{"id":29015,"date":"2020-02-04T10:43:43","date_gmt":"2020-02-04T17:43:43","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=29015"},"modified":"2022-11-16T11:08:40","modified_gmt":"2022-11-16T18:08:40","slug":"watchman-device-alternative-to-blood-thinners","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/watchman-device-alternative-to-blood-thinners\/","title":{"rendered":"The Watchman device proves to be an effective alternative to blood thinners for arrhythmia patients"},"content":{"rendered":"
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\"woman
Sue Femmber’s history of hemorrhaging, along with her mountain home far from emergency care, gave doctors reason to look for an alternative to blood thinners to continue to protect her from strokes. Photo by Joel Blocker, for UCHealth.<\/figcaption><\/figure>\n

In a quaint cabin atop Flagstaff Mountain near Boulder lives 70-year-old Sue Femmer has a clear view of the sprawling Denver metropolis and the Rocky Mountains.<\/p>\n

She has an effervescent smile, a warm and friendly energy, a jolly approach to life. She loves to knit, usually for the delight of gifting her creations to others. Femmer greets her guests with coffee and freshly baked bread.<\/p>\n

Before she retired, Femmer worked in Boulder Valley School District as a special education professional and, before that, a juvenile probation officer. Her firewood is cut and stacked, porch and walks shoveled and her property has been mitigated for wildfire. Femmer is not at all intimidated by the challenges of mountain living.<\/p>\n

Her heart, though, has a much different story, one that would require the expertise of medical professionals she saw through a partnership with UCHealth cardiology and the Boulder Medical Center.<\/p>\n

Where it all began<\/strong><\/h3>\n

\u201cI was passing out in weird places for no reason, like in the police chief\u2019s office,\u201d Femmer said. \u201cAnother time I was walking the Boulder Creek path, and then a few times at the school. \u2026 Each one brought me to the hospital.\u201d<\/p>\n

Femmer\u2019s primary care doctor looked for common themes among the incidents, and Femmer recalled each time she\u2019d experienced breathing issues. Living at 8,000 feet and working at an elevation even higher during her school years, she figured her \u201csymptoms\u201d were products of her Rocky Mountain lifestyle.<\/p>\n

But it was actually heart arrhythmia, a change in the normal sequence of electrical impulses, causing the heart to beat too fast, too slowly or erratically.<\/p>\n

\u201cWe don\u2019t see that people have worse symptoms (of arrhythmia) at higher altitude, but what we do see is that they feel<\/em> worse \u2014 there is less oxygen, so they tend to be winded,\u201d said Dr. Eric Riles<\/a>, a clinical cardiac electrophysiologist at UCHealth Heart and Vascular Center \u2013 Medical Center of the Rockies<\/a>.<\/p>\n

\"Woman
Sue Femmer lives in a quaint cabin atop Flagstaff Mountain west of Boulder, a location that had her looking for alternatives to blood thinners. Photo by Joel Blocker, UCHealth.<\/figcaption><\/figure>\n

Needing an alternative to blood thinners<\/strong><\/h3>\n

In 2015, about the time she retired from teaching, Femmer was prescribed warfarin, a common blood thinner medication.<\/p>\n

With heart arrhythmias, the blood doesn\u2019t pass efficiently through the heart because the top chambers are beating irregularly. Slowing of the blood means clots can form, and those clots account for 25-30% of all strokes, according to Riles.<\/p>\n

\u201cWe put patients on blood thinners to prevent that,\u201d he said.<\/p>\n

Medications are usually the first line of treatment for such heart conditions because they are fairly straightforward and people respond well to them, Riles said.<\/p>\n

\"woman
Sue Femmer loves to knit, usually for the delight of gifting her creations to others, and she’ll greet her guests to her mountain cabin with coffee and freshly baked bread. Photo by Joel Blocker, for UCHealth.<\/figcaption><\/figure>\n

But on Sept. 28, 2015, Femmer was once again in the hospital, and this time for a cerebral hemorrhage (bleeding inside the brain). She spent more than 10 days in the hospital but recovered without needing surgery. It was clear that they needed to consider an alternative to blood thinners.<\/p>\n

Dealing with arrhythmia<\/strong><\/h3>\n

On June 18, 2018, shortly after UCHealth partnered with Boulder Medical Center, Femmer\u2019s primary care physician referred her to Dr. Riles.<\/p>\n

\u201cSue had lots of symptoms, palpitations, shortness of breath, and was not feeling well,\u201d Riles said. \u201cShe had a history of abnormal heart rhythm and had undergone ablations in 2017 for atrial tachycardia.\u201d<\/p>\n

Atrial tachycardia is one type of arrhythmia. Ablation is a treatment in which doctors identify a tiny area of abnormal heart tissue where the arrhythmia originates and cauterize that region to stop the arrhythmia. It\u2019s usually the next line of defense when medication is no longer an option.<\/p>\n

Identifying arrhythmias to better treat the condition<\/strong><\/h3>\n
Types of Arrhythmias<\/strong><\/p>\n

Atrial fibrillation (AFib)\u00a0= upper heart chambers contract irregularly<\/p>\n

Bradycardia\u00a0= slow heart rate<\/p>\n

Conduction disorders\u00a0= heart does not beat normally<\/p>\n

Premature contraction\u00a0= early heartbeat<\/p>\n

Tachycardia\u00a0= very fast heart rate<\/p>\n

Ventricular fibrillation\u00a0= disorganized contraction of the lower chambers of the heart<\/p>\n

Source: heart.org <\/div>\n

Femmer\u2019s previous two sessions of ablation treatment had provided only temporary relief, so when she met Riles, her condition had worsened.<\/p>\n

\u201cAt that point it was unclear what was causing it \u2014 she had arrhythmia, but what type?\u201d Riles said. \u201cWe weren\u2019t sure if it was a recurrence of the arrhythmia she had before or something new.\u201d<\/p>\n

Cardiologists are able to correlate palpitations and shortness of breath with specific heart conditions. But in order to do this, they must be able to see and hear those often-sporadic symptoms when they examine the patient, which can be difficult.<\/p>\n

To capture cardiac symptoms over a longer period of time, patients are often sent home with heart monitors. There are several different monitoring options, both short- and long-term.<\/p>\n

\u201cRecording is everything,\u201d Riles said. \u201cCatching it is like fishing. You need to be there at the right time.\u201d<\/p>\n

Femmer was hooked up to a long-term monitor that was placed under her skin and records rhythms for up to three years. Doctors download that information and use it in their diagnosis.<\/p>\n

Dealing with several heart arrhythmias<\/strong><\/h3>\n

There are about a half-dozen arrhythmias, which originate in and affect different locations of the heart, according to Riles. The type and location direct the treatment plan.<\/p>\n

Femmer was found to have both AFib and tachycardia.\"\"<\/p>\n

Doctors started again with medications, but Femmer had various side effects that made her and her care team consider other options.<\/p>\n

\u201cWe have to talk about the risks and benefits (with the options),\u201d Riles said. \u201cWe knew we needed to protect her against stroke with blood thinners, but the cost of bleeding was too high.\u201d<\/p>\n

That\u2019s when Riles reached out to his colleague, Dr. Justin Strote<\/a>.<\/p>\n

Team-based approach to cardiology<\/strong><\/h3>\n

Riles is part of a specialized cardiology team of almost a dozen UCHealth providers who visit with patients weekly at Boulder Medical Center<\/a>.<\/p>\n

\u201cWe have selected a group of people for our team that can provide the spectrum of care for different cardiac conditions,\u201d Riles said. \u201cAnd through that partnership with (Boulder Medical Center<\/a>), we can then coordinate care among the other doctors so patients can get advanced care in a small community setting.\u201d<\/p>\n

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Specialties in cardiology<\/h2>\n

Cardiovascular services at UCHealth Heart and Vascular Clinic \u2013 Broadway, 2750 Broadway St., in Boulder<\/h5>\n