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 THE FIT HEART 

The Way To A Healthy Heart

DISORDERS OF RHYTHM - ARRHYTHMIA

As I explained earlier that our heart has an electric circuit which maintains the normal rhythm of the heart which refers to a regular beating of heart at the rate of 60-100/min with resultant effective contraction of heart. Any disorder of this beating will lead to impaired output of blood from the heart.  When there is a problem in either the rate or rhythm of the heart beat or when both are disturbed, the condition is called arrhythmia. So an arrhythmia could be due to heart beating too fast (tachyarrhythmia) or too slow (bradyarrhythmia) or with an irregular rhythm (for example extra or premature beats).

While some arrhythmias could be harmless, they could turn serious if they affect the pumping action of the heart.

 

                                                                    

Causes

Arrhythmias occur if there is a block or delay in the electrical pathways, irregular signal generation from pacemaker node, irregular impulse conduction or due to impulse generation in any part of heart other than the pacemaker node. This could happen:

  • As a side effect of excessive smoking, alcohol use, caffeine and nicotine use, illicit drug abuse, or as side effect of certain over the counter or prescription drugs.
  • Due to strong emotional stress and anger outbursts.
  • Due to high blood pressure, coronary heart disease, rheumatic heart disease, heart attack, heart failure, or under or over active thyroid gland.
  • May be Since birth called congenital arrhythmia (for example Wolff-Parkinson-White syndrome).
  • At times no cause is found.

Signs and symptoms

  • Anxiety 
  • Palpitations (conspicuous feeling of ones own heartbeat)
  • Feeling of missed beat
  • Sweating 
  • Chest pain
  • Shortness of breath
  • Dizziness, light-headedness, fainting and fainting-like feeling
  • Generalised weakness

Investigations

  • ECG This simple test helps record your heart beat. It tells the doctor about irregular heart beats, fast beats, previous heart attacks, and problem in the conduction of impulses in the heart.
  • Holter and Event monitorsThese are small machines with leads or electrodes that will be attached to your chest to record your ECG continuously for longer duration. The recorder can be kept in a pocket or hung over your neck. You have to wear it for 24-48 hours or longer while you go about your normal routine. 
  • Blood tests: Your blood may be drawn to test for electrolytes (such as potassium, calcium, magnesium), blood sugar, or thyroid hormones.
  • Chest X Ray: This can show a large heart or fluid in lungs . It can also tell the doctor if you have a lung disease.
  • Echocardiography (ECHO): This is like an ultrasound of heart where your doctor can see your moving heart. This test tells your doctor about the size of heart and its chambers, the thickness of the walls of the artery, contraction of heart, mixing of blood, previous heart attack, force of blood flow etc.
  • Stress Test: If you are capable of running on a tread mill, your doctor may take you up for this to examine how your heart behaves under stress. An ECG recording and blood pressure monitoring will be done while you run. The test is often followed up with ECHO and nuclear heart scans.
  • Coronary Angiography: Your doctor may ask for this test if he suspects a block in the heart arteries. A dye is injected through a tube placed in the blood vessel of your groin or arm and taken up to your heart. The doctor can see the flow of the dye on a screen in front of him.
  • Electrophysiology study (EPS): In this test a thin wire will be inserted through a vein in your upper thigh or arm and guided to the heart to record the electrical signals. The doctor can electrically stimulate your heart to see if arrhythmias are occurring or not. The doctor can also record the signals after giving an anti-arrhythmia medication to see if it is working or not.
  • Tilt table testing: If you complain of fainting spells, your doctor may request this test to rule out other causes of fainting. You will lie on a table that will move from horizontal to upright position to see if you faint. While the table moves, your doctor will record your ECG, heart rate, blood pressure and symptoms.
  • Implantable loop recorder: This device is placed under the skin of the chest by a minor surgery. This helps detect symptoms and electrical abnormality over a period of 12 to 24 months in patients who rarely have symptoms.
Treatment
Medicines

Medications used to treat arrhythmias are called antiarrhythmics. Some of these medications have serious side effects. You must take the medications as prescribed.You must also immediately report any new symptom or recurrence of an old symptom.

Antiarrhythmic medications can:

  • Slow down a fast rate: Examples: beta blockers, calcium channel blockers (such as diltiazem and verapami, and digoxin.
  • Restore the normal rhythm of heart: Examples: amiodarone, disopyramide, sotalol, procainamide, quinidine, etc.

Apart from antiarrhythmics, your doctor may prescribe blood thinners or medicines to control thyroid disorders. 

Medical Devices and Procedures
  • Pacemaker: Your doctor will place this small device under the skin of your chest to control abnormal heart rhythms. The device senses an abnormal heart rhythm and sends out electrical signals to normalize the rhythm. Usually used to treat bradyarrhythmias.
  • Cardioversion (shock therapy): In defibrillation or cardioversion, a device called defibrillator is used to give electric shocks to the chest to treat arrhythmia. Sometimes a defibrillator device is placed under the skin of the chest to treat ventricular arrhythmias (implantable cardioverter defibrillator or ICD), which sends out electrical shocks when it senses abnormal rhythms.
  • Catheter Ablation: Here a wire is inserted through a vein in your upper thigh or arm and guided to the heart, and a special machine is used to send energy through this wire to destroy small portions of heart tissue which are generating the abnormal rhythm.
Surgery
  • Maze Surgery: Here small cuts or burns are given to the atria (upper chambers of heart) to prevent spread of abnormal electrical signals.
  • Coronary artery bypass surgery is done if coronary heart disease is the cause of arrhythmia. This surgery improves blood flow to the heart and prevents arrhythmia.
Vagal maneuvers

Simple exercises can slow down or stop abnormal heart rhythms by affecting the Vagus nerve. These are usually done by doctors as the first measure to control very high heart rates. However, please do not do these exercises yourself without consulting your doctor.