Heart Arrhythmias

The heart beat (contraction) begins when an electrical impulse from the sinoatrial node (SA node) moves through it. The SA node is sometimes referred to as the heart's "natural pacemaker" because it initiates impulses for the heartbeat. These impulses follow a very specific pattern every time; however, this exact route must be followed for the heart to pump properly. As long as the electrical impulse is transmitted normally, the heart pumps and beats at a regular pace. In an adult, a normal heart beats 60 to 100 times a minute.

When the SA node has issues though, you get a change in your heart's rhythm. This is known as an arrhythmia. Almost everyone has felt some type of arrhythmia throughout their life. Some examples include: a “fluttery” feeling in the chest or the feeling of the heart “skipping” a beat. Don’t panic if you’ve occasionally had these symptoms, as most are harmless. However, arrhythmias that last for longer periods of time, may present some problems. These types of arrhythmias include: premature (early heartbeat), too slow (bradycardia), too fast (tachycardia) or too erratic (fibrillation).

Heart Arrhythmias

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Types of Heart Arrhythmias

Heart arrhythmias are sometimes classified according to their origin: supraventricular (atria-heart’s upper chambers) or ventricular (ventricles-heart’s lower chambers). They can also be classified based on their effect on heart rate, such as: bradycardia (less than 60 beats per minute) and tachycardia (more than 100 beats per minute). Some examples of various arrhythmias include:

Supraventricular arrhythmias

  • Atrial fibrillation
  • Atrial flutter
  • Supraventricular tachycardia (SVT): This type of arrhythmia is characterized by a rapid heart rate that ranges between 100 and 240 beats per minute. SVT usually begin and end suddenly. SVTs are usually not life-threatening; however, consult with your doctor if you have any other heart-related problems.
  • Premature atrial contractions (PACs): A common type of arrhythmia that makes you feel like your heart “skipped” a beat. PACs originate away from the SA node and typically occur after the SA node has initiated one heartbeat and before the next regular SA node impulse. Though PACs are mostly harmless, consult with your doctor if you have any other heart-related problems.

Ventricular arrhythmias

  • Ventricular fibrillation (VFib): This type of rapid heartbeat is severely abnormal and causes the ventricles to quiver ineffectively at a heart rate that ranges up to 600 beats per minute. During VFib, the heart cannot pump blood, resulting in a lack of oxygen to the brain and body. VFib can lead to sudden cardiac death.
  • Ventricular tachycardia (VT): This type of rapid heartbeat causes the ventricles to speed up to a heart rate that ranges up to 200 beats per minute. VT prevents the ventricles from fully contracting, which means that less blood is pumped to the body. VT can lead to sudden cardiac death.
  • Premature ventricular contractions (PVCs): A common type of arrhythmia that makes you feel like your heart “skipped” a beat. PVCs originate in the ventricles and disrupt the heart’s normal rhythm. The heart fills with more blood during the pause following the PVC, giving the next beat extra force. Though PVCs are mostly harmless, consult with your doctor if you have any other heart-related problems.

Causes of Heart Arrhythmias

Although the exact cause is unknown, certain traits, conditions, or habits may raise your risk for the disease. These conditions are known as risk factors and include:

Non-modifiable risk factors: These factors are irreversible and cannot be changed. The more of these risk factors you have, the greater your chance of developing heart arrhythmias.

  • Older age
  • Family history/Genetics

Modifiable risk factors: These factors can be modified, treated or controlled through medications or lifestyle changes.

  • High blood pressure
  • Diabetes
  • Smoking or drug abuse
  • Obesity or having a body mass index “BMI” of 30 or greater.
  • Excessive alcohol consumption over the years.
  • Excessive amount of caffeine or other stimulants.
  • Extreme emotional stress.

Other conditions that contribute to the development of heart arrhythmias

  • Obstructive sleep apnea: a condition in which your breathing abruptly stops and starts while sleeping.
  • Heart surgery
  • Heart valve disease
  • Heart failure
  • Thyroid disease: a condition that is caused by the over or under function of the thyroid gland. The thyroid gland is an essential organ for producing thyroid hormones, which maintains the body’s metabolism.
  • Congenital heart disease

Symptoms of Heart Arrhythmias

Arrhythmias may not cause any signs or symptoms. In fact, your doctor might find you have an arrhythmia before you do, during a routine examination. Noticeable signs and symptoms don't necessarily mean you have a serious problem. Various symptoms include:

  • Chest pain, fullness, discomfort or pressure
  • Blurred or double vision
  • Discomfort in the upper body, including both arms, the back, stomach, neck and jaw.
  • Confusion or impaired thinking
  • Lightheadedness/Fainting
  • Fatigue
  • Rapid heart rate (tachycardia) of over 100 beats per minute.
  • Heart palpitations: when you feel like your heart is racing, pounding or fluttering.
  • Shortness of breath and anxiety
  • Nausea and/or vomiting
  • Cold sweat

Diagnosis of Heart Arrhythmias

To diagnose a heart arrhythmia, your doctor will review your symptoms, your medical history and conduct a physical examination. Your doctor will also recommend some of the following:

Diagnostic tests and procedures

Treatment of Heart Arrhythmias

If you have an arrhythmia, treatment may or may not be necessary. Usually, it's required only if the arrhythmia is causing significant symptoms or if it's putting you at risk of a more serious arrhythmia or arrhythmia complication. Treatment options include:

Lifestyle changes

  • Avoid smoking
  • Eat a heart-healthy diet
  • Exercise under directions from your doctor.
  • If you're overweight, talk to your doctor about weight-loss options.
  • Limit alcohol consumption to 1 drink per day for women and 2 drinks per day for men.
  • Manage stress
  • Make and keep appointments to see your doctor for routine check-ups and follow-up tests.

Medications

  • Antiarrhythmic medications will help control your heart’s rhythm.
  • Anticoagulants “blood-thinners” will help treat, prevent and reduce blood clotting.
  • Beta blockers will help reduce your blood pressure.
  • Calcium channel blockers will help relax blood vessels and increase the supply of blood and oxygen to the heart while also reducing the heart's workload.

Medical and surgical procedures

Clinical trials

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