Atrial Fibrillation – A silent but deadly condition

Fit mother of two discovered huge risk of stroke after routine heart screening

 

Sylvia Thompson

 

              

I was a fit and healthy child and teenager, playing volleyball, basketball and tennis in school and riding horses until I was pregnant with my second child, Dawn, who was born five years ago.

In fact, we are a fit family. Dawn and her sister, Hazel (8), play Gaelic football and swim. Hazel also plays tennis and basketball and is in an athletics club. My husband, Tony, does triathlons and I play Gaelic football and run in marathons.

I took the free HeartBeat screening after I received an offer with the annual renewal letter from my private healthcare insurance provider, Laya. I hadn’t had any annual health check-ups in recent years so I just decided to go along for the screening in July of last year.

Electrical malfunction
My blood pressure was taken. My BMI (Body Mass Index) was calculated and I was given an electrocardiograph test. The nurse immediately said that she noticed an irregularity on the ECG readout. I then went into the doctor who asked me about my exercise levels.

I explained that I was training for the Dublin marathon in October and was planning to ramp up to longer runs over the next three months. He explained how the ECG showed that I had atrial fibrillation (an electrical malfunction in the heart beat) and that I needed to see a cardiologist to have it sorted out.

The HeartBeat team faxed my GP the results of the screening and he rang me back straight away. He knows I run and is fairly fit himself but he explained how important it was that I have the irregularity investigated. “It’s a little more than a heart murmur. You’ll have to stop running and football training until you find out what’s causing it,” he told me.

He gave me a prescription for a form of aspirin to thin the blood while I awaited an appointment with a cardiologist.

Valve defects
Of course I Googled the condition and realised that while the more common form of AF was a racing heartbeat (with more than 200 beats a minute) and palpitations, I had a form in which my heart skipped a beat every one in four beats. I still had to find out what was causing it.

The cardiologist did an echo ECG which didn’t show up any valve defects or fibroids in my heart. What it did show though was the lower chamber of my heart was enlarged. We discovered there wasn’t enough blood being pumped down from the upper chambers (right and left atria) into the lower chambers of my heart (right and left ventricles).

The problem with this is that a blood clot can form if the blood is not being pumped enough and this clot can be passed out of the heart into another part of the body. If the clot lodges in an artery in the brain, this can cause a stroke. I was told that I was five times more likely to have a stroke than most people.

Meanwhile, I got all of my family – my three sisters and my brother – to have ECGs to check if they also had the condition. It turned out that they hadn’t so that ruled out a genetic component even though our mother died of a stroke and heart attack at 73. She also had high blood pressure and smoked, neither of which I had.

The cardiologist suggested I have a cardiac MRI scan to check that there was no underlying fault in my heart. Meanwhile, he prescribed a stronger blood-thinning medication.

The MRI scan didn’t show up any fault in my heart. The next step was to have a cardioversion, a procedure under general anesthetic which would send an electric shock through my heart to get it to stay in rhythm. I was told that there was a 50 per cent chance that this operation would bring my heart beat back to normal but that the longer one had atrial fibrillation, the less likely it would work.

I was much younger than any other patients who have the operation but I still didn’t know how long I had the condition.

Within five days of the operation, I knew my heart had gone out of rhythm again. I felt sluggish. I got up and sat on the bed, took my pulse and could feel my heart out of rhythm again. Another cardioversion operation was scheduled for six weeks after the first and while that worked, the cardiologist also put me on betablockers to keep my heart in rhythm.

Betablockers
On a more recent check-up with the cardiologist, my betablocker prescription was reduced from two tablets a day to one and I will have to take these for the rest of my life. My blood-thinning medication was also changed to a lower dose one.

The only other option for me is to have pulmonary aversion – a surgical procedure which will cauterise a vein at the back of my heart to change the electrical signal from the top to the bottom chamber. While I don’t like the idea of being on medication for the rest of my life, I don’t have any symptoms at all so the cardiologist sees no rush to do such a procedure.

The cardiologist has told me that 50 per cent of people with atrial fibrillation don’t have any symptoms, but it’s the biggest cause of stroke. Yet because my heart is perfect – apart from the electrical malfunction in its beat, the chances of me having a stroke are much less than other people with AF who have defects in their heart as well.

Overall, I have been told that my fitness levels have helped me. I’m back running again and back playing football. I haven’t decided for definite yet, but I plan to do the Dublin Marathon in October.

Heartaid takes the field to highlight cardiac problems

By Fintan O’Toole

Saturday, March 24, 2012

By a quirk of fate Ed Donovan was in London last Saturday when Fabrice Muamba collapsed in White Hart Lane.

Work had brought the founder of Heartaid, the only mobile cardiac screening company in Ireland, to the English capital. Ever since they inked the contract with the GPA to provide the service to all inter-county senior football and hurling squads, Donovan has been doing the rounds putting elite GAA panels through the test.

He had been out in Ruislip testing the members of London’s football and hurling setups when he returned to his hotel room last Saturday to take in the Ireland-England Six Nations game.

“I flicked over to Sky Sports after the match and it was all over the news about the Bolton player collapsing on the pitch,” he said.

“It was a coincidence really that I happened to be over doing screening at the time. It was very sad to see but I also thought it was great to see the brilliant reaction of the medical staff present. Even this week I’ve found, by the amount of enquiries we’ve got, that the story has raised awareness. It’s unfortunate it takes a serious situation like that for headlines to be generated.”

The subsequent avalanche of tributes and messages of support to Muamba this week has been heart-warming, yet has also thrown the issue of cardiac problems amongst sports people into the spotlight. Donovan’s background is originally in healthcare management and, having worked in the US for a radiology group, the Cork native returned to work in Blackrock Clinic in Dublin. The tragedies involving Irish sports stars like Cormac McAnallen and John McCall got him thinking about the issue of SADS (Sudden Adult Death Syndrome).

“I wondered what was the cause of it and was there any solution. I read up on it and found that in countries like Italy, anyone who plays organised sport has to get the mobile cardiac screening done. That has reduced SADS deaths in Italy by 89% over the last 25 years.

“I consulted with a lot of cardiologists both at home and abroad and the feedback was that there was a need for cardiac screening.”

It took Donovan, whose sporting background is in rugby having played for Cork clubs UCC and Dolphin, six months to get the pieces in place before Heartaid was born at the end of 2010. A study last year by the GAA’s Medical Advisory Committee found all players under 35 should receive cardiac screening and this led Donovan to contact officials about offering his services to inter-county teams.

“We’d talked to a lot of sports medicine doctors and they were aware of us. I made contact with the GAA and Dessie Farrell in the GPA and told them about our service. We did a pilot with the Dublin minor team, which Dessie managed, last year in February 2011. After a successful pilot, we agreed a contract with the GPA to screen test all inter-county hurling and football teams.”

The test that Heartaid offers is simple. On the day we meet, the sports scholarship students in UCC are undertaking the cardiac screening with Kevin O’Driscoll and Liam Jennings, members of Cork’s All-Ireland U21 winning side in 2009, and current Kerry U21 footballer Mark Reen amongst those being tested. Donovan guides me through the process with the first step involving the completion of a personal and family history questionnaire. A physical examination with a doctor then takes place where an individual’s Body Mass Index (BMI) is calculated. It’s followed by a heart exam with a stethoscope to detect any murmurs or irregular heart rhythms before testing for radial and femoral pulses. The final step involves a 12-lead electro cardiogram examination with cardiac technician Jimmy Ashraf conducting the test. Within 15 minutes it is completed and in 10 days I receive the results which are also relayed to my GP. In an inter-county setup, a team doctor also receives the results. People are sometimes unsure what to expect,” admits Donovan. “But the test is painless and doesn’t take long. If something is picked up, it can then be tested further.”

The contract with the GPA ensures Donovan is hitting the road most weekends. When we met he had been screening the Laois footballers the previous Saturday morning and went on to test the two Derry inter-county squads the following day. Next weekend the Armagh hurlers are his port of call. But the service is not just GAA based with rugby sides like the Connacht academy and the senior team also getting tested while Irish hockey player John Jermyn is one of those who has a testimonial supporting the service on their website.

“We’re the only company of the kind currently in operation in Ireland. But I think it was definitely needed. The goal is to reduce the cases of SADS in Ireland and raise awareness, so that’s what we’re trying to do.”

* For more information see www.heartaid.ie

Read more: http://www.irishexaminer.com/sport/kfididcweyid/rss2/#ixzz1sNbIph4u

Tyrone squads latest for Cardiac Screening by HeartAid

Ed Donovan of Heartaid, Conor Gormley & Mark Donnelly – Tyrone Senior Footballers
Ed Donovan of Heartaid, Conor Gormley & Mark Donnelly – Tyrone Senior Footballers

Over 60 Tyrone footballers and hurlers were the latest to undergo the GPA’s cardiac screening initiative which is being provided to all county squads over the coming months.

As part of the GPA’s Health and Wellbeing Programme all county players are entitled to be screened and the mobile screening unit has visited 38 county squads all over the country since the initiative commenced earlier this year.

The tragic loss of Tyrone star Cormac McAnallen in 2004 thrust the issue of Sudden Cardiac Death to the fore in Irish sport and led to the provision of automated external defibrillators in many sports clubs nationwide. It also highlighted the need to promote cardiac screening for young athletes.

The GAA’s Medical and Scientific Committee subsequently carried out an extensive body of work in this area and issued a number of recommendations for the screening process. Given that up to 100 young persons (under 35 years) die each year in Ireland from Sudden Adult Death Syndrome, it also recommended that all players should be screened.

In line with the GAA’s Medical and Scientific Committee’s Cardiac Proposals, the GPA, in association with mobile cardiac screening service Heartaid, is providing the screening facilities for each squad.

The Cardiac Screening Programme is funded by the GPA and is seen as a critical welfare component of the Association’s Player Development Programme.

The Development Programme, supported by the GAA, provides a comprehensive suite of support services for inter-county GAA players in the areas of Career Development, Education, Health and Wellbeing, Life Skills and Benevolent Support.

 

GPA kick on with Cardiac Screening

By Michael Moynihan

Friday, October 28, 2011

MORE than half of the senior inter-county hurlers and footballers in the country have been screened forheart problems by a new company working with the Gaelic Players’ Association, it has emerged.

Ed Donovan of mobile cardiac screening company Heartaid says the remaining hurlers and footballers will be screened in the coming weeks, but he stresses the need for sportspeople operating at all levels to be screened for cardiac problems.

"We’re a service provider to the GPA but we don’t just work with elite sportspeople — we’ve screened the Connacht [rugby] Academy and various other sports clubs such as Church of Ireland Hockey Club.

"It’s mandatory in Italy, for instance, where figures for Sudden Adult Death Syndrome have dropped by 89% as a result."

The unexpected and untimely death of Tyrone Gaelic footballer Cormac McAnallen in 2004 brought the necessity of cardiac screening to the fore.

Donovan explained: "If a club chairman rings and asks about the service, we’ll arrange a convenient time — usually in the evening or at the weekend. We send a designated liaison person in the club a time sheet and they allocate each player a time.

"They send back the time sheet and we text the players to remind them. The day of the testing we set up the clinic in a changing room or committee room in the club. The player arrives, fills out a family history questionnaire, signs a consent form and then he or she is seen by our doctor, who’ll carry out various basic tests — blood pressure, body mass index and so on.

"The player is then seen by our cardiac technician, who does a 12-lead electrocardiogram, which helps to pick up genetic cardiac abnormalities, particularly in young people.

"The player’s free to leave then, and we send the information to a consultant cardiologist. He reviews the information and a report is sent to each person, or their guardian/parent depending on age, within a working week. In the event of something being found, we also write to their GP."

Donovan adds that a screening is valid for two years, with best practice recommending sportspeople be tested every second year. For more information log onto heartaid.ie

Read more: http://www.irishexaminer.com/ireland/kfqlcwkfeyoj/rss2/#ixzz1dK6RKq3x

GAA still not scoring well with Cardiac Screening

GAA still not scoring well with cardiac screeningMonday October 03 2011 The awareness and uptake of cardiac screening to detect potential heart problems among GAA players is still too low, according to a new study. The GAA introduced cardiac screening in 2006 following the high-profile death of Tyrone All Star Cormac McAnallen, who died of sudden cardiac death two years earlier. Many young people do not have any signs or symptoms before sudden cardiac death so players may have undetected heart conditions, which leave them at risk. It now advises that screening is the most effective way to identify players at risk over the age of 14. This involves completion of the GAA’s cardiac screening questionnaire, a physical examination and an ECG, which records the electrical activity of the heart. A team from the Department of Rheumatology, Sports and Exercise Medicine at University College Cork recently investigated how aware GAA players were about the service and what the level of uptake is. Data was collected at one hurling competition and one football competition in Cork and it involved a questionnaire handed personally to each player. It found that out of 880 players, 258 (29pc) were aware of the GAA cardiac screening programme. Sixty-two (seven per cent) players had completed the process. They said that media was the most common source of informing them about the issue (39pc). Seven per cent of those asked had been told about it by a doctor. The study found that players with inter-county experience were more informed and more likely to avail of the screening that those who played locally. "Ulster fared best in both awareness levels (42pc) and uptake levels (11pc)," said the research. The authors pointed out that studies had proven that cardiac screening could significantly reduce rates of sudden cardiac death amongst athletes. "It is clear from our study that both awareness and uptake levels are well below the desired target," reported the authors. "A more effective and robust system must be put in place in order to protect our athletes." Most of the conditions that cause sudden cardiac death can be treated, demonstrating how important screening is. Around 100 or more people under the age of 35 die in Ireland every single year from it. It does not just affect sports people but if someone has a serious undetected heart problem, over exertion during sport can act as a trigger. Risk factors include: ?A family history of unexplained death (including cot death) in people under 35 years of age. ?Breathlessness on effort. ?Chest pain on effort. ?Dizziness, fainting and blackouts with no known cause. ?Fast heart rate that comes and goes, even when you are resting. ?Palpitations due to an irregular heart rhythm.