By James Beckerman, MD, FACC
Former presidential candidate John Edwards has requested a postponement of his upcoming court dates because of a heart condition reportedly related to an abnormal heart rhythm. There is always more to the story, and more behind the story, but in this case, it’s important to clear up some misconceptions about abnormal heart rhythms, or arrhythmias.
There are as many different types of arrhythmias as there have been Republican front-runners in this year’s primary race. It becomes easier to understand them (arrhythmias that is) if we review a rough sketch of how electricity travels through the heart.
While all of the heart’s cells are capable of initiating a heartbeat, the task typically falls to a group of cells in the right upper chamber of the heart called the sinoatrial node. Electricity then passes south toward another group of cells called the atrioventricular node. The atrioventricular node is like a toll booth, which limits the number of electrical impulses that may proceed throughout the cells in the bottom chambers of the heart. This sums up the electrical pathways that result in a normal heartbeat.
But like in politics, anything can change. Cells can beat too quickly or too slowly, and they can even flip flop. Cells from the upper chambers of the heart can create too many electrical impulses, overwhelming the atrioventricular node and resulting in a fast, irregular heartbeat. Or cells from the bottom chamber can fire on their own, creating an erratic heart rhythm which can be dangerous or unstable.
As you can imagine, any irregularity in your heartbeat or any significant change in your heart rate can cause symptoms, although some asymptomatic people can be surprised to learn they have an arrhythmia. Some people describe their symptoms as palpitations, but they may also experience chest pain, shortness of breath, fatigue, or just a weird sensation. According to John Edwards’ representative, his abnormal heart rhythm may have been associated with a fainting episode. Certain types of arrhythmias may also increase the risk of stroke.
The most important steps in evaluating an abnormal heart rhythm include (1) making sure that the person having it is safe and (2) identifying the abnormal heart rhythm so that it can be treated appropriately. Treatments run the gamut from medications to manage the heart rate or rhythm to devices to prevent extremely slow or very fast heart rates and electrical procedures to shock the heart back into normal rhythm or even burn very small areas of heart tissue to stop the arrhythmia in its tracks. News reports suggest that John Edwards will be undergoing a procedure of some kind, but he has decided to keep the details of his diagnosis and his treatment plan between him and his doctors for the time being.
So it turns out that there is a lot that we still don’t know about John Edwards. But I guess we knew that already.