Teresa Kelbaugh thought she had a cold last winter. She couldn’t catch her breath, felt like a weight was sitting on her chest and was very fatigued. She sought care at an urgent care clinic in Lutherville, Maryland, near her home. To her surprise, following some testing, she was taken away in an ambulance to UM St. Joseph Medical Center’s Harry & Jeanette Weinberg Emergency Department (ED).
The Tell-Tale Heartbeat
“The clinic staff checked my blood pressure and did an EKG,” Kelbaugh said. “My heart was racing at 180 beats per minute (BPM).” A normal resting heart rate is between 60 and 100 BPM. “I thought my racing heart might be from the cold medicine that I’d been taking,” Kelbaugh said. “However, my family has a history of stroke and diabetes.”
At the UM St. Joseph ED, the staff worked on lowering Kelbaugh’s heart rate. She met Elliot Sultanik, MD, a board-certified cardiologist with UM St. Joseph Cardiovascular Associates, who was called to the ED to consult on her care. “Dr. Sultanik put me at ease immediately,” Kelbaugh said. “He told me, ‘Don’t worry. You’re going to be all right.’”
An Irregular Heart Rhythm
Kelbaugh underwent an echocardiogram, a painless, noninvasive ultrasound that creates a moving image of the heart. In addition to being diagnosed with atrial fibrillation, which is a type of arrhythmia (irregular heartbeat), she was in heart failure, a serious condition that occurs when the heart can’t pump enough blood and oxygen to the body’s organs. Atrial fibrillation (AFib) is one of the most common heart arrhythmias.
“Usually, the heart’s rhythm is very coordinated from the top chambers to the lower chambers. It’s like a symphony. With atrial fibrillation, the rhythm is more like a high school jam band. It’s a disorganized heartbeat.”
AFib symptoms include heart palpitations, fatigue and even congestive heart failure. Risk factors include high blood pressure, coronary artery disease and being overweight.
Creeping Weight and Fluid Buildup
Symptoms of heart failure include fatigue, shortness of breath and swelling of the lower body. Kelbaugh had noticed her weight creeping up and her legs becoming swollen. She attributed the swelling to her job, in which she sits for much of the day, and would elevate her feet in the evening at home to relieve the swelling.
Kelbaugh was admitted as an inpatient, and Dr. Sultanik prescribed medication management for her fluid buildup as well as her blood pressure. “Every single person from the ambulance to the ED to the hospital was wonderful and treated me really well,” Kelbaugh said. “They explained every step of my care to me.” Once her fluid buildup, blood pressure and heart rate improved, she was discharged from the medical center, but she required further care.
Cardioversion or Ablation Restore Rhythm
Soon after, Kelbaugh returned as an outpatient to the Sandra R. Berman Heart Institute for a transesophageal echocardiogram, which provided further images of her heart. Dr. Sultanik performed a cardioversion, “which shocks the heart out of AFib by delivering energy that restores a regular heart rhythm, known as the sinus rhythm,” he explained.
Kelbaugh felt immediately better following the cardioversion. “I was like, ‘Wow!’” she said. “I could breathe better. I didn’t have a racing heart. I was so happy to have immediate improvement and relief.” Some AFib is benign and only requires medication management.
When cardioversion isn’t effective, more severe AFib may require cardiac ablation, during which a cardiologist uses electrical energy that is delivered through a catheter inserted into a blood vessel and guided to the heart. The arrhythmia is destroyed by using heat, cold or short bursts of energy to create scar tissue that prevents abnormal electrical signals from traveling through the heart.
Which Comes First?
Although not all AFib is accompanied by heart failure, one may cause the other. According to Dr. Sultanik, it’s not always possible to discover which condition comes first. “Having a very sick heart can lead to AFib, or AFib can lead to heart failure,” he said. “We try to be detectives to figure it out.”
AFib is important to treat because it carries a risk of stroke. “The typical AFib patient is 50 and older,” Dr. Sultanik said. “AFib comes in many degrees of severity. Some patients experience it just once, for others, it’s variable, and for some patients, AFib will persist permanently. Sometimes it happens in younger people in excellent condition and may be brought on by thyroid disease, medications, heavy alcohol use or drug abuse.”
Dr. Sultanik explains there’s also a condition called “holiday heart.” “After a fun weekend of drinking alcohol and eating salty foods, patients come in on Monday morning saying, ‘My heart feels like it’s beating out of my chest,’” he explained.
“Today, I’m going to show up and say yes!”
—TERESA KELBAUGH
Hearty Recovery: A Dance Hobby Is Born
Under Dr. Sultanik’s care, Kelbaugh has made a great recovery. Following her cardioversion, she wore a portable heart monitor for 10 days to make sure that her heart was beating properly. “It came out fine,” she said. “Dr. Sultanik has been my biggest cheerleader. I’ve lost more than 30 pounds. I’m eating right and being mindful to get up and move around rather than sitting all day.”
Best of all, Kelbaugh developed a new hobby— ballroom dancing. “I love music,” she said. “I was at a home and garden show, and there was a booth for ballroom dancing. I thought, ‘Today I’m going to say yes!’ For me, dancing isn’t exercise. It’s active and fun, and I’m enjoying dressing up and being in competitions.”
Atrial Fibrillation Symptoms
- Chest pain
- Dizziness or fainting
- Extreme fatigue
- Heart palpitations or racing heart
- Trouble breathing
Heart Failure Symptoms
- Bluish color in the lips or fingers
- Chest pain or discomfort
- Chest palpitations—fluttering, racing or pounding feelings
- Coughing or wheezing
- Extreme tiredness
- Feeling dizzy or fainting
- Fluid buildup in legs, ankles, feet or stomach
- Shortness of breath
- Unexplained weight gain
More to Read
- Talk to Your Provider About Improving Your Heart Health
- How to Lower Your BMI & Why It Matters When You Have Heart Failure
- What Does the Term ‘Ejection Fraction’ Mean for Your Heart?
- Living Your Best Life with Heart Disease
UM St. Joseph Cardiovascular Associates includes board-certified, highly trained cardiologists, interventional cardiologists and electrophysiologists who specialize in diagnosing and treating all heart conditions. Please call 410-427-2580 to schedule an appointment. If you think you are experiencing a heart attack or medical emergency, call 911.