Cardiac Arrhythmia

Cardiac Arrhythmia

An arrhythmia is an irregular or abnormal heart beat.

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Overview

Heart rhythm problems (heart arrhythmias) occur when the electrical impulses that coordinate your heartbeats don't work properly, causing your heart to beat too fast, too slow or irregularly.  They may feel like a fluttering or racing heart and may be harmless. However, some heart arrhythmias may cause bothersome and sometimes even life-threatening signs and symptoms. Heart arrhythmia treatment can often control or eliminate fast, slow or irregular heartbeats. In addition, because troublesome heart arrhythmias are often made worse or are even caused by a weak or damaged heart, you may be able to reduce your arrhythmia risk by adopting a heart-healthy lifestyle.

There are several different types or categories of arrhythmias as listed below:

  • Tachycardia: A fast heart rhythm with a rate of more than 100 beats per minute. 

  • Bradycardia: A slow heart rhythm with a rate below 60 beats per minute. 

  • Supraventricular arrhythmias: Arrhythmias that begin in the atria (the heart’s upper chambers). “Supra” means above; “ventricular” refers to the lower chambers of the heart, or ventricles. 

  • Ventricular arrhythmias: Arrhythmias that begin in the ventricles (the heart’s lower chambers). 

  • Bradyarrhythmias: Slow heart rhythms that may be caused by disease in the heart’s conduction system, such as the sinoatrial (SA) node, atrioventricular (AV) node or HIS-Purkinje network.

Why do I have a Cardiac Arrhythmia?

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Arrhythmias can be caused by many different factors which include the following:

  • Coronary artery disease

  • High blood pressure

  • Changes in the heart muscle (cardiomyopathy)

  • Valve disorders

  • Electrolyte imbalances in the blood, such as sodium or potassium

  • Injury from a heart attack

  • The healing process after heart surgery

  • Other medical conditions

How are Cardiac Arrhythmias diagnosed?

An arrhythmia may be “silent” and not cause any symptoms. A doctor can detect an irregular heartbeat during an examination by taking your pulse, listening to your heart or by performing diagnostic tests.

If symptoms occur, they may include: 

  • Palpitations: A feeling of skipped heartbeats, fluttering, "flip-flops" or feeling that the heart is "running away" 

  • Pounding in the chest 

  • Dizziness or feeling lightheaded 

  • Shortness of breath 

  • Chest discomfort 

  • Weakness or fatigue (feeling very tired)

After evaluating your symptoms and performing a physical examination, the cardiologist may perform a variety of diagnostic tests to help confirm the presence of an arrhythmia and indicate its causes. Some tests that may be done to confirm the presence of an irregular heart rhythm include: 

  • Electrocardiogram (ECG or EKG): a picture of the electrical impulses traveling through the heart muscle. An ECG is recorded on graph paper, through the use of electrodes (small, sticky patches) that are attached to your skin on the chest, arms and legs. 

  • Ambulatory monitors, such as:

    • Holter monitor: A small portable recorder that is attached to electrodes on your chest. It continuously records your heart’s rhythm for 24 hours. 

    • Transtelephonic monitor: A small monitor is attached to electrode leads, usually on your finger or wrist. With the help of this device, your heart’s rhythm is transmitted over the phone line to your doctor’s office. 

    • Transtelephonic monitor with a memory loop: A small, portable recorder that is worn continuously for an extended period of time to record and save information about your heart’s rhythm around the time you experience an arrhythmia. The recording is triggered by pushing a button (event button). The rhythm is recorded, saved and transmitted over the phone line. 

  • Stress test: a test used to record arrhythmias that start or are worsened with exercise. This test also may be helpful in determining if there is underlying heart disease or coronary artery disease associated with an arrhythmia. 

  • Echocardiogram: a type of ultrasound used to provide a view of the heart to determine if there is heart muscle or valve disease that may be causing an arrhythmia. This test may be performed at rest or with activity. 

  • Cardiac catheterization: using a local anesthetic, a catheter (small, hollow, flexible tube) is inserted into a blood vessel and guided to the heart with the help of an X-ray machine. A contrast dye is injected through the catheter so X-ray movies of your coronary arteries, heart chambers and valves may be taken. This test helps your doctor determine if the cause of an arrhythmia is coronary artery disease. This test also provides information about how well your heart muscle and valves are working.

  • Electrophysiology study (EPS): a special heart catheterization that evaluates your heart’s electrical system. Catheters are inserted into your heart to record the electrical activity. The EPS is used to find the cause of the abnormal rhythm and determine the best treatment for you. During the test, the arrhythmia can be safely reproduced and terminated. 

  • Tilt table test (also called a passive head-up tilt test or head upright tilt test): records your blood pressure and heart rate on a minute-by-minute basis while the table is tilted in a head-up position at different levels. The test results may be used to evaluate heart rhythm, blood pressure and sometimes other measurements as you change position. 

What are my treatment options for Cardiac Arrhythmias?

Treatment depends on the type and severity of your arrhythmia. In some cases, no treatment is necessary. Treatment options include medications, lifestyle changes, invasive therapies, electrical devices or surgery.

Medications include antiarrhythmic drugs which are used to convert the arrhythmia to a normal sinus rhythm or to prevent an arrhythmia. Other medications may include heart rate-control drugs and anticoagulant or antiplatelet drugs such as warfarin (a “blood thinner”) or aspirin, which reduce your risk of stroke or developing blood clots. It is important that you know the names of your medications, why they are prescribed, how often and at what times to take them, what side effects may occur, and what medications you have previously taken for your arrhythmia.

Lifestyle changes- arrhythmias may be related to certain lifestyle factors. The following tips can help reduce your risk:

  • Stop smoking

  • Limit alcohol intake.

  • Limit or stop using caffeine.

  • Avoid using stimulants. Beware of stimulants used in cough and cold medications and herbal or nutritional supplements. Some of these substances contain ingredients that cause irregular heart rhythms. Read the label and ask your doctor or pharmacist which medication is best for you.

  • Your family may also want to be involved in your care by learning to recognize your symptoms and how to start CPR if needed.

  • If you notice that your irregular heart rhythm occurs more often with certain activities, you should avoid them.

Invasive therapies can be used to treat or eliminate irregular heart rhythms. Your doctor will determine the best treatment for you and discuss the benefits and risks of these therapies with you.

  • Electrical cardioversion: for patients with persistent arrhythmias, such as atrial fibrillation, they may not be able to achieve a normal heart rhythm with drug therapy alone. Electrical cardioversion delivers an electrical shock to your chest wall, which synchronizes the heart and allows the normal rhythm to restart. This procedure is done after you receive short-acting anesthesia.

  • Catheter ablation: during ablation, energy is delivered through a catheter to tiny areas of the heart muscle. This energy can either “disconnect” the pathway of the abnormal rhythm, block the abnormal pulses and promote normal conduction of impulses, or disconnect the electrical pathway between the atria and the ventricles.

Electrical devices may be implanted to help regulate your heart rhythm.

  • Permanent pacemaker: A device that sends small electrical impulses to the heart muscle to maintain a normal heart rate. The pacemaker has a pulse generator (which houses a battery and a tiny computer) and leads (wires) that send impulses from the pulse generator to your heart muscle, as well as sense the heart’s electrical activity. Pacemakers are mostly used to prevent the heart from beating too slowly. Newer pacemakers have many sophisticated features that are designed to help manage arrhythmias, optimize heart rate-related functions and improve synchronization.

  • Implantable cardioverter-defibrillator (ICD): A sophisticated electronic device used primarily to treat ventricular tachycardia and ventricular fibrillation — two life-threatening abnormal heart rhythms. The ICD constantly monitors the heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle to cause the heart to beat in a normal rhythm again.

Heart surgery may be needed to correct arrhythmias that can’t be controlled with medications or nonsurgical treatment methods. Arrhythmia surgery may also be recommended if you need surgery, such as valve or bypass surgery, to correct other forms of heart disease. The Maze and modified Maze procedures are two surgeries used to correct atrial fibrillation. Your doctor will determine the best treatment for you and discuss these options with you, including more information about surgical treatment if it is an appropriate treatment option.


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