Listening to the patient as well as the heart
Doctor’s philosophy helps him discover correct diagnoses for patients with arrhythmias
Atrial fibrillation is a condition that affects more than 2.7 million Americans. It can lead to serious consequences like blood clots, strokes and heart failure, and often requires management with lifelong medication or invasive procedures. But for UCHealth cardiologist Dr. Ethan Ellis, a specialist in electrophysiology and abnormal cardiac rhythms, managing A-fib requires not just treating someone else’s heart, but using his own.
“My first priority is to really listen to my patients and identify with what they’re dealing with,” Ellis said. “There’s not one right answer for a lot of these problems.”
Just ask Patrick Fleming and Dennis Klinker.
For more than five years, numerous cardiologists told Patrick Fleming, 55, that he had chronic pericarditis, or inflammation of the tissue surrounding his heart. The same doctors also had presumed that the pericarditis was causing Fleming’s atrial fibrillation.
Yet despite an aggressive treatment regimen, Fleming’s symptoms persisted. And the chief investment officer for the Wyoming State Treasury Office, a self-described “numbers guy,” wasn’t satisfied.
“I could be functioning fine (at rest) but my normal active lifestyle wasn’t the same,” Fleming said. “I’d feel the irregular heartbeat coming on, and it would make me very lethargic. I used to be a (10K and half) marathon runner, and I love to be outdoors, and every time I exercised I was worried my A-fib would kick in.”
In June 2015, Fleming saw Ellis at the UCHealth Heart Center office in Fort Collins. After reviewing his patient’s prior test results, Ellis, too, was unconvinced.
“The diagnosis of chronic pericarditis was unusual, and based on the history he gave me, and the studies he had already had done, I wasn’t convinced the diagnosis was correct,” Ellis said. “Because of his A-fib, his heart muscle had started to weaken. We needed to suppress his arrhythmia (abnormal heart rhythm) to allow his heart to recover.”
A-fib occurs when disorganized electrical signals originating in the upper chambers of the heart (the atria) cause the heart muscle to contract fast and irregularly.
Ellis also was concerned that the aggressive anti-inflammatory medications Fleming was taking for “chronic pericarditis” were irritating his pre-existing gastrointestinal problems and increasing the risk of serious side effects.
So in August 2015, Ellis took Fleming off all his medications and performed an ablation, a highly specialized procedure where catheters are inserted through the veins in the groin and extended up to the heart. Electrodes on the end of the catheters are then used to record the heart’s electrical signals and identify the regions where abnormal heart rhythms originate. Other catheters are then used to freeze and cauterize the problem areas in the hopes of eliminating arrhythmia.
Since the procedure, Fleming’s A-fib is gone and he no longer takes any medications.
“It’s been a life changer,” Fleming said. “I have the ability to exercise and not think twice about it. I’m much healthier now.”
Dennis Klinker feels similarly.
The 68-year-old had been dealing with a chronic arrhythmia for years. When a kidney stone landed him in the emergency room, he was diagnosed with atrial tachycardia, an arrhythmia similar to A-fib, and his heart rate was more than 200 beats per minute, double the normal rate. Even after a long hospital stay, his pulse remained dangerously high and an echocardiogram, which measures the heart’s working capacity, showed that his heart was pumping at 20 to 25 percent of its normal function.
“Mr. Klinker was extremely sick when he first came to us,” Ellis said. “He was in decompensated heart failure, and I was concerned that his incessant atrial tachycardia was causing his heart to fail.”
Ellis initially prescribed a strong drug to try to suppress the arrhythmia. But he was concerned about the medicine’s potential toxicities. “It’s not something I wanted to keep him on long term,” he said.
Like he had done with Fleming, Ellis decided an ablation was the best course of action. And it worked. Again.
He was able to identify a small area of abnormal heart muscle where the atrial tachycardia originated and after cauterizing this small region, Mr. Klinker’s arrhythmia was gone.
“After his arrhythmia was gone, Dennis went from being a really sick man with decompensated heart failure back to normal healthy guy,” Ellis said.
At his three-month follow up with Ellis at UCHealth Heart Center, Klinker’s heart function was back to normal. So the cardiologist discontinued a few of Klinker’s medications and adjusted some others.
Klinker said he’s back working “as hard as ever” and has been thrilled with Ellis’ work.
“Dr. Ellis is very caring, and he focuses on the person. He did a great job of explaining everything, including showing us the photographs after the procedure,” Klinker said. “He has changed my life.”
Fleming also was impressed that his care involved more than just expensive tests and fancy equipment.
“Dr. Ellis is a unique and special doctor,” Fleming said. “You can honestly tell that he cares. He’s willing to do things that I’ve never had another doctor do. It’s apparent that he looks at his job in a very different way.”
Ellis attributes much of his skill to a well-rounded training program and lots of practical experience. But in addition to a steady hand and diagnostic aplomb, he clearly takes just as much pride in approaching patient care straight from, well, the heart.
“In order to help a patient figure out what treatment strategy is right for them, you really need to understand who that patient is and where they’re coming from,” Ellis said. “I try not to make decisions for people. I help people make their own decisions. That’s what I’d expect for a family member of mine, and that’s how I try to approach the care of my patients.”