March 24, 1997 in Nation/World

Persistence Gets To Heart Of The Trouble Spokane Doctor Helps Clear Up Misdiagnosed Heart Trouble

By The Spokesman-Review
 

Her heart was a Ferrari, racing from normal to hundreds of beats per minute in seconds.

Cindy Vella felt trapped in her home. She was afraid she’d have a heart attack while driving. She was scared she’d collapse in church.

Nobody was quite sure what the problem was. Maybe a heart murmur. A mitral valve disorder. A panic attack.

“You start to believe them, like maybe I am crazy,” Vella said.

Finally, after a persistent primary-care doctor helped guide her through a maze of cardiologists, the 38-year-old Detroit woman found out she had a treatable heart problem that wasn’t life-threatening.

She also wound up in a study that shows doctors routinely misdiagnose the rhythm disorder as a panic attack. Most of the misdiagnosed patients are women.

The study, by Dr. Tim Lessmeier of Spokane and colleagues in Detroit, was just published in the American Medical Association’s Archives of Internal Medicine. He’s been touting the research on national news shows.

The research means that people are being sent to psychiatrists instead of being treated for their condition - abnormal electrical impulses that control their heart rate.

“A lot of these people feel very strongly that something’s physically wrong,” Lessmeier said. “When we label them as having psychiatric or psychological problems, I think that’s wrong.”

The congenital problem, known as paroxysmal supraventricular tachycardia, or PSVT, can sometimes be treated with medication.

Or it can be fixed in hours, through a nonsurgical procedure called radiofrequency ablation.

Catheters are threaded into the heart until the abnormal electrical pathway is found. It’s then destroyed or burned with high-frequency energy.

The study was performed in 1992 and 1993 at the Harper Hospital in Detroit, when Lessmeier was on a fellowship at Wayne State University.

The researchers looked at 107 consecutive patients who walked into their clinic with PSVT. The condition, which affects from 80,000 to 150,000 people per year in the United States, causes a rapid heartbeat from 150 to 250 beats per minute.

Most of the condition’s symptoms, such as a rapid heartbeat, shortness of breath, lightheadedness and fear of death, mimic symptoms of panic disorder.

The researchers found that 67 percent of the people in the study met both the criteria for panic disorder and PSVT.

The researchers found the disorder was initially incorrectly diagnosed in 55 percent of the patients studied. Of those unrecognized cases, patients waited a median of 3.3 years before finding a correct diagnosis.

Doctors attributed symptoms to “panic,” “anxiety” or “stress” in 54 percent of the unrecognized cases. Women were almost twice as likely as men to have symptoms ascribed to psychiatric conditions.

During this time, many were told that nothing was wrong. That they suffered from stress. That the problems were in their heads.

After being diagnosed, “they were so happy that there was something concrete,” said Dr. Michael Lehmann, director of the Arrythmia Center at Sinai Hospital in Detroit, who worked with Lessmeier on the study.

Both Lehmann and Lessmeier were spurred to do the study by Deborah Gamperling, a nurse who talked with patients and noticed similarities in case histories.

Gamperling remembers the woman who broke out in tears when treated because she couldn’t believe it. For 20 years she had been told she was panicky and weak.

“This can be devastating to their self-esteem,” Gamperling said. “People are suffering needlessly because it’s unrecognized.”

The condition is stealthy, hiding for months and erupting for only minutes at a time. To be properly diagnosed, the episode must be recorded on a monitor.

Doctors often place a monitor on a patient for a day or two at most.

But a patient sometimes must wear a monitor for months before an episode happens. Vella had blisters on her chest from the monitor patches, from wearing it 30 days.

Finally, after her condition was identified, she underwent life-changing treatment in 1992. Now she has a job. She chases after her two teenage kids. She even Rollerblades.

“I really thought I would end up being like that forever - pretty much housebound,” Vella said. “I was very, very afraid that I would have a heart attack. It really is a feeling that you’re going to die.”

, DataTimes ILLUSTRATION: Color photo

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