Atrial fibrillation treatment requires careful physician management
Whether treatment by medications or cardiac ablation, there are serious risks
In my career as a Texas medical malpractice lawyer, I have frequently represented patients and their families, where serious injury or death from care provided by a cardiologist or electrophysiologist was at issue. One common area where I have seen substandard care is the management and treatment of atrial fibrillation.
Atrial fibrillation is a condition where the heart’s atria beat irregularly and too fast. The American Heart Association describes it like the heart beating like a quivering bowl of gelatin. When the heart is not beating properly, the body does not get enough oxygen and nutrients.
Symptoms of atrial fibrillation include irregular and rapid heartbeat, heart palpitations (rapid thumping inside the chest), dizziness, sweating and chest pain or pressure, shortness of breath or anxiety, tiring more easily when exercising, and fainting (syncope). Many people are first diagnosed after they pass out or experience a fainting spell.
Untreated atrial fibrillation can progress to stroke, heart failure, and chronic fatigue.
Medication therapy for atrial fibrillation
People who suffer from atrial fibrillation typically seek care from a cardiologist. If testing reveals that the problem is caused by a rhythm disorder, the cardiologist may attempt a trial of medications to see if it can get the cardiac rhythm under control.
According to the American Heart Association, the two components of atrial fibrillation problems include an abnormal heart rate and an abnormal heart rhythm. There are different medications to address each issue, and the standard of care requires an additional prescription of blood thinners to prevent formation of deadly blood clots.
Cardiologists start by addressing the abnormal heart rate, if it is present. Cardiologists may try one or more of three types of medications to control an abnormal heart rate. The first type of medication is beta blockers (like atenolol, bisoprolol, carvedilol, metoprolol, nadolol, propranolol, and timolol), which slow the heart rate. The second type of medication is calcium channel blockers (like dilitiazem and verapamil), which slow the heart rate in patients with atrial fibrillation and reduce the strength of the heart muscle cells’ contraction. The third type of medication is digoxin, which slows the rate at which electrical currents are conducted from the atria to the ventricle.
Once the abnormal heart rate is under control, cardiologists use different medications to attempt to convert an abnormal heart rhythm to a normal rhythm (called chemical/pharmacological cardioversion). There are two classes of medications, both of which come with serious risks and require close monitoring by the doctor. The first medication class is sodium channel blockers (like flecainide/Tambocor, propafenone/Rythmol, and quinidine), which help regular cardiac rhythm by slowing the heart’s ability to conduct electricity. The second medication class is potassium channel blockers (like amiodarone/Cordarone or Pacerone, sotalol/Betapace, and dofettilide).
If a doctor prescribes any of these medications without blood thinners, it is likely a medical mistake or negligence that can cause death from blood clots. Similarly, failing to closely monitor patients as they are placed on drug therapy is dangerous and can lead to adverse outcomes.
Even if the medications are properly prescribed and monitored, though, they sometimes will not bring heart rate and rhythm disorders under control. In such cases, surgical intervention, like cardiac ablation, may be necessary.
What is cardiac ablation?
Cardiac ablation is a procedure performed by an electrophysiologist, a cardiologist with additional advanced training on heart rhythm disorders. When cardiac ablation is performed correctly, it can correct irregular and fast heartbeats, and restore a regular heartbeat.
Cardiac ablation is a procedure where the doctor uses an instrument to apply radiofrequency energy (similar to the way a microwave oven works) to burn or freeze targeted areas of heart tissue that are causing rhythm problems. The idea is to destroy the specific tissue that is causing the cardiac abnormality.
Think about it like this: Medications help to control heart tissues that cause bad heartbeats, while cardiac ablation destroys the tissue.
Risks of cardiac ablation
One of the biggest risks after cardiac ablation is bleeding around the heart. When bleeding occurs between the heart and pericardium (the outer covering sac of the heart) it is called cardiac tamponade. Cardiac tamponade is dangerous because it prevents the heart ventricles from fully contracting and the extra pressure prevents the heart from working properly.
Symptoms of cardiac tamponade include anxiety; restlessness; sharp chest pain that is felt in the neck, shoulder, back, or abdomen; chest pain that gets worse with coughing or deep breathing; breathing problems; discomfort that is sometimes relieved by sitting upright or leaning forward; fainting or passing out; being lightheaded; skin appearance turns pale, gray, or blue; palpitations; rapid breathing; leg or abdominal swelling; jaundice; dizziness; drowsiness; and weak or absent pulse.
Doctors performing a cardiac ablation need to closely monitor patients for these symptoms. If a patient is discharged home and any of these symptoms develop, he or she needs to notify the cardiologist and electrophysiologist immediately.
In cases where there is suspected cardiac tamponade, then the standard of care requires the doctor to perform an emergency electrocardiogram (ECG), which allows immediate diagnosis.
Cardiac tamponade is an emergency medical condition and the treatment is to use a needle to drain the extra fluid that collected around the heart. If it goes untreated, it can quickly lead to death.
We are here to help
If you or someone you care for has been injured as a result of negligent care by a cardiologist or electrophysiologist, then the experienced Houston medical malpractice lawyers at Painter Law Firm are here to help. Call 281-580-8800 for a free consultation.
Robert Painter is an experienced medical malpractice lawyer who represents plaintiffs/patients who were injured by medical negligence or mistakes. He has handled medical malpractice cases in Texas state courts and federal courts, as well as courts in other states. Robert Painter has pursued a wide variety of medical negligence cases, including wrongful death and injuries from cardiac/electrophysiology care, anesthesiology care, surgical mistakes, botched bariatric surgeries, bedsores, birth injuries, brain injuries, sepsis, and others.
Robert Painter is a medical malpractice lawyer at Painter Law Firm PLLC.
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On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes [...]read more
A physician has to supervise the care and prescriptions of nurse practitioners and physician assistants under written, signed agreements
On 4/1/2018, the new law will end the current practice where doctors can secretly enter a DNR order against patient and family wishes
This article was originally published in the September/October 2017 edition of "The Houston Lawyer" magazine
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