Atrial fibrillation: Brenda's story

Brenda Salonek, 38, knew something was wrong when she picked up the phone to call her husband. "I couldn't get my hand to function the way I wanted to," she says.

She also couldn't remember how to add or subtract. "That scared me, because it shouldn't be hard for anybody," she says.

During the May 2003 scare, Salonek was in the hospital recovering from surgery. Her cardiologist, Stephen Hustead, realized she had a thrombotic stroke, a common complication of what put her in the hospital: atrial fibrillation.

High risk of stroke

During atrial fibrillation, the upper chambers of the heart called the atria, lose their organized pumping action. Blood pools in the chambers, and little blood clots can form in the atria.

If a blood clot moves into the bloodstream, it can cause a blockage that leads to a stroke. Hustead says, "It doesn't take much more than something the size of the tip of a pencil lead to cause problems."

Fortunately, Salonek's stroke was minor. Her blockage dissolved in about eight hours with the help of heparin, a drug that decreases the blood's ability to form clots.

Two weeks later, Salonek returned to work as a quality inspector for a metal manufacturer. In December 2003, she passed a medical examination by Hustead.

Although the cardiologist believes Salonek's condition is under control, Hustead says, "We'll be tracking Brenda for awhile."

A two-year ordeal

Salonek and her family remember the time leading up to her diagnosis and treatment of atrial fibrillation as constantly stressful.

"I was always worried," says her husband, Dan. "It was hard to concentrate. I kept thinking, ‘Is she okay? Will she pass out at work today?'"

The Saloneks spent nearly two years trying to cope with Brenda's recurring lightheadedness, rapid heartbeat and breathlessness. Afraid of an unexpected episode, they curtailed most family activities. Sick days away from work threatened Brenda's job security and income.

Dan, a member of the Army Reserves, spent training weekends away from home, fearful of an emergency situation while he was away.

Physicians identified a heart problem. Numerous prescriptions relieved Salonek's symptoms for awhile, then stopped working. Some drugs caused unmanageable side effects that forced her to stop taking them.

At the height of her ordeal, Salonek says, "I was in one episode after another. It was all the time."

Salonek's father, who had bypass surgery at Mercy Hospital, encouraged her to go there for help.

Diagnosis and treatment

At Mercy, Hustead diagnosed Salonek's symptoms as atrial fibrillation.

"It is probably most common over 60. But for unknown reasons, some people like Brenda experience it much earlier," says Hustead.

The cardiologist describes atrial fibrillation as a storm of electrical activity that makes the two upper chambers of the heart, the atria, quiver or fibrillate. This can occur if any of the four pulmonary veins that bring blood to the heart are not flush to the heart's back wall. In the tiny gap between the vein and the heart, extra tissue forms.

"Some of that extra tissue is electrically active, causing premature heartbeats," says Hustead.

To treat atrial fibrillation, the extra tissue is surgically burned or cauterized to stop the tissue from sending out bad signals. Called ablation, the procedure is also used to electrically separate the pulmonary veins.

"We used to treat one vein at a time," says Hustead. "Then we discovered that the veins are connected electrically. An erratic signal can begin in one vein, track down another vein and go out from there."

The cauterization must occur carefully so as not to damage any muscle tissue. Muscle within the pulmonary vein carries oxygenated blood from the lungs to the heart. To make sure no muscle damage occurs, dye is injected and pictures of the vein are taken before and after the procedure.

Hustead cautions that ablation does not always take away all symptoms. Also, symptoms may return with time.

"The irritable tissue can act up as you grow older," he says. "The incidence of atrial fibrillation is increasing as the population ages. Some are not aware they have it. Others, like Brenda, are acutely aware of it."

Taking life as it comes

Salonek's experience with atrial fibrillation has taught her to take life as it comes. She's thankful for every episode-free day.

"I can go to work and not worry about having to leave," she says.

Brenda can again do activities with her husband and three children -- something they've learned not to take for granted.

"We can go walking now without worrying about something happening," says husband, Dan.