The Tribune Democrat, Johnstown, PA

February 17, 2013

At heart lab, it’s all about the beat: Cardiologist expands program to include diseases that affect rhythm

Randy Griffith

JOHNSTOWN — One of Johnstown’s newest cardiologists adds a new line of service for the region’s heart patients.

Dr. Genevieve Brumberg is a cardiac electrophysiologist, specializing in the rhythms and electrical functions of the heart.

“Electrophysiology involves medical treatment of irregular heartbeats, abnormal heart rhythms and related conditions,” Brumberg said.

Brumberg comes to Johns-town’s Memorial Medical Center from fellowship training in electrophysiology at UPMC’s heart program in Pittsburgh. She drew on her experience there to help the local hospital set up a new electrophysiology lab.

“I modeled that lab after the labs I worked at in Pittsburgh,” she said. “I picked out all of the best tools from the different labs.”

Brumberg’s training allows her to use medication, implanted medical devices and intervention procedures to get the heart back into sync and keep it in rhythm. A normal rhythm allows the patient to not only survive, but live a normal life, she said.

Since the heart is responsible for getting blood and oxygen to all areas of the body, patients with heart rhythm conditions get tired and out of breath more easily.

“I see patients in their 40s and 50s whose heart rates prevent them from doing their normal activities,” Brumberg said.

“If we get them in rhythm, and keep them in rhythm, that is more quality of life.”

Keeping the beat

The most common type of arrhythmia is atrial fibrillation, an irregular and rapid heartbeat in the heart’s upper chambers, or atria. More than 2 million people in the U.S. have A Fib.

Although it is not usually life threatening, it can lead to other conditions, including chronic fatigue, congestive heart failure and stroke.

It can cause blood to pool in the heart’s upper chambers, leading to blood clots. Strokes are frequently caused by clots that break off from other areas of the body and lodge in an artery of the brain. About 15 percent of strokes are associated with atrial fibrillation, the Texas Heart Institute reports.

An arrhythmia in the heart’s lower chamber can be even more critical, Brumberg said.

“Those are the ones that make the heart stop,” she said.

Called ventricular fibrillation, the electrical condition is characterized by an uncontrolled, irregular beat. The chaotic heartbeat can sometimes reach 300 beats a minute, sending very little blood through the body and to the brain.

It can result in fainting and requires immediate medical attention, including CPR, an external defibrillator or both. The sooner the treatment starts and the sooner the heart gets into rhythm, the less likely there will be permanent damage to the heart muscle.

People who have had a heart attack or have heart disease have the highest risk for ventricular fibrillation, the Texas Institute says.

Technology prolongs lives

Implantable devices used to treat rhythm issues include pacemakers and defibrillators, Brumberg said.

A pacemaker monitors and regulates the rhythm by transmitting electrical impulses to stimulate the heart. An implantable defibrillator detects life-threatening arrhythmias and shocks the heart back into rhythm.

“Often we are able to successfully treat patients with medication or implantable devices,” Brumberg said. “But sometimes more advanced treatments such as cardiac ablation are needed. This area is where the (electrophysiology) lab will become such a valuable tool for our community.”

Cardiac ablation is a nonsurgical procedure in which a thin wire-like catheter is fed through a blood vessel into the heart. Then agents are sent through the catheter using either heat or freezing to selectively destroy tiny pieces of tissue and remove the electrical triggers and circuits causing the  arrhythmias.

Heart rhythm conditions affect all ages, and include many genetic factors, Brumberg said. It is different from coronary artery disease, in which the heart’s blood vessels are narrowed with cholesterol plaque and deprive the heart muscles of oxygen.

Familiar prevention advice

But coronary artery disease can lead to arrhythmias or sudden cardiac arrest, Brumberg said, adding that the controllable risk factors are the same.

They include: Smoking, poor diet, inactive lifestyle, obesity, diabetes, high blood pressure and high cholesterol levels.

Because of the relationship with coronary artery disease, Brumberg said she expected to be primarily treating older patients when she came to Johns-town. But that hasn’t been the case.

“This week I saw somebody who was 20 and I saw somebody who was 82,” she said. “I am seeing the same age range in the population that I saw in Pittsburgh.”

Although Brumberg is a member of the Conemaugh Physicians Group, she says she tries to be as independent as she can. Her specialty does not take the place of a heart patient’s general cardiologist, who often becomes a de facto primary care doctor.

“I don’t follow patients over time to monitor their cholesterol and those things,” she said. “They go back to their regular cardiologist for that.

“We consult each other. I try to make a point to work with everybody because I am the only person in the area doing what I am doing.”

Local cardiologists have welcomed her new service, referring a patients to fill a busy schedule.

Many appreciate not having to travel to other areas for the electrophysiology service.

“I have had a lot of self-referrals from patients of other electrophysiologists in Pittsburgh,” she said. “They don’t have to go to Pittsburgh now.”

Patients here appreciate being able to get their care locally, she said. They also appreciate Conemaugh Physicians Group’s new one-stop location for cardiac outpatient care and follow-up visits at Conemaugh Medical Park, off Franklin and Napoleon streets in the Kernville section of Johnstown.

The facility was formerly Greater Johnstown Tech Park.

“I think the patients really love this office,” Brumberg said at the medical park building.

“They are able come here and get all their cardiac care under one roof. We do a lot of diagnostic testing in this office.”

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