Heart arrhythmia: Symptoms, diagnosis and treatment
Arrhythmias are common and usually harmless. Most people with regular, irregular heartbeats may feel palpitations. Some arrhythmias can be uncomfortable.
Diagnosisbook supporting video - Heart arrhythmias diagnosis and treatment
An arrhythmia occurs when the electrical impulses in the heart, the transmitters that make the heartbeat, do not work properly, causing the heart to beat too fast, too slow, or suddenly.
Arrhythmias are common and usually harmless. Most people with regular, irregular heartbeats may feel palpitations. However, some arrhythmias can be bothersome - sometimes even life-threatening - causing signs and symptoms.
Treatment of arrhythmias can often control or eliminate arrhythmia. In addition, complex arrhythmias that often make the situation worse - or even cause heart failure, can reduce the risk of arrhythmias by adopting a heart-healthy lifestyle.
Arrhythmias may not cause any signs or symptoms. In fact, a doctor can see an arrhythmia during a routine checkup.
Some people have noticeable arrhythmia symptoms, which may include:
Vibrations in the chest.
Slow heart rate.
Shortness of breath.
Fainting (fainting) or near fainting.
Noticeable signs and symptoms do not always indicate a serious problem. Some people feel an arrhythmia without a serious problem, while others have a life-threatening arrhythmia with no symptoms at all.
An arrhythmia may feel the heart beating fast, or it may feel that the heart is beating too slowly. Other signs and symptoms may be related to a decreased heart rate. These include difficulty breathing or wheezing, weakness, dizziness, lightheadedness, fainting or near fainting, and chest pain or discomfort. Seek emergency medical attention if suddenly or frequently experience any of these signs and symptoms.
Ventricular fibrillation is a deadly type of arrhythmia. It occurs when the heart beats fast, the electrical impulses are erratic. This causes the left heart chamber (ventricle) to vibrate uselessly, instead of pumping blood. Without an effective heartbeat, blood pressure resistance cuts off blood supply to vital organs. A person with ventricular fibrillation will collapse within seconds and quickly stop breathing or have no pulse. If this happens, follow these steps:
Call the emergency number.
If someone nearby knows cardiopulmonary resuscitation (CPR), start doing it if necessary. CPR can help maintain blood flow to organs until electrical shocks (defibrillation) can be administered.
Portable, electrically powered defibrillators that can restart a heartbeat are available in many places, such as airplanes, police cars, and shopping malls. Can even be bought at home. The portable defibrillator comes with instructions for use.
Before learning about what can cause an arrhythmia, first consider what happens in a normal heart rhythm.
Normal heart rate
When the heartbeats, the electrical impulses must follow a precise path through the heart. Any interruption in electrical impulses can cause arrhythmia.
The heart is divided into four hollow chambers. The heart chambers are a pump, with an upper chamber (atria) and a lower chamber (ventricles).
During a heartbeat, the atrial muscle contracts and pours blood into the ventricles. This contraction begins when the sinus node - a small group of cells in the right atrium - sends an electrical impulse to the atrium to contract.
This impulse then travels to the center of the heart, to the atrioventricular node, which lies on the line between the atria and ventricles. From here, the impulses exit the atrioventricular node and pass through the ventricles, causing contraction and pumping of blood throughout the body.
In a healthy heart, this process usually goes smoothly, resulting in a normal resting heart rate of 60-100 beats per minute. Athletes often have heart rates below 60 beats per minute, because their hearts are so efficient.
Causes of arrhythmias
Many things can lead to or cause an arrhythmia, including:
Scarring of heart tissue (such as after a heart attack).
Drinking too much alcohol or coffee.
Supplements and herbs.
In healthy people with a normal healthy heart, arrhythmias do not develop in the absence of an external trigger, such as an electric shock or the use of drugs. Mainly because healthy people dismiss any conditions that cause an arrhythmia.
However, if the heart is diseased or deformed, the heart's electrical impulses may not go properly, making it more likely to develop an arrhythmia.
Any condition that causes structural changes in the heart can lead to the development of arrhythmias due to:
Not enough blood. If the blood supply to the heart is reduced, it can change the ability of heart tissues - including the cells that conduct electrical impulses - to function properly.
Damage to heart tissue. May affect how electrical impulses propagate in the heart.
Changes in the structure of the heart can come from:
Coronary artery disease (CAD). CAD, when the heart's arteries are narrowed, can cause part of the heart muscle to die from ischemia (heart attack). A heart attack causes scarring of heart tissue, which can prevent electrical impulses from conducting normally. This can make the heartbeat fast, dangerously (ventricular tachycardia), or flutter (ventricular fibrillation).
Cardiac disease. Occurs mainly when the ventricular wall is dilated (dilated cardiomyopathy) or when the left ventricular wall is enlarged (myocardial hypertrophy). In both cases of cardiomyopathy, the heart's pumping efficiency is reduced and often leads to myocardial cell damage.
Heart valve disease. Open or narrowed heart valves can lead to dilation and enlargement of the heart muscle. When the heart's chambers become dilated or weakened due to open or narrow valves, there is an increased risk of developing arrhythmia.
Types of arrhythmias
Doctors classify arrhythmias not only by the place of origin (atria or ventricles) but also by the speed of the heartbeat:
Fast heartbeat. Tachycardia - resting heart rate greater than 100 beats per minute.
Slow heart rate. Bradycardia - resting heart rate less than 60 times a minute.
Not all tachycardias (tachycardias) or bradycardias (bradycardias) mean heart disease. For example, during exercise, it is normal to develop a rapid heart rate to deliver more oxygen-rich blood to the tissues.
Tachycardia from the atrium
Atrial flutter. Rapid and chaotic palpitations of the atria are common arrhythmia. Mainly affects the elderly. The risk of developing atrial fibrillation after age 60 is increased, mainly in heart conditions that are not normal, especially if high blood pressure or other heart disease is present. During atrial fibrillation, the electrical signal causes the heart to beat uncoordinated. The atrium beats very fast - fast 350 - 600 beats a minute, instead of making contractions, it vibrates (fibrillate). A paroxysmal type of atrial fibrillation may last a few minutes to an hour or more before returning to a normal heart rhythm. Atrial fibrillation can be dangerous, and over time can cause more serious problems, such as stroke.
Atrial flutter. Atrial flutter is similar to atrial fibrillation. Both can occur, coming and going alternately. The heartbeats in atrial flutter are more organized. Atrial flutter can be life-threatening.
Supraventricular tachycardia (SVT). SVT is a broad term that includes many forms of arrhythmias that originate in the upper ventricles. SVTs often cause episodes of tachycardia that begin and end suddenly and can last from a few seconds to several hours. The bouts begin when the electrical impulses from a heartbeat begin to circle over and over again through an accessory pathway. SVT can make the heartbeat 160-200 times a minute.
SVT is usually caused by underlying heart disease. Although SVT is generally not life-threatening in a normal heart, the symptoms can feel quite uncomfortable. Cardiac arrhythmias are common among young people.
Wolff-Parkinson-White syndrome. One cause of SVT is known as Wolff-Parkinson-White. This arrhythmia is caused by an accessory electrical pathway between the atria and ventricles. This pathway can allow electrical current to pass between the atria and ventricles without passing through the atrioventricular node, resulting in tachycardia.
Tachycardia from the ventricles
Ventricular tachycardia (VT). Tachycardia is caused by abnormal electrical impulses that start in the ventricles. Usually due to a problem with the electrical impulses traveling around a scar from a previous heart attack. VT can cause the ventricles to contract more than 200 beats per minute.
Most VT occurs in people with certain heart-related problems, such as scarring or damage to the ventricular muscle from coronary artery disease or a heart attack. Sometimes VT can last for 30 seconds or less, and it is usually harmless, even though it causes an ineffective heartbeat. However, VT may carry a risk of more serious, ventricular arrhythmias, such as sustained VT. A sustained episode of VT is a medical emergency. Without prompt treatment, sustained ventricular tachycardia often worsens and leads to ventricular fibrillation.
Ventricular fibrillation. In ventricular fibrillation, the electrical impulses are rapidly chaotic, and the ventricles vibrate in vain instead of pumping blood. Without an effective heartbeat, blood pressure drops, immediately cutting off blood supply to vital organs, including the brain. Most people lose consciousness within seconds and immediately require medical help, including cardiopulmonary resuscitation (CPR). Chances of survival may be better if CPR can return the heart to a normal rhythm with a device called a defibrillator. Without CPR or defibrillation, death occurs within minutes. Most cases of ventricular fibrillation are associated with some form of heart disease. Ventricular fibrillation is usually caused by a heart attack.
Long QT syndrome (LQTS). LQTS is a potential arrhythmia that can cause rapid, chaotic heartbeats. Tachycardia, caused by changes in a part of the heart, can lead to fainting, which can be life-threatening. In some cases, the heart rate can be so erratic that it can cause sudden death.
May be born with a genetic mutation that increases the risk of long QT syndrome. In addition, more than 50 drugs, many of which are common, can cause long QT syndrome. Medical conditions such as congenital heart defects can also cause long QT syndrome.
Slow heart rate
Although a heart rate below 60 beats per minute while at rest is considered bradycardia, a low resting heart rate is not always a signal of a problem. It is possible to have an efficient heart that is able to pump an adequate amount of blood less than 60 times a minute at rest. However, if there is a slow heart rate and the heart is not pumping enough blood, bradycardia may be present, including:
Sinus node disease. If the sinus node, which is responsible for setting the heart's speed, does not send an impulse, the heart rate may be too slow, or it may speed up and slow down continuously. If the sinus node is not functioning well due to disease, the scar near the sinus node slows, interrupts, or blocks impulse conduction.
Transmission. The heart's electrical pathways can travel in or near the atrioventricular nodes, which lie on the line between the atria and ventricles. Conduction may also travel along a different pathway to each ventricle. Depending on the location and type of conduction, the impulses between the upper and lower halves of the heart may be slowed or blocked. If the signal is completely blocked, certain cells in the atrial or ventricular nodes can replace, although usually, the heart rate is slower. Some conduction problems may cause no signs or symptoms, and may also cause skipping or bradycardia.
Although it often feels like skipping a beat, a premature heartbeat is actually an extra beat between two normally beating heartbeats. Premature heartbeats that occur in the ventricles come before the time the right ventricle fills with blood after a normal heartbeat.
Although it may be felt occasionally, that means there is rarely a more serious problem. However, premature beats can cause arrhythmias to last longer - especially in people with heart disease. Premature heartbeat is often caused by stimulants, such as caffeine, tea and soft drinks; contains pseudoephedrine and some asthma medicines.
Several factors can increase your risk of developing arrhythmia. These include:
Age. With age, the heart muscle naturally weakens and loses some of its flexibility. This can affect the way the electrical impulses behave.
Genetics. Being born with an abnormal heart can affect the heartbeat.
Coronary artery disease, other heart diseases, and previous heart surgery. Narrowing of the heart arteries, heart attack, abnormal valves, previous heart surgery, cardiomyopathy, and other heart damage are risk factors for most types of arrhythmias.
Thyroid problem. Metabolic rate when thyroid hormone is too much. This can cause a fast or irregular heartbeat and can be linked to atrial fibrillation. Metabolism slows down when the thyroid doesn't have enough hormones, which can cause bradycardia.
Drugs and supplements. Prescription cough and cold medicines that contain the prescription drug pseudoephedrine may contribute to the development of certain arrhythmias.
Hypertension. This increases the risk of developing coronary heart disease. It can also cause the wall of the left ventricle to thicken, which can change the electrical impulses that travel through the heart.
Obesity. Along with a risk factor for coronary heart disease, obesity can increase the risk of developing arrhythmia.
Diabetes. Uncontrolled diabetes is a significant risk factor for developing coronary heart disease and hypertension. In addition, low blood sugar (hypoglycemia) can cause arrhythmia.
Obstructive sleep apnea. This disorder, in which breathing is disrupted during sleep, can cause bradycardia and atrial fibrillation.
Electrolyte imbalance. Substances in the blood called electrolytes, such as potassium, calcium, sodium, and magnesium, help activate and conduct electrical impulses in the heart. Electrolytes that are too high or too low can affect the heart's electrical impulses and contribute to the development of arrhythmias.
Alcohol. Drinking too much alcohol can affect the electrical impulses in your heart or increase your chances of developing atrial fibrillation. In fact, developing atrial fibrillation is seen after heavy drinking. Chronic alcoholism can make the heart less efficient and can lead to cardiomyopathy.
Caffeine or tobacco use. Caffeine, nicotine, and other stimulants can make the heart beat faster and can contribute to the development of many serious arrhythmias. Drugs such as stimulants and cocaine can affect the heart and lead to a variety of arrhythmias or sudden death from ventricular fibrillation.
Certain arrhythmias can increase your risk of developing problems such as:
Stroke. When the heart flutters, it can't pump blood efficiently, which can cause pooling. This can cause blood clots to form. If the clot breaks loose, it can travel and block an artery in the brain, causing a stroke. This can damage part of the brain or lead to death.
Heart failure. This can result if the heart is not pumping efficiently for a long time due to a slow heart rate or a fast heart rate, such as atrial fibrillation. Sometimes, controlling the rate of the arrhythmia that is causing heart failure can improve heart function.
Tests and diagnostics
To diagnose an arrhythmia, your doctor may ask about or test for conditions that may be causing your arrhythmias, such as heart disease or problems with your thyroid gland. Your doctor may also perform specific arrhythmia-specific heart tests. These may include:
Electrocardiogram (ECG). In an electrocardiogram, sensors (electrodes) that can detect the electrical activity of the heart are attached to the chest and sometimes limbs.
Holter followed. A handheld electrocardiogram device can be worn for a day or more to record heart activity.
Record events. For discrete arrhythmias, keep the portable ECG device at home, attach it to the body, and use it only when symptoms of arrhythmia are present. This allows the doctor to check the heart rate at the time of the symptoms.
Echocardiography. In a noninvasive test, a hand-held device (transducer) placed on the chest uses sound waves to create images of the heart's structure, size, and movement.
Cardiac computed tomography (CT) or magnetic resonance imaging (MRI). Although commonly used to check for heart failure, these methods can be used to diagnose heart problems and to detect heart rhythm disturbances. During a cardiac CT scan, you lie on a table in a pie-shaped machine. An X-ray tube inside the camera rotates around the body and collects images of the heart and chest.
During a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. Magnetic fields associated with atomic particles. When radio waves are emitted, these particles bind, producing signal changes depending on the type of tissue. The signals that create images of the heart can help doctors determine the cause of the arrhythmia.
If your doctor doesn't find an arrhythmia on these tests, he or she may try to induce an arrhythmia with other tests, which may include:
Stress test. Some arrhythmias are triggered or worsened by exercise. During the stress test, you'll be asked to run on a treadmill or bicycle while your heart's activity is monitored by an ECG. If it's difficult to do so, your doctor may use medication to stimulate your heart in a similar way to exercise.
Tilting table test. Your doctor may recommend testing. Heart rate and blood pressure are monitored while lying flat on a table. The table then tilts as if it were standing. The doctor watches the heart and the nervous system that controls it respond to the change.
Electrophysiological examination and mapping. In this test, a flexible tube (catheter) with electrodes attached is threaded through a blood vessel to a series of points in the heart. When in place, the electrodes can map electrical impulses and conduction through the heart. In addition, the doctor may use electrodes to stimulate the heart to beat at a rate that would cause or prevent an arrhythmia. This allows the doctor to see the location of the arrhythmia and what may be causing it.
Treatments and drugs
If an arrhythmia is present, treatment may or may not be necessary. Usually, it's only required if the arrhythmia causes significant symptoms or if it risks serious arrhythmias or arrhythmia complications.
Slow heart rate treatment
If bradycardias have no cause that can be treated - such as low thyroid hormone levels or a side effect of medication, your doctor usually uses a pacemaker. A pacemaker is a small battery-powered device usually implanted near the collarbone. One or more electrode-tipped wires run from the pacemaker through the blood vessels to the inside of the heart. If the heart rate is too slow or if it stops, the pacemaker sends electrical impulses that stimulate the heart to beat at a reasonably steady rate.
Treating heart palpitations
For tachycardias (tachycardias), treatments may include one or more of the following:
Vagal's test. An arrhythmia that begins in the upper half of the heart (suppressive ventricular tachycardia, or SVT) can be stopped using specific maneuvers including holding your breath, dipping your face in ice, or coughing. Your doctor may recommend other exercises to stop tachycardia. Exercises that affect the nervous system that controls heart rate (vagal nerve), often slow the heart rate.
Medicine. Many types of tachycardia respond well to antiarrhythmic drugs. Although it does not cure the root problem, it is possible to reduce episodes of tachycardia or slow the heart down when tachycardia occurs. Some medications can slow your heart rate and you may need a pacemaker. It is very important to carry out treatment with any medication exactly as directed by your doctor, to avoid complications.
Electric shock. If there is tachycardia from the atria, including atrial fibrillation, the doctor may use electroconvulsive shock, which is used to re-establish a regular heart rhythm.
Cut off therapy. During this procedure, one or more catheters are threaded through a blood vessel to the inside of the heart. Placed on areas of the heart that your doctor believes is the source of the arrhythmia. The catheterization electrodes are heated with radiofrequency energy. Another method involves catheter cooling, which freezes the problem tissue. Usually, the arrhythmia will resolve.
Treatment of arrhythmias may also involve the use of an implantable device:
Heart pacemaker. A pacemaker is a device implanted under the skin that corrects bradycardia (bradycardia). A small battery-operated device is placed under the skin near the collarbone with minor surgery.
If the pacemaker detects that the heart rate is too slow or there is no heartbeat, it sends out electrical impulses that stimulate the heart to speed up or start beating again. Most pacemakers have a sensor that can control the heart rate to a certain extent. It only works when the heart rate is too slow. Most people stay in the hospital for 1-2 days after a pacemaker is implanted.
An implantable defibrillator (ICD). Your doctor may recommend this device if you are at high risk of developing a dangerously fast heart rate or ventricular fibrillation (ventricular tachycardia or ventricular fibrillation). Implantable defibrillators for atrial fibrillation are also available.
The ICD is a battery-powered unit implanted near the left collarbone. One or more electrodes tipped wire run through a vein to the heart. The ICD continuously monitors the heart rate. If it detects that the rhythm is too slow, it acts on the heart as a pacemaker. If VT or VF is detected, it will give an energy shock to reset the heart rate. An ICD may reduce the risk of fatal arrhythmias compared with medication.
In some cases, surgery may be the recommended treatment for cardiac arrhythmias:
Atrial scarring. This involves making a series of surgical incisions in the upper half of the heart (the atria). The carefully created scars in the atria form the boundaries of electrical impulses in the heart that go the right way to make the heartbeat efficient. This procedure has a high success rate, but because it requires open-heart surgery, it's usually reserved for people who don't respond to other treatment. Surgeons can use a cryoprobe - a tool that applies extreme cold to tissue - or a hand-held radiofrequency probe, rather than a knife, to create scars.
Aneurysm. In some cases, an aneurysm in a blood vessel from the heart is the cause of the arrhythmia. If catheter ablation and implantation of an ICD don't work, this surgery may be needed. Includes removal of the aneurysm that is causing the arrhythmia. By removing the source of the abnormal pulse, arrhythmias can often be eliminated.
Coronary surgery. If you have severe coronary artery disease, in addition to ventricular tachycardia, your doctor may recommend coronary bypass surgery. This can improve the blood supply to the heart and reduce the rate of ventricular tachycardia.
Lifestyle and remedy
Many arrhythmias can be blamed on underlying heart disease, so your doctor can show that, in addition to other treatments, making lifestyle changes will keep your heart as healthy as possible.
Lifestyle changes may include:
Eat heart-healthy foods.
Increase physical activity.
Cut down on caffeine and alcohol.
Find ways to reduce the amount of stress in your life.
Avoid irritants, like cold and nasal congestion medications.