Some heart conditions are worse than others

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At about 6 p.m. on Day 2 of the 2009 World Series of Poker $2,500 razz event, “Miami” John Cernuto seemed to be taking a little nap between hands. When one of the players nudged him, he collapsed unconscious onto the table. Play stopped and paramedics were called. About 30 minutes later Cernuto regained consciousness and was taken to the hospital.

Last month we discussed arrhythmias, abnormal heart rhythms, which may be predictors of serious illness. In my simplistic classification system, I advised slight elevations in heart rate or an occasional skipped beat usually fit into a “no big deal” category. Think about the possible causes like caffeine, stress, stimulants or dehydration and, if the arrhythmia persists, seek medical attention to look for more serious conditions. A completely irregular rhythm or really rapid rates fall into the “call for help” category. Have the floorman cash out your chips and call for an ambulance. This would not be a good time to play one more round.

This month, we’ll cover the “OMG you’re dead!” category, but first, a little background. The heart is a pump, a lot like the one attached to your pool. There are big pipes coming in and big pipes going out and some electrical connections to power the thing. Your heart also has a few smaller pipes (the coronary arteries) that supply nourishment to the pump itself, the heart muscle.

Over time, the plumbing in your house can get clogged with lime and scale. Likewise, your coronaries can get narrowed with french fries, cheeseburgers and pizza until one day a little clot forms and, bingo, a very important pipe supplying your heart muscle becomes blocked. If someone doesn’t get the clot out fairly quickly, say within an hour or two, some of your heart muscle will die and your pump will forever be less powerful. This is what a heart attack is, basically a plumbing problem.

When this happens to your home plumbing, you call a smelly overpriced guy with baggy pants to come over and snake your line. In the ER if you’re having a heart attack, we do exactly the same thing. We call in a plumber for your heart. Interventional cardiologists snake your clogged pipes, hike up their baggy scrubs and hand you a big bill, just like your plumber.

But the bad heart rhythms we’ve been talking about so far are not heart attacks, not plumbing problems at all, but actually electrical problems. More like short circuits or loose wires than clogged pipes.

The biggest danger occurs when, during a heart attack, the heart muscle becomes so irritated that the electrical circuits that run through it short out. The arrhythmia that can occur, called ventricular fibrillation, is a quick killer. The official name of this condition, “Sudden Death”, is so clearly descriptive that you don’t need me to tell you it’s a bad thing. Now not all heart attacks develop ventricular fibrillation, but when they do, this would not be the time for a plumber. This is a job for electricity. Time to charge up the paddles and reboot. Restore power first, then have the pipes unclogged.

Clearly, this is not something you can do much about if it happens to you. It’s “Sudden” so you really don’t have time to call 911 before you hit the felt. And it’s “Death” so your brain will turn to mush within a few minutes if someone doesn’t kick-start your ticker. You’d better hope you haven’t been the table bully because you’ve got to rely on others to save you.

So how do you know if you might someday suffer from this delightful condition? Count your risk factors. Are you older than 65? Do you have high blood pressure? High cholesterol? Diabetes? Do you smoke? Did a close family member have heart disease? Have you had heart problems in the past? Answer “yes” to too many of these questions and you are at risk for what Redd Foxx called “The Big One.”

There are some things you can do to lessen your risk. You can’t control your age or your genetics but you can put out that cigarette. Take your blood pressure medicine every day even if it makes you feel bad. Have your cholesterol checked and keep your diabetes under control.

If you are at risk, there’s one other thing you can do to improve your chances of surviving “Sudden Death” and it’s so important that I’ll devote my entire column to it next month. And, by the way, Miami John survived his collapse at the razz table and was able to return for the main event a few days later. Lucky for him, it wasn’t Sudden Cardiac Death, or even a heart attack. It turns out he had some internal bleeding that curiously enough is just another type of plumbing problem: leaky pipes. That’s what razz will do to you.

— An avid poker player, Frank Toscano, M.D. is a board-certified emergency physician with more than 28 years of front-line experience. He’s medical director for Red Bamboo Medi Spa in Clearwater, Fla. Email your poker-health questions to ftoscano@redbamboomedispa.com