What to know about arrhythmia

An arrhythmia accounts for an irregular heartbeat. With this condition the heart of a person may beat too fast, too slowly, too early, or with an irregular rhythm.

Arrhythmias occur when there is no proper processing of the electrical signals regulating heartbeats. An irregular heartbeat may sound like a heart beating or a flutter.

Many arrhythmias are harmless to the heart. However, arrhythmias can cause serious and potentially fatal symptoms and complications if they are extremely irregular or result from a weak or damaged heart.

We describe Arrhythmia in this article, as well as its causes and symptoms. We also describe the medications and various forms that might be available.

What is arrhythmia?

A lady having chest pain
A person with arrhythmia may experience chest pain.

Cardiac arrhythmia is a group of conditions which cause the heart to beat irregularly, too slowly, or too fast.

There are several categories of arrhythmia, including:

  • bradycardia, or a slow heartbeat
  • tachycardia, or a fast heartbeat
  • irregular heartbeat, also known as a flutter or fibrillation
  • early heartbeat, or a premature contraction

Most arrhythmias are not serious, and are not complicated. But some can increase the risk of stroke or heart arrest.

Some people may hear the term “dysrhythmia” used by doctors when referring to their irregular heartbeat. The terms arrhythmia and dysrhythmia mean the same thing, but more is the word arrhythmia.

What is a normal heartbeat?

Doctors define a healthy heartbeat by counting the number of times each minute (bpm) the heart beats at rest. This is known as heart rate control.

The range for a healthy resting heart rate varies from individual to individual, but the American Heart Association ( AHA) suggests it usually is between 60 and 100 bpm.

The fitter a person is, the lower it becomes their resting heart rate. For example, olympic athletes would normally have a heart rate of less than 60 bpm, since their hearts are highly effective.

With a normal rhythm, the heart should beat consisting of double “ba-bum” beats with even spaces in between.

One of these beats is the heart contract to supply oxygen to the already flowing blood and the other includes the heart pumping oxygenated blood throughout the body.

A person can measure their heart rate using their pulse. This is a point where they can sense the beat of their heart through the skin. The best positions for that on the body are:

  • the wrists
  • the insides of the elbows
  • the side of the neck
  • the top of the foot

To learn more about how the heart works here.

Types

There are several types of arrhythmia, as described here:

Atrial fibrillation

That is the atrial chambers’ repetitive pounding, and it almost always causes tachycardia. Atrial fibrillation (A-fib) is normal, and occurs primarily in adults over the age of 65.

The chamber fibrillates, or quivers, rather than creating a single, powerful contraction, frequently resulting in a rapid heartbeat.

Atrial flutter

While fibrillation in the atrium produces several random and distinct quivers, atrial flutter usually originates from one region in the atrium that does not conduct properly. This creates consistent pattern in irregular conduction of the heart.

Some people may experience flutter, as well as fibrillation.

Atrial flutter can be a dangerous problem, which typically leads to untreated fibrillation.

Tachycardia suprasventricular

The disorder known as supraventricular tachycardia (SVT) refers to a fast yet steady rhythmic heartbeat. An person can experience a burst of heartbeats that can last from a couple of seconds to a couple of hours.

Atrial fibrillation and flutter are graded by doctors under SVT.

Ventricular tachycardia

This condition refers to irregular electrical impulses that begin in the ventricles, triggering an abnormally rapid heartbeat. This often occurs if a wound from a previous heart attack is in the heart.

Ventricular fibrillation

This is an abnormal heart rhythm composed of the ventricles’ quick, uncoordinated, and fluttering contractions. Instead, the ventricles do not pump blood, but rather quiver.

Ventricular fibrillation can endanger life, and is typically associated with heart disease. Its sometimes caused by a heart attack.

Long QT syndrome

This condition refers to a disturbance of the heart rhythm that often triggers short, uncoordinated heartbeats. This can lead to fainting, which may be life-threatening.

It can also be caused by genetic deficiency or by taking certain medicines.

Causes

Any disruption of the electrical impulses that causes contractions in the heart can lead to arrhythmia.

Many factors may cause the heart to operate incorrectly, including:

  • alcohol abuse
  • diabetes
  • substance use disorder
  • drinking too much coffee
  • heart disease, such as congestive heart failure
  • high blood pressure
  • hyperthyroidism, or an overactive thyroid gland
  • stress
  • scarring of the heart, often due to a heart attack
  • smoking
  • certain dietary and herbal supplements
  • some medications
  • structural changes in the heart

An individual with good heart health will hardly ever experience long-term arrhythmia unless they have an external cause, such as a problem of drug use or an electrical shock.

An underlying heart condition, however, may mean that electrical impulses do not pass right through the heart. This raises the chance of becoming arrhythmic.

Symptoms

Arrhythmia can not cause symptoms which are evident. A doctor can however detect an arrhythmia during a routine examination or after applying for an electrocardiogram (EKG).

And if a person shows signs, they don’t actually have a serious arrhythmia.

Some people with life-threatening arrhythmias may not have symptoms, and those with symptoms do not have significant arrhythmias.

Symptoms depend on the form of arrhythmia according to the following:

Symptoms of tachycardia

Symptoms of a rapid heartbeat include:

  • breathlessness
  • dizziness
  • fainting or nearly fainting
  • fluttering in the chest
  • chest pain
  • lightheadedness
  • sudden weakness

Symptoms of bradycardia

Bradycardia can cause the following symptoms:

  • angina, or chest pain
  • trouble concentrating
  • confusion
  • finding exercise more difficult than usual
  • dizziness
  • tiredness
  • lightheadedness
  • palpitations
  • shortness of breath
  • fainting or nearly fainting
  • profuse sweating

Symptoms of A-fib

When A-fib symptoms occur, they often have a rapid onset and may involve:

  • angina
  • breathlessness
  • dizziness
  • palpitations
  • fainting or nearly fainting
  • weakness

Complications

Because of arrhythmia some people do not experience active symptoms. Treatment is, however, also necessary to avoid further complications, which may include stroke and heart failure.

Stroke: Atrial fibrillation means the heart is not actively pumping. This condition can cause blood to gather in pools, form clots.

If a clot dislodges, it can travel to a brain artery causing, or stroke, a potentially fatal blockage. Stroke may cause damage to the brain and can need emergency treatment.

Learn more about stroke, and how to stop one.

Heart failure: Long-term tachycardia or bradycardia may cause heart failure. When the heart is failing, it can not pump enough blood to the body and its organs. Typically treatment will help to improve that.

Treatments

Arrhythmic treatment is only required if the disorder raises the likelihood of more severe arrhythmia or a complication, or if the symptoms are severe.

Different arrhythmias require different treatments.

Treatments for bradycardia

If bradycardia is caused by an underlying disorder, a physician may first need to treat the condition. The doctor can suggest implanting a pacemaker if they find no underlying issue.

A pacemaker is a small device placed under the skin of the chest or abdomen by a doctor to help regulate irregular heart rhythms. Pacemakers use electrical pulses to cause the heart to beat at a minimum daily rate.

Treatments for tachycardia

Various treatments for tachycardia exist:

Vagal maneuvers: Unique moves and exercises that a person can perform at home can stop some types of arrhythmia starting above the lower half of the heart.

Medications: These may not cure an arrhythmia but are mostly effective in minimizing the number of episodes of tachycardia. Even some medicines facilitate electrical conduction through the heart.

Cardioversion: The doctor can reset the heart to its normal rhythm using an electric shock or medication.

Ablation therapy: One or more catheters are implanted into the inner heart by a surgeon The catheters are mounted in areas of the heart that they believe may be the cause of the arrhythmia. They are then used by the surgeon to remove small parts of damaged tissue, which also corrects the arrhythmia.

Implantable cardioverter-defibrillator (ICD): This is inserted above the left collarbone by a surgeon. The unit then tracks the rhythm of your heart. If an unexpectedly fast rate is detected, the heart is stimulated to return to its normal velocity.

Maze procedure: The surgeon makes a number of surgical incisions in the heart during the maze technique. These then heal into scars and form blocks that direct the electrical impulses, helping to effectively beat the heart.

Ventricular aneurysm surgery: An aneurysm, or bulge, often may cause arrhythmia in a blood vessel that leads to the heart. If the other therapies are not successful, the aneurysm can need to be removed by a surgeon.

Coronary bypass surgery: A surgeon grafts arteries or veins on to the coronary arteries from elsewhere in the body. This helps the circulation bypass any narrow regions and increase blood flow to the heart muscle.

Diagnosis

A doctor must recognise the irregular heartbeat to diagnose an arrhythmia, and try to locate its source or cause. This will require a detailed interview that may influence the history of medicine, family history, nutrition, and lifestyle.

A doctor can order the following tests to help in the diagnosis of arrhythmia:

  • blood and urine
  • EKG
  • A Holter monitor, a wearable device to record the heart for 1–2 days
  • echocardiogram
  • chest X-ray
  • a tilt-table test to help identify if sudden decreases in blood pressure or heart rate are the cause
  • electrophysiologic testing
  • heart catheterization

Risk factors and prevention

The following may increase a person’s risk of arrhythmia:

  • being 65 years of age or older
  • inherited genetic anomalies
  • underlying heart problems
  • hypothyroidism or hyperthyroidism
  • some prescription medications and over-the-counter drugs
  • hypertension
  • obesity
  • uncontrolled diabetes
  • obstructive sleep apnea
  • electrolyte imbalances
  • heavy and regular alcohol consumption
  • too much caffeine
  • illegal drugs

While some of these are inevitable, a person can take a couple of measures to reduce their risk of arrhythmia.

These activities include being healthy, avoiding the daily use of alcohol or illicit drugs and restricting the consumption of caffeine.

The AHA suggest at least 150 minutes of moderately intense exercise each week.

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