Heart Arrhythmia
Troubles of the heart
Heart arrhythmia (or dysrhythmia) is an abnormal change in your heart rate and/or rhythm. Arrhythmias, which affect many people, may cause the heart to beat faster than normal (tachycardia), slower than normal (bradycardia), or irregularly (erratic). They range from mild, asymptomatic disturbances to life-threatening conditions that may require immediate medical intervention.
Pronunciation
hart ar-RITH-mee-ah
Synonyms
- Dysrhythmia
- Atrial ectopic beats
- Ventricular ectopic beats
- Paroxysmal tachycardia
- Ventricular fibrillation
- Atrial fibrillation
- Palpitations
Detailed Description
The heart is made up of four chambers: two atria and two ventricles. In a healthy heart, each of these chambers contracts in a precise sequence to move the maximum amount of blood while using the least amount of energy. Normally the heartbeat starts in the right atrium when a special group of cells called the sinus node (the "pacemaker" of the heart) sends an electrical signal. As the electrical impulse moves through the heart, the heart contracts -- normally 60 to 100 times a minute. Each contraction represents one heartbeat. The atria contract a fraction of a second before the ventricles. This lets them empty their blood into the ventricles before the ventricles contract. Arrhythmias occur when the electrical impulse that controls these muscle contractions is disrupted.
Arrhythmias can be dangerous to the extent that they reduce the heart's ability to function properly. Very occasional irregular heartbeats are harmless and require no treatment. Most arrhythmias don't cause symptoms or interfere with the pumping action of the heart, so they pose little risk, and are readily controlled by proper medication. If, however, you experience recurring or persistent arrhythmia, or it is accompanied by other symptoms, such as chest pain or dizziness, contact a doctor immediately.
How Common Is Heart Arrhythmia?
Arrhythmias affect all age groups and occur equally in both sexes. Stress-related arrhythmia is more likely to occur in adults.
Established Causes
Mild arrhythmias may be caused by stress, overwork, exercise, excessive alcohol consumption (often referred to as "holiday heart"), or smoking. Arrhythmias may also be triggered by various endocrine disorders, especially thyroid and adrenal gland diseases. In addition, certain drugs, including some used to treat lung disease or high blood pressure, allergy medications, and diet pills, can cause irregular heartbeats. Arrhythmias can also occur when either the heart muscle or the sinus node, the heart's natural pacemaker, has been damaged. Such damage may be due to a heart attack, congenital defect, rheumatic fever, damaged heart valves, or heart infection.
Risk Factors
Risk factors for arrhythmia include the following:
- Stress
- Chronic kidney disease
- Fatigue
- Sleep deprivation
- High blood pressure
- Heart diseases like rheumatic fever, congenital heart disease, cardiomyopathy, or previous attacks
- Endocrine disorders, particularly thyroid and adrenal gland diseases
- Use of certain drugs, including caffeine, alcohol, stimulants, diuretics, amphetamines, and many nonprescription cough and cold remedies
Risk factors are traits or behaviors that may make you statistically more likely than others in the general population to have a certain condition. They are not necessarily "causes" of the condition.
Symptoms
To start, it helps to be aware of your own heartbeat, knowing whether it skips, beats faster than normal, beats slower than normal, or suddenly changes rhythm.
Arrhythmias may be either symptomatic or, as is frequently the case, asymptomatic (without symptoms). Some people experience the following symptoms:
- Shortness of breath
- Sudden faintness or weakness
- Palpitations
- Dizziness or lightheadedness
- Fatigue
- Chest pain
How Is Heart Arrhythmia Diagnosed?
Initially, your physician will conduct a physical examination, review your medical history, and ask about symptoms. If you do experience symptoms, help your doctor make a preliminary diagnosis and evaluate the seriousness of the problem by answering the following questions:
- Is your heartbeat fast or slow?
- Is your heartbeat regular or irregular?
- Is the episode brief or prolonged?
- Are the arrhythmias accompanied by feelings of dizziness, lightheadedness, or faintness?
- Do you experience chest pain, shortness of breath, or any other unusual sensations at the same time?
- Do the arrhythmias occur while you are resting or only during strenuous exercise or unusual activity?
- Does the problem start and stop suddenly or gradually?
Specific Tests
Specific tests may include the following:
- Blood sample analysis: blood count.
- ECG (electrocardiogram) and 24-hour Holter monitoring: the Holter monitor allows for any arrhythmias to be recorded over a 24-hour period.
- Electrophysiologic studies: can determine more precisely the type of arrhythmia you have and monitor the effect of antiarrhythmic medication. These tests are often conducted if the arrhythmia appears to be life-threatening.
- Exercise stress test: that shows your heart activity via electrocardiogram and monitors your symptoms as you exercise to a predetermined level.
- Thyroid function tests.
Imaging
Your doctor may order the following tests to determine heart abnormalities and heart structural diseases:
- Chest X-ray
- Echocardiogram that uses sound waves to create an image of the heart
Goals of Treatment
Most arrhythmias can be controlled with proper treatment. Depending on the nature and severity of the condition, your doctor may prescribe antiarrhythmic medication, implantation of a pacemaker, or both. If the arrhythmia is due to an underlying heart condition, more aggressive surgical intervention may be required. Very occasional irregular heartbeats are harmless and require no treatment.
In cases in which arrhythmia is due to lifestyle-related causes such as stress, overwork, or smoking, changes in behavior may end the problem. Arrhythmia stemming from organic causes, such as heart disease or endocrine disorders, can be controlled but not cured.
Treatment Overview
While most arrhythmias respond to drug therapy, you may need to try several drugs to find the most effective one for you. Also, because drugs can control but not cure arrhythmia, it is important that you strictly follow the regimen your doctor prescribe-- even if you become symptom-free.
Call your doctor immediately if any new, unexplained symptoms develop because any of the drugs used in treatment may produce side effects. You should also inform your doctor immediately if you continue to experience heart problems despite being on medication.
A few arrhythmias can be life-threatening unless CPR (cardiopulmonary resuscitation) is performed immediately. As a matter of course, at least one family member, friend, or designated caregiver should be certified in this technique.
Drug Therapy
Drugs most commonly prescribed include the following:
- Beta-blockers like Inderal (propranolol),and Tenormin (atenolol), and Lopressor or Toprol (metoprolol)
- Calcium-channel blocking agents like Calan or Isoptin (verapamil) and Cardizem (diltiazem)
- Lanoxin (digoxin)
Other drugs for treating arrhythmias
- Procanbid (procainamide)
- Norpace (disopyramide)
- Corvert (ibutilide)
- Duraquin or Quinaglute (quinidine)
- Rythmol (propafenone)
- Mexitil (mexiletine)
- Betapace (sotalol)
- Cordarone (amiodarone)
- Bretylol (bretylium)
Surgery
Depending on the nature and severity of the arrhythmia, surgical options could include a temporary pacemaker, a permanent pacemaker, or cardiac surgery.
A temporary pacemaker consists of a long, thin electrode wire, one end of which is inserted into the heart through a vein while the other end is attached to an external, battery-powered, pacemaker pulse generator. It can be left in place for up to several days until normal heart rhythms are restored.
With a permanent pacemaker, the pulse generator is implanted under the skin. The pacemaker is implanted while the patient is under local anesthesia, although patients may need to remain in bed for up to 24 hours following surgery in order to ensure that the leads have attached well to the heart wall.
Patients with recurring, life-threatening dysrhythmias may require an automatic implantable cardioverter defibrillator (AICD) implant. This device senses when the heart rhythm becomes abnormal and administers an electrical shock to the heart to correct the problem. AICD implantation, which requires making an incision in the chest, is done under general anesthesia; patients should expect to remain hospitalized for about a week following surgery.
If the arrhythmia is caused by an underlying cardiac condition, other surgical procedures may be required. The two most commonly performed surgeries to unblock the blood vessels leading to the heart are angioplasty and coronary bypass surgery, but a relatively new treatment called transmyocardial revascularization also shows promise for certain patients. The location and severity of the disease in the coronary arteries determine which procedure is chosen.
- Angioplasty: A catheter with a balloon tip is inserted into the coronary arteries. When the catheter reaches a narrowed segment, the balloon is inflated to flatten the plaque and widen the artery. In one newer variation, a rotating blade shaves the plaque into tiny particles, and in another, a laser beam vaporizes the plaque.
- Coronary bypass surgery: This procedure is reserved for severe cases of coronary blockage that cannot be addressed by any other means. Segments of healthy blood vessels, either from the chest or leg, are used to bypass the severely narrowed parts of the coronary arteries. The result is greatly increased blood flow to the heart muscle, reducing angina and risk of a heart attack.
- Transmyocardial revascularization: A laser cuts a series of channels in the heart muscle to increase blood flow. A surgeon makes an incision on the left side of the chest and inserts a laser into the chest cavity. With the laser, the surgeon shoots from 15 to 30 holes, each a millimeter in diameter, through the heart's left ventricle, in between heartbeats. (The laser is fired when the chamber is full of blood so the blood can protect the inside of the heart.) Then the surgeon seals the outer openings but lets the inner channels stay open, allowing oxygen-rich blood to flow through the heart muscle.
Activity & Diet Recommendations
Psychotherapy or counseling may be helpful in alleviating arrhythmia if you and your doctor determine that stress is a major factor.
Some heart medicines require that you add extra potassium to your diet. Potassium-rich fruits include oranges, orange and grapefruit juice, bananas, melons, nectarines, prunes, peaches, pears, and avocados. Vegetables high in potassium include collard greens, cucumbers, potatoes, sweet potatoes, cabbage, beans, peas, winter squash, and tomatoes.
Monitoring the Condition
Your doctor may have to prescribe different antiarrhythmic medications to find the most suitable one for you. Record all side effects and report them to your doctor. Discontinue use immediately if the side effects are severe.
Possible Complications
The most serious cardiac rhythm disturbance is called ventricular fibrillation. The lower chambers of the heart quiver and the heart cannot pump any blood. Ventricular fibrillation is a life-threatening medical emergency.
Blood clots can form during atrial fibrillation, a condition in which the two small upper chambers of the heart quiver instead of beating effectively. Since blood isn't pumped completely out of the atria when the heart beats, the blood pools and clots. If a piece of the blood clot in the atria becomes lodged in an artery in the brain, a stroke results.
These serious arrhythmias are usually treated by defibrillation-- an electric shock applied to the heart to reestablish a normal rhythm.
Quality of Life
If lifestyle factors are determined to be wholly or partially responsible for the arrhythmia, consider making serious behavioral changes. These could include abstaining from or significantly decreasing your consumption of alcohol and caffeine-containing beverages, quitting smoking, and actively seeking ways to reduce the stress level in your life.
Considerations for Women
Pregnancy
If you are pregnant, consult your doctor before taking any antiarrhythmic medication.
Nursing mothers
If you are breastfeeding, consult your doctor before taking any antiarrhythmic medication.
Considerations for Older People
Side effects of medication may be more frequent and severe in older people. Make sure your doctor is aware of any other medicines you already take.
Herbs
Any alternative therapies that help to prevent heart disease can also help to prevent heart arrhythmia.
Chinese herbalists recommend several herbal combinations, including the following:
- Bupleurum, cinnamon, and ginger, or bupleurum and dragon-bone formulas for palpitations
- Pinellia and magnolia for tachycardia
- Atratylodes and hoelen herbal combination for bradycardia (slow heartbeat)
Supplements
Other dietary supplements that may help alleviate arrhythmias include the following:
- Potassium
- Magnesium
- Vitamin C
- Vitamin E
- L-Carnitine
- Coenzyme-Q10
- Flaxseed oil
- Multivitamin/mineral supplement
Discuss your specific condition with a knowledgeable healthcare provider before you use any alternative therapies.
Relaxation Therapies
- Pressing on certain points along the inner forearms using shiatsu, an acupressure technique, may help control arrhythmias caused by anxiety. Visit an acupressure and/or shiatsu practitioner for advice.
- Yoga and meditation can help some people control arrhythmias caused by stress.
- You can help alleviate dizziness due to bradycardia by putting your head down between your knees.
- Your healthcare provider can demonstrate two other techniques that may be helpful in bringing a racing heartbeat (tachycardia) under control:
- One, carotid sinus massage, involves rubbing first one side of the neck and then the other in a particular manner for no more than five seconds each. It is very important to learn this technique from a health care professional. Never massage both sides of the neck simultaneously. Improper technique, such as applying too much pressure or massaging for too long, can block blood flow to the brain, possibly leading to a stroke, or triggering new, more dangerous dysrhythmias.
- The other technique, called Valsalva's maneuver, involves inhaling deeply, holding your breath, and straining hard for at least 10 seconds before exhaling. The resulting increase in intrathoracic pressure helps convert the dysrhythmia to a normal rhythm.
Diet
Eliminate stimulating, caffeine-containing beverages like coffee, black tea, cola, and chocolate from your diet.
Lifestyle
Most arrhythmias are not life-threatening, although they can cause considerable anxiety. Sometimes understanding their harmlessness is sufficient to take away the feelings of distress or panic that often accompany and exacerbate an arrhythmia episode.
If the arrhythmia is due to external rather than organic causes, changes in behavior may diminish the severity of the condition or even cause it to cease. These behavioral changes could include avoiding alcohol or strenuous exercise, giving up smoking, and abstaining from recreational drug use. Fatigue, stress, overwork, and lack of sleep are other risk factors you can control.
Websites & Organizations
American College of Cardiology
911 Old Georgetown Road
Bethesda, MD 20814
Phone: 301-897-5400
American Heart Association
7320 Greenville Ave.
Dallas, TX 75231
Phone: 214-750-5300
Austin Heart
Medical Park Tower
1301 West 38th Street, Suite 300
Austin, TX 78705
Phone: 512-206-3636
Fax: 512-454-2581
Email: schedule@austinheart.com
The Coronary Club, Inc.
9500 Euclid Avenue, E-37
Cleveland, OH 44195
Phone: 216-444-3690
Doctor's Guide
Heart Information Network
Heartmates, Inc.
PO Box 16202
Minneapolis, MN 55416
Phone: 800-9HM-3331 (800-946-3331)
E-mail: heartmates@outtech.com
The Mended Hearts
7272 Greenville Avenue
Dallas, TX 75231
Phone: 214-706.1442
National Heart, Lung, and Blood Institute
Information Office
P.O. Box 30105
Bethesda, MD 20892-0105
Phone: 301-251-1222
Village of Freeport: What Is an Arrhythmia?
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