October 7, 2014 was a Tuesday like many others in the South Bay. Blue skies,
light breeze, perfect 78º weather on the beach.
That afternoon Peter Weinstein was playing volleyball with his friends,
like he often does two to three times a week, near 3rd Street in Manhattan
Beach. The 54-year-old marketing consultant and father of two began to
feel irregular heartbeats. As he jumped, lunged for the ball and continued
to play, he recognized what was happening.
Weinstein has been treated for irregular heart rhythms in the past, so
he knew the signs. He describes his heart feeling “like the sound
of tennis shoes in a dryer” during past episodes. On this day, however,
it felt more like a pulsing, nonstop, “rapid-fire heart rate.”
At first he just slowed down but continued to play. The palpitations were
excessively fast, but since he’s had these before, he didn’t
think it was anything serious. “I was having an episode, but I’m
so used to them and they typically go back to normal,” says Weinstein.
Little did he know, this time was different. After a few minutes of playing
less strenuously, Weinstein decided to take a break from the game. Ten
minutes later, however, nothing had resolved. In fact he later learned
his condition had become worse. But since Weinstein had experience with
arrhythmia, he remained calm and didn’t suspect much danger.
Instead he walked to his car and used an app on his iPhone called Instant
Heart Rate, which showed his heart rate was 186 beats per minute. He then
drove home and used another iPhone app called AliveECG by AliveCor. The
app records the electrical activity of his heart, so Weinstein and his
wife, Tracy Bercu, MD, got a better idea of what was happening. Weinstein
says his graph “looked like hundreds of icicles,” which is
not what someone wants to see.
Weinstein’s wife was able to then text the ECG to
Victoria Shin, MD, a cardiologist on staff with Torrance Memorial Medical Center. Although
Dr. Shin wasn’t in town, she forwarded the information to a
Torrance Memorial Lundquist Emergency Department physician. By the time Weinstein arrived, an entire team was ready for him.
Dr. Shin, who is a big fan of the AliveCor apps, says she had suggested
that Weinstein use the app, since he had experienced arrhythmias in the
past and the instant information could help him determine if he needed
to get help. “Peter is a pretty stoic guy. He doesn’t complain
much. So if he didn’t have this app, he may have just brushed off
the symptoms,” she says.
Clearly Dr. Shin knows her patient well, as Weinstein admitted that even
with the ECG, he wasn’t quite ready for medical treatment, as he
“felt fine.” That’s the insidious thing about irregular
heart rhythms—the people who experience them often have no way of
discerning the harmless from the fatal.
“I’m telling her that I feel fine, by the way; we don’t
need to go to hospital. I’m cracking jokes, telling Tracy that it’ll
resolve itself. I’m saying, ‘We’re fine, I’ve
had these type of episodes before,’” Weinstein explains, laughing.
Looking back, he says he’s glad he had the app on his phone and
that his wife was home that day, as he’d likely have stayed at the
house waiting for his heart to revert back to a normal rhythm—which
might not have happened this time. Even in the ER, Weinstein says he cracked
a few jokes and told staff, “I’m okay, it’ll resolve
itself.” He also took a silly selfie to send to his children so
they’d know he was okay.
But once multiple doctors came into the room and pads were in place to
shock his heart back if necessary, Weinstein sensed the gravity of the
David Z. Presser, MD, the ER physician, “was amazingly calm and reassuring,” says
“Dr. Presser was saying, ‘All this equipment is like an umbrella,
and we probably won’t need it, but it’s here if we do.’
In that environment, he was very calming—a very Zen man.”
Weinstein was then given an intravenous infusion of amiodarone, and when
his heart went into a recognizable rhythm he received an injection of
the drug adenosine, which nearly stops the heart in order to reset its
rhythm back to normal. It is rarely ineffective, but if so cardioversion—the
delivery of an electrical shock to the heart—may be necessary, hence
the pads nearby.
“The heart burned like hot lava, and then it went back into rhythm.”
At this point, Weinstein tried to get up and go back home. The physicians
wouldn’t allow it, insisting he be admitted for three days for testing
and to undergo an
electrophysiology (EP) test to assess and diagnose the cause of his arrhythmia.
TORRANCE MEMORIAL’S HEART RHYTHM CENTER
Matthew Ostrom, MD, stepped in for testing and treatment; he explains that Weinstein’s
case was sensitive since Weinstein had already undergone two previous
ablations for supraventricular tachycardia (SVT) and atrial fibrillation
(AF), a type of irregular heartbeat (arrhythmia) in which the heart’s
upper chambers quiver, or fibrillate.
AF increases a patient’s risk of blood clots, which may cause stroke
or other problems. The lower chambers beat without a regular rhythm and
may beat too fast, potentially creating symptoms like lightheadedness
or chest pain as well.
“We had to assume the worst and hope for the best. The first goal
was to determine what the arrhythmia was and the second goal to potentially
treat it, if possible,” Dr. Ostrom explains.
To do this, EP tests were performed at
Torrance Memorial’s Heart Rhythm Center, housed with state-of-theart technology and highly trained, specialized
staff. This EP test would determine if Weinstein’s condition was
dire or more benign and possibly treatable with ablation.
There were two possible diagnoses: a wide complex ventricular tachycardia,
which can be life-threatening and often requires an implantable defibrillator,
or an SVT with aberrancy, which can be treated and corrected with catheter
ablation. During the EP test, performed by inserting specially designed
catheters into the heart which measure the electrical signals of the cardiac
tissue, Dr. Ostrom made an amazing discovery. Weinstein had a rare but
entirely curable condition: Wolff-Parkinson-White (WPW) syndrome.
In WPW, an extra electrical pathway exists between the heart’s upper
chambers (atria) and lower chambers (ventricles), causing a rapid heartbeat
(tachycardia). The extra electrical pathway is present at birth and causes
arrhythmia in only about 4 out of every 100,000 people.
“He had a concealed pathway that he was born with on the left side
of his heart between his atrium andventricle, predisposing him to having
arrhythmias: Wolff-Parkinson-White (WPW) Syndrome. We could immediately
see that [the pathway] was the cause of his wide complex tachycardia,”
says Dr. Ostrom.
He continues, “Once we were able to map and ablate the pathway on
the left side of the heart, the tachycardia went away. It’s an optimal
outcome. He should do well and not have any more arrhythmia going forward.
That’s the beauty of the EP lab: We go in to answer a question and
make a diagnosis, while at the same time we can deliver potentially curative
Clearly Dr. Ostrom was thrilled. “It’s very fulfilling for
us as physicians because there are few conditions in medicine that we
can say we truly cure. Successful accessory pathway ablation achieves
this; it’s quite rewarding.”
Weinstein’s life has returned back to its normal rhythm too. He’s
back out on the beach playing volleyball. He’s still cracking jokes.
Perhaps the only adjustment he’s made to his life is one we could
all benefit from: “Just a little less coffee and no red wine.”