COLUMBIA, Mo. - Richard Weachter, MD, a cardiac electrophysiologist at University of Missouri Health Care, recently used an implantable monitoring system to diagnose a patient's heart problem from more than 100 miles away.
Keith Urbon, a 44 year-old chemical engineer from Quincy, Ill., was experiencing symptoms of uncharacteristic exhaustion and shortness of breath. His primary care physician referred him to several specialists, but the symptoms continued.
"Everyone told me that nothing was wrong, and yet I had these symptoms that no one seemed to be able to explain or what to do about them," said Urbon. "My quality of life was not what it had been, and I had gotten to the point that I couldn't enjoy some of the physical activity, like golfing, that I used to."
Although several tests were performed by other specialists, no definitive diagnosis could be made, and Urbon's condition worsened. Eventually Urbon was referred to Weachter at University Hospital.
"Mr. Urbon's symptoms were sporadic enough that many of the traditional diagnostic devices like the Holter monitor and 30-day cardiac event monitors didn't pick up what was wrong," said Weachter. "So we turned to the Medtronic Reveal Plus Insertable Loop Recorder and CARELINK transmitter that would allow us to monitor his condition for an extended period of time, as well as from a distance."
The insertable loop recorder is a device that is about two inches long and about a quarter-inch thick that is implanted in the patient's chest above the heart. Small electrodes on the recorder surface monitor abnormal heart rhythms, such as the heart beating faster than 150 beats per minute or heart rhythms slower than 40 beats per minute. The information is saved onto the device and is then transmitted via telephone line and a secure Web site to the physician.
Approximately a month after the device was implanted, Weachter was able to see that Urbon's symptoms indicated he had bradycardia, where the heart rate slows. In Urbon's case, his heart actually stopped beating for up to three seconds at certain times. With the diagnosis, Weachter was able to implant a pacemaker in Urbon. The pacemaker not only adjusts Urbon's heart rate, but also continues to monitor his heart as the loop recorder did.
"Getting the right piece of information at the right time is vital to making a diagnosis in patients who have these symptoms at odd times and that are spread out over what can be days, weeks or even months," said Weachter. "As an added bonus, being able to transmit the information from the patient's own home to my office allows the patient to continue his or her lifestyle and negates the travel often involved in such monitoring. It's just a great combination of tools for cardiologists to use to overcome some of the obstacles that we face in more complex symptom diagnosis."
For Urbon, describing the results is much simpler.
"I feel great," said Urbon. "I have my energy back, I'm able to do the things that I was doing before these symptoms cropped up. In my case, my symptoms weren't life threatening, but they definitely affected my quality of life in a very negative way. Now I'm back to where I was."
University of Missouri Health Care's system of hospitals, clinics and telehealth sites employs approximately 5,700 clinicians, scientists, educators and other health professionals. The system includes University Hospital and Clinics, Children's Hospital, Columbia Regional Hospital, Ellis Fischel Cancer Center and University Physicians, all based in Columbia, Mo. MU Health Care also includes a long-term acute care facility, Missouri Rehabilitation Center, in Mount Vernon, Mo. The MU Health System includes the University of Missouri-Columbia School of Medicine, Sinclair School of Nursing and School of Health Professions.