What Is Arrhythmia?

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What Is Arrhythmia?

An arrhythmia is a problem with the rate or rhythm of your heartbeat. It means that your heart beats too quickly, too slowly, or with an irregular pattern. When the heart beats faster than normal, it is called tachycardia. When the heart beats too slowly, it is called bradycardia. The most common type of arrhythmia is atrial fibrillation, which causes an irregular and fast heart beat.

Many factors can affect your heart’s rhythm, such as having had a heart attack, smoking, congenital heart defects, and stress. Some substances or medicines may also cause arrhythmias

Heart arrhythmia, also known as cardiac dysrhythmia or irregular heartbeat, is a group of conditions in which the heartbeat is irregular, too fast, or too slow. A heart rate that is too fast – above 100 beats per minute in adults is called tachycardia and a heart rate that is too slow below 60 beats per minute is called bradycardia. Many types of arrhythmia have no symptoms.

When symptoms are present these may include palpitations or feeling a pause between heartbeats. More seriously there may be lightheadedness, passing out, shortness of breath, or chest pain. While most types of arrhythmia are not serious, some predispose a person to complications such as stroke or heart failure. Others may result in cardiac arrest.

There are four main types of arrhythmia: extra beats, supraventricular tachycardias, ventricular arrhythmias, and bradyarrhythmias. Extra beats include premature atrial contractions, premature ventricular contractions, and premature junctional contractions. Supraventricular tachycardias include atrial fibrillation, atrial flutter, and paroxysmal supraventricular tachycardia.

Ventricular arrhythmias include ventricular fibrillation and ventricular tachycardia. Arrhythmias are due to problems with the electrical conduction system of the heart. Arrhythmias may occur in children; however, the normal range for the heart rate is different and depends on age. A number of tests can help with diagnosis including an electrocardiogram (ECG) and Holter monitor.

Most arrhythmias can be effectively treated. Treatments may include medications, medical procedures such as a pacemaker, and surgery. Medications for a fast heart rate may include beta blockers or agents that attempt to restore a normal heart rhythm such as procainamide.

 

This latter group may have more significant side effects especially if taken for a long period of time. Pacemakers are often used for slow heart rates. Those with an irregular heartbeat are often treated with blood thinners to reduce the risk of complications. Those who have severe symptoms from an arrhythmia may receive urgent treatment with a controlled electric shock in the form of cardioversion or defibrillation.

Arrhythmia affects millions of people. In Europe and North America, as of 2014, atrial fibrillation affects about 2% to 3% of the population. Atrial fibrillation and atrial flutter resulted in 112,000 deaths in 2013, up from 29,000 in 1990. Sudden cardiac death is the cause of about half of deaths due to cardiovascular disease or about 15% of all deaths globally. About 80% of sudden cardiac death is the result of ventricular arrhythmias. Arrhythmias may occur at any age but are more common among older people.

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.

Heart arrhythmias (uh-RITH-me-uhs) may feel like a fluttering or racing heart and may be harmless. However, some heart arrhythmias may cause bothersome 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

An abnormal heart rhythm is called an arrhythmia.

Sometimes palpitations are symptoms of arrhythmias. You might feel like your heart is racing, thumping or skipping beats. You might notice them during exercise, when you’re stressed or after having caffeine or nicotine.

If you have palpitations or feel you have an irregular heart beat, it’s important to see your doctor or health practitioner to find out the cause. All arrhythmias require treatment.

There are 4 different kinds of arrhythmias:

Premature (extra) beats are the most common type of arrhythmia. They can feel like fluttering in the chest. These can result from stress, too much exertion, caffeine or nicotine.

Supraventricular tachycardias are fast heart rates. Atrial fibrillation is a form of this. More details about atrial fibrillation, for professionals, is here.

Ventricular rhythm issues can stop the ventricle pumping blood around the body. It can result in sudden cardiac arrest.

Bradycardia is when your heart beat is too slow. It can mean that not enough blood reaches your brain and can cause you to pass out.

In an arrhythmia the heartbeats may be too slow, too rapid, too irregular, or too early. Rapid arrhythmias (greater than 100 beats per minute) are called tachycardias. Slow arrhythmias (slower than 60 beats per minute) are called bradycardias. Irregular heart rhythms are called fibrillations (as in atrial fibrillation and ventricular fibrillation). When a single heartbeat occurs earlier than normal, it is called a premature contraction.

The term arrhythmia comes from the Greek a-, loss + rhythmos, rhythm = loss of rhythm.

An arrhythmia is a disorder that affects the normal heart rate. With an arrhythmia, the heart tends to beat too slow (bradycardia), too fast (tachycardia), or irregularly. These disorders can affect the amount of blood pumped by the heart.

The heartbeat is controlled by electrical impulses that normally travel on a smooth path through the heart, causing the ventricles and atria to contract in a specific order, pushing blood through the lungs and body. These electrical impulses are controlled by the heart’s sinoatrial (SA) node, or sinus node, the heart’s natural pacemaker.

Although many arrhythmias will never cause health problems, they can cause troublesome symptoms, such as dizziness or chest discomfort. Other, more dangerous arrhythmias can impact blood supply and require medical management. Left untreated, they can eventually lead to stroke, heart attack, heart failure, or sudden death.

Atrial fibrillation (afib) is the most common arrhythmia. Different types of atrial fibrillation may last for seconds or be permanent. The condition is more common in older people and can have many different causes.

Ventricular fibrillation is the most dangerous type of arrhythmia. With this condition, the heart’s ventricles lose the ability to contract, stopping blood flow to the body and brain. Ventricular fibrillation rapidly leads to loss of consciousness and death, and requires electrical shock (defibrillation) to restart the heartbeat.

Symptoms

Symptoms of arrhythmias include:

  • Fast or slow heart beat
  • Skipping beats
  • Lightheadedness or dizziness
  • Chest pain
  • Shortness of breath
  • Sweating

Your doctor can run tests to find out if you have an arrhythmia. Treatment to restore a normal heart rhythm may include medicines, an implantable cardioverter-defibrillator (ICD) or pacemaker, or sometimes surgery

Arrhythmias may not cause any signs or symptoms. In fact, your doctor might find you have an arrhythmia before you do, during a routine examination. Noticeable signs and symptoms don’t necessarily mean you have a serious problem, however.

Noticeable arrhythmia symptoms may include:

  • A fluttering in your chest
  • A racing heartbeat (tachycardia)
  • A slow heartbeat (bradycardia)
  • Chest pain
  • Shortness of breath
  • Lightheadedness or dizziness
  • Sweating
  • Fainting (syncope) or near fainting

Symptoms of arrhythmias can include:

  • Heart palpitations (a racing or irregular heartbeat)
  • Lightheadedness or dizziness
  • Fainting or almost fainting
  • Shortness of breath
  • Chest pain or discomfort

Many of these symptoms can be confused with the effects of aging or physical inactivity, or with other diseases affecting the heart.

Diagnosis

  • Common Tests for Arrhythmia (American Heart Association)
  • Electrophysiology Studies (EPS) (American Heart Association)
  • Heart Health Tests: MedlinePlus Health Topic From the National Institutes of Health (National Library of Medicine)
  • Also in Spanish
  • Holter and Event Monitors From the National Institutes of Health (National Heart, Lung, and Blood Institute)
  • Skipped Beats (Heart Rhythm Society)
  • Slow Heartbeat (Heart Rhythm Society)
  • Syncope From the National Institutes of Health (National Institute of Neurological Disorders and Stroke)
  • Tilt Table Test (Mayo Foundation for Medical Education and Research)

To see if you have an arrhythmia, your doctor may use tests like:

  • electrocardiogram (ECG)
  • stress tests
  • tilt tests
  • electrophysiology studies.

Tests commonly used to diagnose arrhythmias include:

Electrocardiogram: to identify problems with heart rhythm

Holter monitor: a portable electrocardiogram machine used to continuously monitor the heartbeat over one or two days

Event monitor: similar to a Holter monitor, but used for weeks or months. An event recorder is turned on by the patient when symptoms occur

Electrophysiology studies: to track and stimulate electrical impulses in the heart

Stress (exercise) testing: to test whether an arrhythmia occurs when the heart is challenged to work harder than normal

Treatments

  • Antiarrhythmics (Texas Heart Institute)
  • Also in Spanish
  • Automated External Defibrillator From the National Institutes of Health (National Heart, Lung, and Blood Institute)
  • Cardioversion From the National Institutes of Health (National Heart, Lung, and Blood Institute)
  • Catheter Ablation From the National Institutes of Health (National Heart, Lung, and Blood Institute)
  • Catheter Ablation of Ventricular Tachycardia (American Heart Association)
  • Medications for Arrhythmia (American Heart Association)
  • Pacemakers and Implantable Defibrillators: MedlinePlus Health Topic From the National Institutes of Health (National Library of Medicine)
  • Also in Spanish
  • Prevention and Treatment of Arrhythmia (American Heart Association)

There are different treatments for arrhythmias. The best one for you depends on the cause and how much the arrhythmia affects you.

A variety of approaches can be taken in treating and managing arrhythmias. Some arrhythmias need only to be monitored, while others require urgent treatment.

Drug Therapies

Many drugs are available for reducing the occurrence of arrhythmias or managing symptoms.

These include drugs to:

  • Slow the heartbeat (beta blockers and calcium channel blockers)
  • Keep the heart rhythm normal (antiarrhythmic drugs)
  • Help prevent blood clots (blood thinners, such as warfarin)

Implantable Devices

Some people with arrhythmias may need an implantable device to help the heart work properly.

A pacemaker is a small device implanted near the heart. It is usually used to treat bradycardia. The pacemaker monitors the electrical activity of the heart and delivers a small electrical pulse when the heart beats too slowly. For more information, see the Pacemaker Implantation Patient Guide.

An implantable cardioverter-defibrillator (ICD) is similar to a pacemaker but can deliver an electrical shock to restore normal heart rhythms when needed. An ICD may be necessary for patients with more dangerous arrhythmias that can stop the heartbeat, such as ventricular fibrillation. For more information, see the ICD Patient Guide.

Ablation

Some arrhythmias may need to be treated with a minimally invasive technique called radio-frequency ablation. This procedure is performed using a catheter threaded through a blood vessel to the heart. An electrode is inserted through the catheter and used to heat and destroy a small area of tissue. This can block abnormal electrical signalling pathways in the heart.

Lifestyle Changes

Lifestyle changes can help reduce the symptoms of heart disease underlying arrhythmias as well as target arrhythmias directly. Some changes recommended for people with arrhythmias include:

Quitting smoking

  • Limiting alcohol, caffeine, and over-the-counter medications that contain stimulants
  • Increasing physical activity (with a doctor’s supervision)
  • Reducing stress
  • Losing weight if overweight and maintaining a healthy weight
  • Although important, such lifestyle changes may have little effect on arrhythmias.

Treatment depends on the type and seriousness of your arrhythmia. Some people with arrhythmias require no treatment. For others, treatments can include medication, making lifestyle changes, and undergoing surgical procedures.

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