People use the expression “my heart skipped a beat” to describe excitement, fear and even love. But to Cardiac Electrophysiologist, Nisha Tung-Takher, MD, Yavapai Regional Medical Center (YRMC) PhysicianCare Cardiology, an irregular heartbeat can have many meanings.
An accomplished cardiac electrophysiologist, Dr. Tung has spent her medical career studying the heart’s electrical system. Important work, especially when you consider that the heart’s electrical pulses are responsible for pumping blood throughout our bodies. If those electrical pulses get out of sequence, they cause dangerous arrhythmias (irregular heart rhythms or if your heart skips a beat). This can lead to a heart attack, blood clot, stroke or even death.
YRMC’s Heart Center Team
Dr. Tung is among the exceptional YRMC PhysicianCare cardiologists and cardiac subspecialists – physicians with significant training in cardiac electrophysiology, cardiothoracic surgery, interventional cardiology and vascular surgery – who make up YRMC’s James Family Heart Center. She is the Heart Center’s only cardiac electrophysiologist and among the busiest in Arizona.
The Heart Center’s physicians, including Dr. Tung, work with advanced clinical practitioners, nurses, and technologists as they diagnose, treat and care for people with complicated heart conditions.
It’s important to Dr. Tung that patients understand what’s wrong with their hearts and her role in their care. This process typically begins with a relatable analogy.
“Here’s how I explain cardiac electrophysiology to patients,” Dr. Tung said with a smile. “I say, ‘Think of me as an electrician. Only, I work on the electrical wiring of the heart.’”
When the Heart’s Wiring Goes Awry
What conditions cause the heart’s electrical system to go wrong? The most common are heart rhythms that are too fast, too slow, or both fast and irregular. These arrhythmias are specific to each of the heart’s four chambers and include:
- Atrial fibrillation (Afib or AF)
- Atrial flutter (AFL)
- Atrial tachycardia (AT)
- Supraventricular tachycardia (SVT)
- Premature ventricular contractions (PVCs)
- Ventricular tachycardia (VT)
Depending on the type of arrhythmia, people experience fluttering in the chest, a racing or slow heartbeat, chest pain, shortness of breath, dizziness, fainting, and sweating.
“Some of the people I diagnose and treat for rhythm disorders may not have the typical or even noticeable symptoms,” she said.
Dr. Tung’s friendly demeanor gently coaxes these patients to open up about their health.
“Initially, patients often tell me they are ‘feeling fine,’” she said. “As we talk, soon they’re confiding to me that they haven’t felt like being active for the past six months. They say, ‘I can’t exercise. I can’t even do easy household chores.’”
Such critical information can ensure timely diagnosis and treatment as well as very grateful patients.
How to Correct the Heart’s Rhythm
Dr. Tung treats arrhythmia patients with medication or with one of two procedures: cardiac ablation or left atrial appendage closure (LAAC), also known as the WATCHMAN. Some patients may benefit from a device implant (pacemaker or defibrillator or cardiac resynchronization therapy).
During a cardiac ablation procedure, she uses an innovative Heart Center computer three-dimensional mapping program to guide a thin catheter (flexible tube), from the patient’s upper leg into a blood vessel of the heart. With the help of the three-dimensional mapping program, the catheter picks up signals from inside of the heart.
“Three-dimensional mapping allows me to see the area of the heart that is scarred and to see the good, healthy tissue,” Dr. Tung said.
When the catheter reaches the area that’s causing the patient’s arrhythmia, Dr. Tung destroys the bad cells with electrical signals. This returns the heart to its regular rhythm and can heal hearts with an erratic heartbeat or patients who experience feel their heart skips a beat regularly. The procedure – performed in the Heart Center’s state-of-the-art hybrid operating room (OR) – is minimally invasive, so recovery time is brief.
For some people with Afib (atrial fibrillation) – including those who don’t respond well to blood thinners – Dr. Tung may recommend the WATCHMAN.
The Heart Center’s hybrid operating room is where WATCHMAN procedures happen. The advanced computer guidance system in the hybrid OR helps ensure accurate placement of the quarter-sized WATCHMAN device in patients with difficult-to-manage Afib. Once placed, the WATCHMAN reduces patients’ risk of blood clots that originate in the left atrial appendage.
“Afib can cause blood to pool in the left atrial appendage and form a clot, which can lead to stroke,” Dr. Tung explained.
Defibrillators, Pacemakers and More
Dr. Tung also works with YRMC PhysicianCare cardiologists to address their patients’ electrical heart problems. As a physician who specializes in heart rhythm disorders, she implants a variety of electronic devices in people with heart failure, including:
- Cardiac resynchronization devices
- Biventricular pacemakers and defibrillators (a special type of pacemaker that paces both sides of the lower chambers of the heart)
After a device is implanted, Dr. Tung monitors patients via remote/home monitoring. This ensures optimal treatment of patients with device implants. Many hours of work take place in YRMC’s “device clinic.” This is where implantable devices are tested, or as Dr. Tung says, “interrogated and reprogrammed.”
“My job is to make a clinical decision about how the patient is responding to the device,” Dr. Tung said. “I review and scrutinize each patient’s record to understand their health status, closely follow arrhythmias and treat with appropriate medications.”
The Patients’ Physician
Dr. Tung puts her heart into her work. She thinks of patients, their families, the YRMC PhysicianCare staff, and YRMC’s Electrophysiology team as extended family.
“I am extremely grateful to work with YRMC’s wonderful patients and our incredible staff at the James Family Heart Center,” she said. “It’s a joy to be part of the extraordinary work that happens here, which is possible thanks to our supportive administration.”