Stephanie Herrera was watching The Bridge on television when she felt the strange tremor for the first time. Sitting on the sofa next to her husband Alex, while her seven year-old twin daughters, Belle and Venice, were asleep upstairs, she felt a fluttering sensation in her chest like a frog leaping about. Before she could finish telling her husband, it was over.
“It went on for about a minute,” says the company director from Aberdeen. “I hadn’t run a marathon, been binge drinking or downing coffee. I was calm and composed. It was weird.”
Over the next few weeks the same feeling returned with increasing regularity. Aged 49, she consulted her GP. A pulse check and electrocardiogram (ECG) unearthed nothing but, as a precaution, the doctor sent her to a cardiologist. He gave her a holter monitor – a portable device that monitors your heart’s activity – for 48 hours, which confirmed the worst. She had atrial fibrillation (AF), one of the most common forms of abnormal heart rhythm, otherwise known as arrhythmia, a major cause of stroke and heart disease.
“The mood in the room suddenly darkened. I was devastated,” says Herrera. “I bought a friend who was a GP lunch a few days later and grilled her. I’d heard beta-blockers [which block the effects of hormones such as adrenalin on the heart] make some people feel fatigued. I didn’t want that.”
Abnormal fluctuations in heart activity are caused by a disruption of its electrical system. While a normal heart rate is between 50 and 100 beats per minute, an arrhythmia, like Herrera’s, can raise that to up to 200 beats per minute and increase the chance of blood clotting inside the chambers of the heart and, hence, of a stroke.
Other types can cause heart rate to drop dangerously low. As many as one in four of us will develop a heart rhythm disorder in our lifetime and every 15 seconds someone suffers a AF-related stroke.
Fatal arrhythmias in people with heart conditions kill 100,000 in the UK every year. Mitigating the risks can be as easy as checking your pulse or having an ECG from your GP, then taking medication. Given that 30 per cent of AF sufferers experience no symptoms, testing – especially for those in middle age who have experience of it in the family – is essential.
Despite the bleak ramifications of arrhythmia, Dr Kim Rajappan, a consultant cardiologist at John Radcliffe Hospital in Oxford, is keen patients don’t treat a diagnosis as a “catastrophic event”.
“It could be completely benign or quite serious. But picking it up early saves running into a major problem in the future. It can be easily resolved.”
The exact cause of Herrera’s arrhythmia is unknown, but AF is associated with diabetes, an overactive thyroid, binge-drinking and underlying heart disease as well as other factors. Since her diagnosis in March she has suffered more attacks, the longest lasting for 26 hours, and has been prescribed an anticoagulant – a medicine that helps prevent the blood clotting and reduces the risk of stroke by 70 per cent – and a calcium channel blocker to help lower her heart rate. Ablation therapy – a procedure that burns away the pathways in the heart causing the problem – is an option for many, but Stephanie has ruled it out.
“My children are young. There is a chance I could have a stroke during the procedure or it could damage the heart further. My medication is keeping it largely under control at the moment. Touch wood, we caught it quickly.”
Adapting her lifestyle to reduce things that might trigger ‘an episode’ has helped assuage Stephanie’s fears. She has cut out caffeine, become teetotal and eats and exercises in moderation.
However for some sufferers, surgery is the answer. Graham Harper, 44, from Essex, discovered his arrhythmia during a routine health check up before starting a new job in investment banking four years ago. While hooked up to an ECG, the doctor looked at him aghast. “He said, ‘It looks like you are having a heart attack’,” recalls Harper, with some mirth. “I was feeling absolutely fine. I was in good health, I was active. I wasn’t overweight. I couldn’t feel my heart beating irregularly at all.”
After an examination at Bart’s Heart Centre in London it was discovered he had Brugada Syndrome, a rare genetic condition that results in an abnormal heart rhythm and can cause a sudden cardiac arrest. It explained why, throughout his life, he had unexpectedly passed out on several occasions. A disruption of electrical impulses in his heart had triggered an extreme slowing of its beating and caused him to black out. His mother was proved to be a carrier after he insisted his family, including his two children Sam, 15, and Mia, 13, be tested.
“It was incredibly worrying. You never consider your own mortality. It felt numbing.”
Harper says he sometimes feels the slowing of his heart before it happens. “There’s a sense of darkness coming in from the left and right, as though someone is shutting the door on me. I go an alarming shade of grey but usually recover after a couple of minutes.”
Given he was at such a high risk of cardiac arrest, doctors advised an implantable cardioverter defibrillator (ICD) be fitted into his chest to shock his heart rhythm back to normal during an attack. His, a new type of device called the Emblem S-ICD, sits on top of his heart, rather than to the side, and is visible without a shirt on. “It is like a spot, you are more conscious of it than anyone else.” He also takes a statin and an aspirin each day to lower his risk of heart disease.
Despite the condition, and at least three instances since he was diagnosed when his heart has slowed and stopped, Harper is adamant to continue his life in the same vein as before; he drinks wine, works, goes to the theatre and on holiday with his family.
“My condition has made me want to live life to the full,” he says. “In a way it has changed my life positively. I recognise the fact that I have Brugada, but I don’t over-concern myself about it.