Arrhythmia is a disorder in the electrical system of the heart. It is one of the most common and least understood heart problems. They can be benign or life-threatening and affect people of every age group and background. Recent studies indicate that more than 4 million Americans have arrhythmias, with an estimated 2% of people under age 65 and 9% of people over 65 having atrial fibrillation.
This article covers the different kinds of cardiac arrhythmias, their causes and symptoms, and current modes of treatment for a complete overview of this important cardiac condition.
Understanding Cardiac Rhythms
Cardiac rhythms are the patterns of electrical activity that control the heart’s pumping action. These rhythms are essential for maintaining proper blood flow throughout the body.
The heart’s natural pacemaker, the sinoatrial (SA) node, typically controls the heart rate by sending electrical signals through specialized pathways. These signals cause the heart muscles to contract in a coordinated manner, creating the familiar “lub-dub” heartbeat. When this system functions correctly, it maintains a steady rhythm of about 60 to 100 beats per minute at rest for most adults.
However, various factors can disrupt this delicate electrical system, leading to irregular heartbeats or arrhythmias.
What is Arrhythmia?
Arrhythmia is also known as cardiac arrhythmia or heart arrhythmia. It refers to any variation from the normal sequence of electrical impulses that control the heartbeat. This perturbation in the rhythm causes the heart to beat fast, too slow, or irregularly.
When this condition occurs, the heart loses its ability to pump blood efficiently to the rest of the body, which results in a range of symptoms. Arrhythmias may be temporary or long-standing, and although most are harmless, some are potentially life-threatening.
The severity of an arrhythmia depends on various factors, including the type of rhythm disorder, underlying heart conditions, and the individual’s overall health. Some people may experience this condition without any noticeable symptoms, while others may feel significant discomfort or face serious health risks.
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Types of Arrhythmias
Arrhythmias are classified based on their origin in the heart, their effect on heart rate, and their duration over time. An understanding of these types aids in proper diagnosis and treatment.
Tachycardia
Tachycardia is a fast heart rhythm, causing a heart rate of more than 100 beats per minute. This rapid heartbeat can occur in the atria (upper chambers) or ventricles (lower chambers) of the heart. Types of tachycardia include:
- Supraventricular Tachycardia (SVT): This originates above the ventricles, often in the atria.
- Atrial Fibrillation (AFib): This is an irregular and often quicker heartbeat, at times leading to blood clots in the heart.
- Atrial Flutter: This is similar to AFib but with a more organized electrical pattern.
- Ventricular Tachycardia (VT): This is quite a dangerous and even potentially life-threatening arrhythmia that originates from the ventricles.
Bradycardia
Bradycardia is a slow heart rhythm, causing a heart rate of less than 60 beats per minute. While this can be normal for some people, especially athletes, it can also indicate a problem with the heart’s electrical system. Some of the common types of bradycardia include:
- Sinus Bradycardia: A slow but regular heart rhythm originating from the sinus node.
- Heart Block: This occurs when electrical signals from the upper chambers of the heart do not conduct properly to the lower chambers.
- Sinus Pause: This happens when the sinus node temporarily stops sending electrical signals, which results in a pause in the heart’s rhythm.
- Sick Sinus Syndrome: A collection of conditions where the sinus node doesn’t function properly. This leads to episodes of slow heart rates, pauses, or irregular rhythms.
- Tachy-Brady Syndrome: A variation of sick sinus syndrome, where periods of very slow heart rates alternate with episodes of abnormally fast heart rhythms (tachycardia).
Premature Beats
Premature beats are extra heartbeats that occur earlier than the next expected regular beat. These can feel like a skipped beat or a flutter in the chest. The common types are premature atrial contractions (PACs), which are extra beats originating in the atria and premature ventricular contractions (PVCs), which are extra beats originating in the ventricles.
Long QT Syndrome
Long QT syndrome is a disorder of the rhythm of the heart, where the heartbeat becomes fast and chaotic. It may cause fainting and can be life-threatening. It can be inherited, but sometimes it is caused by certain medications.
Causes of Arrhythmia
Many factors, from lifestyle to health conditions, may cause these arrhythmias. Therefore, knowledge of the causes will provide a basis for preventive measures and treatment. Here are some of the common causes of arrhythmia:
- Heart Conditions
A variety of cardiac disorders can cause arrhythmias. Coronary artery disease develops narrowed arteries, which may affect the heart’s electrical conduction system. Similarly, myocardial infarction can cause tissue damage and result in abnormal heartbeats. In cardiomyopathy, a weakening or thickening of heart muscle disrupts the electrical transmission.
- Infections and Fever
Different inflammatory markers are released during infection or in states of sepsis that affect the heart’s normal electrical activities. As a result, individuals can experience arrhythmia. Similarly, electrolyte imbalances and increased activity of the sympathetic nervous system due to fever also result in arrhythmia.
- Lifestyle Factors
Personal decisions provide a greater contribution to having an arrhythmia. This includes excessive intake of alcohol, smoking, ingesting high levels of caffeine, and use of drugs that may eventually result in irregular heartbeats. Severe stress or anxiety further increases the risk.
- Medical Conditions
Arrhythmias may also result from non-cardiac medical conditions. For example, thyroid disorders, including hyperthyroidism and hypothyroidism, affect heart rhythm. Diabetes and sleep apnea have also been linked to this condition. Electrolyte imbalances in the blood can disrupt the electrical activity of the heart.
- Medications
Many drugs, both over-the-counter and prescription, may be well known to cause arrhythmias. These comprise some cold and allergy medications, appetite suppressants, antidepressants, and blood pressure. Some of the common drugs to be avoided are chloroquine, hydroxychloroquine, and azithromycin. Therefore, patients should discuss the effects of these medications on the heart with their health provider when any new medications are prescribed.
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Cardiac Arrhythmia Symptoms
Arrhythmia symptoms can vary widely, ranging from barely noticeable to severely disruptive. If you have an arrhythmia, then you can anticipate these common cardiac arrhythmia symptoms:
- Palpitations (sensations of a racing, pounding, or fluttering heart)
- Shortness of breath
- Chest discomfort or pain
- Dizziness or lightheadedness
- Fainting (syncope) or near-fainting episodes
- Fatigue
- Weakness
- Anxiety
- Sweating
In some cases, particularly with certain bradyarrhythmias, patients may experience:
- Confusion
- Difficulty concentrating
- Reduced exercise tolerance
Not all arrhythmias cause noticeable symptoms. Some individuals may have “silent” arrhythmias, detected only during routine medical examinations or when complications arise. The severity and duration of arrhythmia symptoms can vary depending on the type and cause.
Diagnosis of Arrhythmias
Accurate diagnosis of arrhythmias is essential for proper treatment. Cardiologists and electrophysiologists use various tests and procedures to identify and characterize heart rhythm disorders.
- Electrocardiogram (ECG or EKG)
An ECG is the primary tool for diagnosing arrhythmias. This non-invasive test records the heart’s electrical activity through electrodes placed on the skin. It can detect irregular heartbeats, heart rate abnormalities, and other cardiac issues.
- Holter Monitor
A Holter monitor is a portable ECG device worn for 24 to 48 hours or longer. It continuously records the heart’s electrical activity during daily activities, helping to detect arrhythmias that may not occur during a standard ECG.
- Event Recorder
Similar to a Holter monitor, an event recorder is used for longer periods, typically up to 30 days. Patients can activate the device when they feel symptoms, allowing for a correlation between symptoms and heart rhythm.
- Echocardiogram
An echocardiogram uses sound waves to create images of the heart’s structure and function. While not specifically for arrhythmia diagnosis, it can reveal underlying heart conditions that may contribute to rhythm disorders.
- Electrophysiology Study
In this more invasive procedure, thin, flexible wires are inserted through blood vessels to the heart. These wires record the heart’s electrical signals and can also stimulate the heart to induce arrhythmias for study.
Arrhythmia Treatment
Once the condition is confirmed, the cardiologist creates a personalized arrhythmia treatment plan. This treatment depends on the type, severity, and underlying causes of arrhythmia. The main goals are to restore normal heart rhythm, prevent complications, and improve quality of life.
- Medications
Drug therapy is generally the first treatment for arrhythmias. Antiarrhythmic drugs act directly on the heart’s electrical conduction signals to restore normal rhythm. Beta-blockers lower the heart rate, reducing the heart’s workload. Calcium channel blockers can slow AV conduction. In the event of atrial fibrillation, anticoagulants are given to prevent blood clot formation.
- Cardioversion
Cardioversion is indicated when medication is not effective. The procedure restores the heart’s normal rhythm through electricity-a controlled shock, or chemically by using some medications.
- Catheter Ablation
Catheter ablation is a minimally invasive procedure used to treat certain types of tachycardia. A thin, flexible tube (catheter) is guided to the heart, where localized heat or cold energy is applied to destroy small areas of heart tissue that cause an abnormal rhythm. This helps restore normal heart rhythm by targeting the arrhythmia’s source.
- Implantable Devices
For some arrhythmias, patients may need implantable devices, such as pacemakers, that send electrical pulses to the heart to maintain a normal rhythm and implantable cardioverter-defibrillators (ICDs)). They detect and correct dangerous arrhythmias by delivering electric shocks to the heart.
- Lifestyle Changes
In many cases, lifestyle modifications, such as stress reduction techniques, regular exercise (as advised by a doctor), avoiding triggers like caffeine or alcohol, smoking, and consuming a heart-healthy diet, work best to manage arrhythmias.
- Surgery
Surgical procedures are required only in rare cases of arrhythmias. The two most commonly performed surgeries are:
- Maze Procedure: In this procedure, the surgeon creates scar tissue in the atria to prevent abnormal electrical signals. A recent study reported the overall success rate of the maze procedure at approximately 84.1%, offering significant benefits for patients with atrial fibrillation.
- Coronary Bypass Surgery: When coronary artery disease is the main cause of the arrhythmia, the patient may also need to undergo coronary bypass surgery. These surgical options usually come into consideration when other ways of treatment have failed.
Living With Arrhythmia
Life with an arrhythmia is often so much more than the medications that are prescribed to treat the issue. In fact, it requires more of a holistic approach toward heart health and well-being:
- Adhering To A Treatment Plan: It is important to take medications and therapies directed at managing arrhythmia well.
- Regular Medical Check-Ups: These are routine visits with a cardiologist or an electrophysiologist that allow for monitoring of the condition and changing treatments as necessary.
- Lifestyle Changes: Depending on the type and seriousness of the arrhythmia, changes in daily activities, exercise, or diet could be necessary for certain patients.
- Support Systems: Available support groups or professional counseling can offer assistance with emotional issues associated with living with a chronic heart condition.
Emergency preparation for life-threatening arrhythmias, for instance, should involve the formulation of a plan with the physician in the event of emergencies and teaching family members what to do in case of cardiac arrest.
Effective Steps Toward Arrhythmia Treatment!
Cardiac rhythm disorders encompass a wide pathophysiological and clinical spectrum, ranging from benign to life-threatening conditions that may include sudden cardiac death. Therefore, proper diagnosis, selection of appropriate treatment, and follow-up are critical in the management of an arrhythmia.
Recent advances in electrophysiology have transformed our understanding and treatment of arrhythmias. The most significant advance is perhaps that of catheter ablation techniques, which have transformed the approach to many SVTs and some ventricular arrhythmias; indeed, conditions considered hitherto chronic are now often curable. Despite such advances, challenges persist. Hence, people should consider getting certified in CPR or basic life support to stay prepared in cardiac or respiratory emergencies.
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