Arrhythmias are abnormal rhythms of the heart. The heart rate can become abnormally rapid, slow and/or irregular. A normal heart rate is 50 to 100 beats per minute. Arrhythmias and abnormal heart rates don't necessarily occur together. Arrhythmias can occur with a normal heart rate, or with heart rates that are slow (called bradyarrhythmias -- less than 60 beats per minute). Arrhythmias can also occur with rapid heart rates (called tachyarrhythmias -- faster than 100 beats per minute).
Types of Arrhythmia
There are a number of different types of arrhythmia including those listed below : -
Atrial fibrillation (AF) : - This is a common cause of arrhythmia. It occurs when the muscle fibres in the atria don't contract together; instead they flicker, while the ventricles contract irregularly. This irregular movement causes turbulent blood flow in the heart.
Atrial tachycardia (AT) : - Also known as supraventricular tachycardia (SVT), this occurs when an area in the atrium other than the sinoatrial node (the heart's own pacemaker) also produces electrical impulses. This overrides the normal pacemaker with regular impulses in rapid succession, causing the heart to beat at between 140 and 240 beats per minute.
Ventricular tachycardia (VT) : - Also known as broad complex tachycardia, this is when the ventricles contract rapidly but the rate in the atria remains normal. This can be caused by an increased electrical activity of the electrical impulses to the ventricles.
Ventricular fibrillation (VF) : - This is when the whole heart stops beating properly and just flutters. It may follow on from ventricular tachycardia. Blood is not circulated to the brain and the rest of the body and the person usually suddenly collapses and does not have a detectable heartbeat.
Heart block : - Heart block causes an abnormally slow beat. This happens if the impulses generated by the heart's normal pacemaker don't reach the ventricles properly. It may happen after a heart attack if the heart muscle is damaged, or if you have an injury or a disease of part of the heart's conducting system.
Symptoms of Arrhythmia
The most common symptoms of arrhythmia are : -
palpitations or rapid thumping in your chest
feeling tired or light-headed
loosing consciousness
shortness of breath, chest pain
Symptoms of bradycardia : -
feeling tired
short of breath
dizziness
Symptoms of tachycardia : -
heartbeat might feel like a strong pulse in your neck
a fluttering
racing beat in your chest
feelings of discomfort
weakness
shortness breath
fainting
sweaty
dizzy
Tests used to diagnose an arrhythmia or determine its cause include : -
Electrocaridogram (ECG or EKG) : - An ECG is the best test for diagnosing arrhythmia. This test helps doctors analyze the electrical currents of your heart and determines the type of arrhythmia you have.
Holter Monitor : - A holter monitor is a small, portable machine that you wear for 24 hours. It enables continuous recording of your ECG as you go about your daily activities.
Event Monitor : - An event monitor (loop recorder) is a small portable transtelephonic monitor that may be worn for several weeks. This type of recorder is good for patients who don't experience symptoms very often. The monitor "loops" a two-minute recording into its memory that is continually overwritten. When you experience symptoms, you press a "record" button on the monitor which stores a correlating strip of EKG material. The recordings are telephoned to a 24-hour monitoring station and faxed directly to the requesting physician
Echocardiogram : - uses high frequency sound waves (ultrasound) to examine shape, size and motion of the heart.
Stress Test : - Is a test used to provide information about how the heart responds to exertion. It usually involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while your electrocardiogram, heart rate and blood pressure are monitored.
Cardiac Catherisation : - X-Rays taken after a dye is injected into the arteries.
Head Up Tilt Table Test : - Tilt table testing is used to diagnose fainting or black-out spells (vasovagal syncope) by trying to reproduce the black-out episodes. You will be tilted upright to about 60 degrees on a special table for a period of time with continuous recording of your ECG and blood pressure.
Electrophysiological Study : - The EP study allows doctors to acquire more accurate, detailed information and, in many cases, provide treatment (i.e. catheter ablation) during the same session.
Treatment for Arrhythmias
Treatment of arrhythmia depends on the type of arrhythmia, the patient's age, physical condition and age.
Sometimes all you may need is reassurance that the palpitation is harmless. It is also helpful to avoid any triggers if you know of any, such as stimulants like caffeine or alcohol.
If your palpitation is troublesome, there are a number of treatments available. Your treatment will depend on the type and cause of arrhythmia.
Treatments include the following : -
Drug treatments
Your doctor may prescribe medicines called anti-arrhythmics. Examples include digoxin and flecainide (eg Tambocor). These drugs will slow down a fast heartbeat or help it return to normal.
If you have atrial fibrillation you may be advised to take aspirin or blood-thinning drugs regularly such as warfarin to reduce the risk of blood clots forming.
Cardioversion
In this procedure, a controlled electrical current is applied to the chest wall, which is synchronised with the heartbeat pattern seen on the ECG. This helps your heart to return to its natural rhythm.
This treatment is performed under a general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain.
Pacemaker implant
A pacemaker implant is a small electrical device, which produces electrical impulses. It ensures that your heart does not go too slowly so is used to treat heart block or slow rhythms (bradycardias) when the heart's own natural pacemaker is not working properly. A pacemaker implant is inserted under the skin of the chest and is connected to the heart muscle with thin wires. You will be given a local anaesthetic that numbs the area but you will be awake. Know More.
Catheter ablation therapy
In this procedure, the abnormal areas in your heart that are creating the arrhythmia will be identified and destroyed. Catheter ablation therapy is carried out using the same catheters as are used for electrophysiological testing, and may be carried out at the same time. Radio frequency energy emitted from the tip of the catheter is used to destroy the areas of the heart that are
causing an arrhythmia.
You will be given a local anesthetic that numbs the area but you will usually be awake.
Implantable cardioverter-defibrillator (ICD)
An implantable cardioverter-defibrillator (ICD) is an implanted device that's fitted in the chest like a pacemaker. It's used if you have had, or are prone to, episodes of life threatening ventricular arrhythmias eg ventricular tachycardia. It recognises the abnormal heart rhythm as soon as it starts and sends a small shock to your heart, which quickly stops the arrhythmia.
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