Getting to the heart of it: Irregular patterns alert to alarming condition

Dan O'Bryan didn't think his dizziness and lightheadedness were anything to worry about. Nearly 100 miles away, the team at Mayo Clinic that was remotely monitoring Dan's heart could see the truth.

Looking back, Dan now can see the connection between his dizzy spells and episodes of lightheadedness, and the slow heart rate and atrial fibrillation diagnoses, that led him to have a pacemaker implanted in his chest.

At the time, however, he didn't realize that his symptoms were anything to worry about. "I didn't think too much about it," Dan says. "I was just having these off-and-on feelings of dizziness once in a while — mostly when I'd get up and walk across a room or while out in the garden. Sometimes it was also associated with heat."

But when Dan told his primary care doctor at Mayo Clinic Health System in Eau Claire, Wisconsin, that the dizzy spells occurred even while he was sitting and watching TV, the seriousness of his symptoms began to come into full view.

"He looked at me and said, 'That's not good,'" Dan says. "So he ordered a number of heart tests — an EKG, echocardiogram. He also ordered a Holter monitor that I had to wear for 48 hours."

In addition to that, Dan's primary care doctor referred him to Diana Trifa, M.D., a Mayo Clinic Health System cardiologist. "I met with her after all of my tests were done," Dan says. "Unfortunately, my test results didn't reveal a smoking gun cause of my dizziness."

Dr. Trifa, however, refused to give up.

"She said, 'We're not going to stop until we find out what's going on,'" Dan says.

Under a watchful eye

Dr. Trifa recommended a mobile cardiac telemetry test. The test uses a device to remotely monitor a patient's heart rhythms for up to 30 days. The portable monitor continuously streams a patient's heart rhythm to a secure online portal and alerts the Mayo Clinic Monitoring Solutions Team if it detects critical cardiac events.

Certified rhythm analysis technicians staff the team 24/7. When it receives an alert, the team reviews the alert and notifies the health care provider about the event. Providers can log in to the portal to access and interpret the patient's heart data and update the team if additional medical attention is required.

"Dr. Trifa ordered the device on a Tuesday, and I got it the next day," Dan says. "When I received it, there were instructions to call Mayo Clinic's Monitoring Solutions Team in Rochester, which I did. And they were just excellent. They walked me through how to do everything — how to wear it, how to apply the leads, how to shower. The step-by-step instructions they gave were very clear."

While the device is capable of continuously monitoring a patient's heart rhythm for up to 30 days, Dan would only need one day for the device to prove its worth. "I got it in the mail on a Wednesday and put it on that night," he says. "The following night ― Thursday ― is when I got my first call from Dr. Yasin."

Almost 100 miles away in Rochester, Minnesota, Omar Yasin, M.D., a Mayo Clinic Cardiovascular Medicine resident physician, was about halfway through his night shift in the ICU when he got a patient alert notification.

"As part of our training, we work in the ICU, and if there are any emergent abnormal findings on the monitors our patients have, we're alerted and then triage whether it's a significant alert that we need to act on immediately or if it's something that can wait," Dr. Yasin says. "Around midnight, I received an alert that Mr. O'Bryan's heart monitor had registered a pause in his heart rate."

Dr. Yasin immediately logged in to the device's secure online portal to confirm the pause. "I also read his medical notes and saw that Dr. Trifa had described episodes where he'd been passing out," Dr. Yasin says.

Although the pause in Dan's heart rate had been short, it was still of concern. After familiarizing himself with Dan's medical history, Dr. Yasin called and woke him up. "I asked him how he was feeling and then told him about the pause," Dr. Yasin says. "He said he'd been sleeping and that he didn't feel too bad."

Given the short length of the pause in Dan's heart rate, Dr. Yasin ended the call by telling Dan he'd contact Dr. Trifa in the morning to let her know about it, and she'd likely want to see him in the clinic.

A few hours later, however, Dr. Yasin received another alert from the Monitoring Solutions Team regarding Dan's mobile heart monitor.

"He called again around 6 a.m. and said, 'Dan, your heart stopped beating for nine seconds,' Dan recalls. "And I said, 'Oh, that is serious, isn't it,' and he said, 'Yes, you need to go to the Emergency Department right now.'"

In good hands

Within the hour, Dan and his wife were walking through the doors of the Emergency Department at Mayo Clinic Health System in Eau Claire. "I still wasn't convinced it was that serious," Dan says. "I was wondering if it was some kind of false alarm. I was worried about wasting everybody's time." Dan compares what happened next to canoeing down a quiet river one minute and being suddenly thrust into raging whitewater rapids the next.

"Everything happened very quickly after I got to the ED. They didn't think it was a false alarm," he says. "They evaluated me, studied my test results and said: 'We're going to admit you. You need a pacemaker.'" Later that day, Dan was being prepped for the procedure. "By midafternoon, my pacemaker had been implanted, and I was back in my room recovering," he says.

Shortly after settling into his recovery room, Dan's phone rang. "Dr. Yasin called me again after he came back on shift that day," Dan says. "He'd seen that I'd been admitted to the hospital, so he was calling to check on me. That really impressed me. I can't say enough about his professionalism."

For his part, Dr. Yasin credits Dan's positive outcome to having access to the Monitoring Solutions Team, as well as to the tools and resources he needed to provide the right care at the right time.

"My ability to log in to his mobile heart monitor and see the trend of his heart rate almost in live time was critical," Dr. Yasin says. "With other heart monitors, patients are sometimes taking notes on a notepad, and it can be hard to correlate how they were feeling at the time of an event. This was very nice because I was able to log in, see what was happening and call him right after the first event to ask him what he was doing 20 minutes before. He was able to give me a very up-to-date and accurate history. That allowed me to act right then and there, even though I was miles away."

This article was originally published on the Mayo Clinic Laboratories website.