug misuse sleep apnea Diagnosing abnormal heart rhythms A doctor typically performs a physical examination, which may include listening to your heart with a stethoscope and examining your heart's electrical impulses with an electrocardiogram (EKG) machine. This can help them determine whether your heart rhythm is abnormal and identify the cause. Other tools that doctors use to diagnose an arrhythmia include: Echocardiogram: This test is also known as a cardiac echo. It uses sound waves to take pictures of your heart. Rhythm monitoring: You'll wear ambulatory rhythm monitoring, such as a Holter monitor or event recorder, for at least 24 hours while doing your daily activities. These monitors allow your doctor to track changes in your heart's rhythm throughout the day. Stress test: For this test, a doctor has you walk or jog on a treadmill to see how exercise affects your heart. The Healthline FindCare tool can provide options in your area if you need help finding a cardiologist. Treating abnormal heart rhythms The treatment for an arrhythmia depends on its cause. You may need to make lifestyle changes, such as increasing your activity level or changing your diet (for example, limiting caffeine intake). If you smoke, a doctor may recommend you consider quitting smoking and provide resources or medication to help. You might also require medication to control your heart rate and any secondary symptoms. This may include rate-controlling medication or antiarrhythmics to control your heart's rate and rhythm. Certain arrhythmias, such as AFib and atrial flutter, can increase your risk of a stroke. A doctor may recommend blood-thinning medications to lower your risk of stroke. For severe abnormalities that don't go away with behavioral changes or medication, a doctor may recommend: pharmacologic cardioversion, which uses medication, or electrical cardioversion, which uses an electrical shock to your heart other heart testing and procedures, such as cardiac catheterization, to diagnose a heart problem catheter ablation to identify and destroy tissue that causes abnormal rhythms implantation of a pacemaker or cardioverter defibrillator surgery to correct an abnormality Outlook: What should I expect in the long term? Although arrhythmias can be quite serious, they can often be managed with treatment. Along with treatment, a doctor may monitor your condition with regular checkups. Prevention Once your arrhythmia is under control, a doctor may discuss ways to keep it from returning. Certain lifestyle choices can go a long way toward helping you control your condition. A doctor will probably recommend that you: eat a heart-healthy diet exercise regularly quit smoking, if you smoke reduce alcohol intake, if you drink alcohol
Medscape
06-05-2025
- Health
- Medscape
Treat AFib ‘Diagnosed' by Smartwatch?
This transcript has been edited for clarity. Welcome to Impact Factor , your weekly dose of commentary on a new medical study. I'm Dr F. Perry Wilson from the Yale School of Medicine. A 77-year-old man with some cholesterol issues, but otherwise healthy, feels a fluttering sensation in his chest, along with some shortness of breath. It's disquieting but not painful. It persists for an hour or so and then seems to go away on its own. The next day it happens again, and his wife finally convinces him to call his doctor. He goes into the office where a 12-lead EKG is placed and the diagnosis is made clear: atrial fibrillation (AFib), the most common arrhythmia in the world. That is how AFib used to be diagnosed: a symptom, a doctor's visit, an EKG. It is data from people diagnosed in that way that gave us all our guidelines about how to treat AFib — rate control with beta-blockers, anticoagulants, and so on. But that's not really how AFib is getting diagnosed anymore. Now, that whole process is boiled down to a smartwatch notification. Whether we realize it or not, we are in a whole new world of medical diagnosis. The era of waiting for a symptom to develop and having a doctor order a diagnostic test is rapidly coming to an end. We have multiple consumer-facing products that give real information about health status, from blood pressure to blood sugar. We have direct-to-consumer testing ranging from genetics to cancer screening. We have machine learning models that can look at your prior data and make predictions about your future health without you ever setting foot in a doctor's office. Is that a good thing? Let's take the AFib example. Your smartwatch tells you it thinks you have AFib. You are having no symptoms whatsoever. We call this 'subclinical AFib.' What emotions are you feeling? Anxiety over a new medical problem? Relief that it was caught? Are you glad you had the watch on or is ignorance bliss? To remove this from the realm of emotion, I will make the argument that detection of a disease is only important insofar as it can be treated. And I'll go one step further to say that early detection of a disease is only important insofar as early treatment provides better outcomes than late treatment. So, how do we treat AFib? Well, in the old 'visit your doctor' days, we knew just what to do. We calculated your risk for stroke based on something like the classic CHA 2 DS 2 -VASc score, and if the stroke risk was high enough — usually 2 or higher — we put you on a blood thinner. But blood thinners aren't exactly gummy vitamins. The data are quite clear that, among people with AFib detected the old-fashioned way, blood thinners reduce the risk for stroke. But they come at a cost, and that cost is bleeding. Risk/benefit. As ever. For always. This is why we estimate stroke risk before prescribing blood thinners; if it is very low, the benefit is not worth the risk. But what about people whose AFib is detected in the new way, the smartwatch cohort? What about their risk? We can actually answer this question now, thanks to two randomized trials — the ARTESIA and NOAH-AFNET 6 studies — that specifically evaluated whether anticoagulation was useful in people with what they call 'device detected subclinical atrial fibrillation.' This would include smartwatch types but also people with other devices, like pacemakers, that might be able to detect AFib incidentally. The studies differed in their primary results. ARTESIA showed that the use of a blood thinner reduced the risk for stroke but increased the risk for major bleeding. NOAH-AFNET showed that the use of blood thinner had minimal effect on the risk for stroke but increased the risk for major bleeding. Benefit and risk. Putting the data together, the benefit in terms of reducing stroke seems rather small, and the risk for bleeding is clear and real, but, how do you compare those things? What's worse — a stroke or bleeding? Or, to make the question even harder, how many bleeding episodes are equal to one stroke? Finally, this week we got a really interesting approach to answer that question, thanks to this study appearing in JAMA Network Open, which integrates not only the two big trials of blood thinners for subclinical AFib, but also the risk for stroke with the risk for bleeding. Here's how it worked. The study was done using a computer. I know — all studies are done with computers. But here I mean literally. The authors simulated 20,000 individuals in a computer. All of them were basically the average of patients in the NOAH and ARTESIA trials — around 77 years old — and had the same baseline risk for stroke, bleeding, and death from other causes as the control group in those trials, which is to say about 1% for strokes and bleeds and 4.3% per year for death from other causes. Half of the virtual humans with subclinical AFib would get blood thinners and half wouldn't. The researchers also assumed that the effect of treating these people would be the average effect seen in those trials — to wit, reducing the risk for stroke by 32% and increasing the risk for bleeding by 62%. With that, they could run these 20,000 little silicon beings through a web of potential changes in health status — this is called a Markov chain — all with various probabilities. Basically, they tell the computer to skip forward a month at a time. Everyone starts out healthy. After a month, most people are still healthy; strokes and bleeding and death are rare events, after all. But some people experience one of those outcomes. And then time leaps forward again, and some more people experience those outcomes, and maybe some of the people from the past month get better and some people develop overt atrial fibrillation and go on the old-fashioned "see your doctor" pathway. It's all driven by probability. And they didn't just capture whether the people would have a stroke or a bleed or not; they captured how bad it would be in terms of quality of life. This is how you start to compare apples and oranges. A stroke can be devastating to quality of life. But bleeding can be as well, particularly bleeding in the brain. With every cycle of the simulation, we know how these 20,000 people are doing not just in terms of whether they are alive, but in terms of their quality of life. With that set up, you can ask a really straightforward question: If I take a healthy person with subclinical AFib, will their quality of life be better over the next 10 years if I treat them with a blood thinner or if I don't? With 20,000 patients iterating in silicon, over the 10-year virtual time scale, you'd see 1076 strokes if you didn't treat with a blood thinner and 843 strokes if you did. That's good. But treatment would net you an additional 453 major bleeding events. That's bad. Treatment would lead to 55 fewer deaths. That's good. But for an individual person, what is the answer? With treatment, do you live longer and with better quality of life? Well, over 10 years, treating someone whose smartwatch tells them they have AFib with a blood thinner will increase their lifespan — by 9 days. It will also increase their quality-adjusted life — by 9 days. Nine days over 10 years of treatment. A net benefit, but, come on. Nine days? Now, I know what you're thinking. We don't just blindly treat everyone, even when they are diagnosed with AFib the old-fashioned way; we treat them based on their stroke risk. Well, the authors could give these simulated patients any stroke risk they wanted. At the high end of risk, treatment with a blood thinner improved quality-adjusted life duration by 11 days. It is very hard for me to look at this data and conclude that we should be treating subclinical AFib with these drugs. Of course, this is one of those 'talk to your doctor' situations. The risk/benefit paradigm requires some personal reflection about risk tolerance as well as thinking through the implications of a stroke and the implications of a major bleed. In a larger sense, this study is emblematic of a problem we'll face in this new direct-to-consumer medical economy. Every medical decision is based on the risk vs the benefit of treatment, but our understanding of risk comes from a dying paradigm of diagnostic care that occurs in the doctor's office. People diagnosing themselves almost certainly have lower risk than those who make it to the clinic, which changes the treatment calculus substantially. That said, for me at least, there is something disconcerting about knowing that something is going on with my heart and doing nothing about it, even if that is the rational choice. I feel like it would nag at me. The AFib alert on your smartwatch is a genie that can't really be put back in the bottle. People may want to think about turning that functionality off. As a great computer once said, 'The only winning move is not to play.'
