It's pretty unusual when a patient has a heart condition that doctors can't explain. It's even more unusual when the patient is a doctor himself. But that was the case for Dr. Walter Roehll, a respected cardiologist from Middletown, Ohio. Dr. Roehll had experienced some heart palpitations every now and then, but didn't think much about it because they would always stop. Until one day, when the active 81-year-old came home from his usual run and felt oddly lightheaded.
Dr. Roehll took his blood pressure and saw it was low. Knowing that something was wrong, he told his wife they'd better go to the ER. As soon as they arrived, Dr. Roehll instructed the staff to run an EKG. The technician had just hooked him up to the EKG monitor when the next thing he heard was "Code 99!"
"It usually deteriorates into a more fatal situation."
Dr. Roehll didn't think that the emergency code 99 was for him, until medical staff rushed to his bedside. He looked over at the EKG monitor and saw his heart activity was going 180 beats per minute-a sign that the condition could become fatal very soon. But they were able to get his heart back to a regular rhythm and once he was stabilized, Dr. Roehll was checked into the hospital for further testing.
The medical term for Dr. Roehll's fast heart rhythm is ventricular tachycardia, and if left untreated it can be life threatening. At the hospital, Dr. Roehll decided to call Dr. William Abraham at Ohio State, a longtime colleague and someone he had referred his own patients to before. Over the phone, Dr. Abraham told Dr. Roehll that he better come to Columbus right away.
TREATING THE MYSTERIOUS HEART CONDITION
"Usually it's on the inside of the heart, but mine was on the outside of the heart."
At Ohio State, Dr. Abraham brought in Dr. Raul Weiss, a cardiac electrophysiologist who specializes in finding electrical problems of the heart. They began running tests on Dr. Roehll, but to their surprise could not find the source of his irregular heartbeat anywhere inside his heart. To take care of the immediate problem, they implanted a defibrillator and after a few days Dr. Roehll returned home.
Over time, his defibrillator began going off. Worried his heart would fail again, he decided to go back to Ohio State. This time, Dr. Weiss was determined to track down the source. After hours of careful exploration, he discovered the problem was actually coming from outside Dr. Roehll's heart, which is highly unusual. Isolating it would take very specialized technique, but the doctors were able to do it all in one procedure.
HE'S BACK TO HELPING PATIENTS
"Ohio State practices medicine the way it should be practiced."
When Dr. Roehll woke up from the procedure, he was relieved to hear they had fixed the problem. Since then, he's been able to monitor any heartbeat irregularity over the phone, with a state-of-the-art device that Dr. Roehll just holds over his heart, so it can transmit information to Ohio State. His heart function has actually become stronger over time, which means he is busier than ever, and back to seeing his own patients.
Dr. Roehll comes from a generation of physicians who believe in taking the time to get to know each of their patients, and that's why he always refers his patients to Ohio State. According to him, they practice medicine the way it should be done-with compassion and personal treatment.
Learn about the care team
Meet Dr. Roehll's Care Team
Behind every patient story we feature are the people who made it a success. Learn more below about Dr. Roehll's talented care team.
Dr. William Abraham, Director of Cardiovascular Medicine at Ohio State
Dr. Abraham was the first person Dr. Roehll thought to call when he was hospitalized for his unusual heart rhythm problem.
He leads the Division of Cardiovascular Medicine at The Ohio State University Wexner Medical Center.
Dr. Roehll has kept in contact with Dr. Abraham for many years and, because of their trusted professional relationship, Dr. Roehll often refers patients to him.
Dr. Weiss works in the Division of Cardiology at Ohio State's Wexner Medical Center and specializes in finding irregular electrical problems of the heart.
Dr. Weiss performed Dr. Roehll's highly sophisticated diagnostic and treatment procedure, which is conducted at only a few hospitals around the country.
Although finding the source of Dr. Roehll's heart problem was extremely challenging, he was able to track it down after many hours of careful exploration.
The heart's electrical system creates the signals that tell your heart when to beat. Electrophysiology (EP) is a specialty that focuses on the electrical behavior of the heart. Electrophysiologists are trained to perform investigational studies to diagnose heart rhythm problems, known as arrhythmias, as well as to perform radiofrequency catheter ablation procedures to eliminate them.
Ventricular arrhythmias are abnormal rapid heart rhythms that start in the lower chambers of the heart (the ventricles), and include ventricular tachycardia and ventricular fibrillation. Both are life-threatening arrhythmias most commonly associated with heart attacks.
Ventricular tachycardia (VT): Occurs when an electrical signal is sent from the ventricles at a very fast but often regular rate. If it's prolonged, you may feel weakness, fatigue, dizziness and palpitations. The rapid heartbeat often causes a sudden dangerous drop in blood pressure and poor blood flow to the brain, resulting in loss of consciousness or fainting. If you experience VT, you should call 911 immediately because an electric shock to "convert," or stop, the VT is required.
Ventricular fibrillation (VF): Occurs when numerous electrical signals are sent from the ventricles at a very fast, erratic rate. As a result, the ventricles are unable to fill with blood and pump, leaving the person with no pulse. If a person experiences VF, he or she will be unconscious and those nearby must call 911 immediately. A prompt electrical shock is necessary from an automatic external defibrillator to restore beating of the heart. VF may cause sudden cardiac arrest and death.
Abnormal levels of electrolytes (minerals) in the blood.
Toxins such as alcohol.
Stimulants such as cocaine and some over-the-counter medications.
Infection or inflammation of the heart muscle.
Diagnosis of Ventricular Arrhythmias
The first step in the diagnosis of VT or VF is a medical history and physical examination by your electrical heart doctor (called an electrophysiologist). Many times, the first diagnosis of a VT or VF is when a patient requires emergency assistance from 911. An electrocardiogram (EKG/ECG) obtained at the time of the heart rhythm problem will confirm the diagnosis of VT or VF. Based on your symptoms, your electrophysiologist may also recommend one or more other tests:
Holter monitor A portable, battery-operated EKG/ECG that is worn for a day or two and provides your physician with continuous data about the electrical activity of your heart.
Exercise stress test A test performed on a treadmill or stationary bicycle to measure heart, lung and muscle function during physical activity. You are attached to an electrocardiogram (EKG/ECG) to record electrical activity of the heart.
Electrophysiology (EP) study An invasive test where the doctor inserts pacing wires through a blood vessel into the heart to evaluate the electrical system of the heart.
Echocardiogram Also called an echo, this test uses sound waves to assess the function and structure of the heart muscle and valves.
Treatment of Ventricular Arrhythmias
Emergency treatments for VT and VF include:
Cardiopulmonary resuscitation (CPR) During VT or VF, the blood flow to the body and brain are inadequate. CPR can help pump blood through the body by mimicking the pumping motion of your heart.
Automatic external defibrillators (AED) Used to deliver an electrical shock through the chest wall to the heart to stop the VT or VF and to restore normal rhythm and beating of the heart.
Long-term therapy for managing VT or VF will be designed by your electrophysiologist and may include one or more of the following:
Antiarrhythmic medications Medications that are specifically designed to help reduce the ventricular arrhythmias
Implantable cardioverter defibrillator (ICD) An implanted device, inserted under the skin, that monitors and treats ventricular arrhythmias by providing a prompt electrical shock.
Catheter ablation Ablation involves inserting a catheter (a narrow, flexible wire) into a blood vessel and positioning the wire into the heart. The catheter is then positioned at the site of the abnormal heart rhythm and energy in the radiofrequency is delivered through the tip of the catheter to eliminate the arrhythmia.
If you are experiencing any of these symptoms, please contact your family physician immediately for evaluation. Your physician can determine if a referral to the heart rhythm team at The Ohio State University Wexner Medical Center is necessary.
Learn More
To learn more about our heart rhythm program or treatments, please call: 614-293-ROSS or 888-293-ROSS
Ohio State Expertise
The Ohio State University Wexner Medical Center's Electrophysiology (EP) program is the largest program in Ohio, and one of the top three in the nation, with extensive experience in managing a wide spectrum of heart rhythm problems. The Richard M. Ross Heart Hospital has also consistently been one of the largest ablation centers in the United States, utilizing physician experience coupled with advanced mapping and ablation technology.
The Electrophysiology Section at Ohio State's Ross Heart Hospital consists of the largest group of electrophysiologists in central Ohio, as well as over 100 nursing staff members dedicated solely to the care of patients with heart rhythm problems.
Ohio State's electrophysiology expertise, technology and talented staff all contribute to why the Heart Hospital was also recognized as a leader in heart care in the 2011 U.S.News & World Report, ranking 24 out of more than 5,000 hospitals around the country.
