Arrhythmia – symptoms, causes and treatment of arrhythmias [EXPLAINED]

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Heart arrhythmia is most often associated with palpitations, but in reality it can manifest itself in both increased and decreased heart rate. Find out how to recognize a cardiac arrhythmia and if it is always a cause for concern. Below, we also present the possible causes of cardiac arrhythmias and the procedures for dealing with it.

Normal heart work

Every human heart consists of four chambers – two atria in the upper part and two lower chambers (chambers). The rhythm of the heart is usually controlled by the natural pacemaker (sinus node) located in the right atrium. The sinus node produces electrical impulses that normally start every heartbeat. These impulses cause the muscles of the atria to contract and pump blood into the ventricles.

The electrical impulses then travel to a cluster of cells called the atrioventricular (AV) node. It slows down the electrical signal before sending it to the chambers. This slight delay allows the ventricles to fill with blood. As electrical impulses reach the muscles of the ventricles, they contract, causing them to pump blood to the lungs or to the rest of the body.

In a healthy heart, this process tends to be “smooth”, resulting in a normal resting heart rate of 60 to 100 beats per minute.

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Read also: Structure of the heart – what should you know about it?

Heart arrhythmia – types

Doctors classify cardiac arrhythmias not only by their origin (atria or ventricles), but also by the speed of the heart rate that causes:

1. tachycardia – refers to a fast heartbeat – resting heart rate greater than 100 beats per minute,
2. bradycardia – refers to a slow heartbeat – a resting heart rate less than 60 beats per minute.

Not all tachycardias or bradycardias are indicative of heart disease. For example, when you exercise, it is normal for your heart to beat faster as your heart speeds up to supply your tissues with more blood rich in oxygen. It is not uncommon for your heart to beat slower when you sleep or when you are deeply relaxing.

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See: Can tachycardia be dangerous in pregnancy?

Cardiac arrhythmia — tachycardia

There are tachycardia originating in the atria and tachycardia originating in the ventricles. Atrial tachycardias include:

1. atrial fibrillation – is the most common supraventricular arrhythmia, defined as the rapid electrical activity of the atria with their systolic failure. It is accompanied by irregular ventricular work, and the simultaneous lack of late diastolic inflow to them reduces the cardiac output and is often associated with heart failure. Atrial fibrillation may be temporary, but some episodes will not be over until healed. This disease may be the basis for a stroke,
2. atrial flutter – is similar to atrial fibrillation. The heartbeat in atrial flutter is a more organized and more rhythmic electrical pulse than in atrial fibrillation. Atrial flutter can also lead to serious complications such as stroke,
3. supraventricular tachycardia – is a broad term that includes many forms of arrhythmia, either from the atria or from the AV node. This type of arrhythmia can cause sudden episodes of heart palpitations that begin and end suddenly.
4. Wolff-Parkinson-White syndrome – WPW syndrome is caused by the presence of at least one atrioventricular junction bypassing the atrioventricular node and capable of conducting electrical impulses. These connections are actually muscle fibers that did not disappear during fetal development. Most of these connections can conduct impulses in both the descending (from the atria to the ventricles) and ascending directions (from the ventricles to the atria).

Tachycardia (tachyarrhythmia) in the ventricles of the heart includes:

1. ventricular tachycardia (VT)– ventricular tachycardia is an arrhythmia in which three or more consecutive beats of ventricular origin occur at a frequency ≥100 / min. It is formed in the conducting system below the His bundle bifurcation or in the working muscle of the ventricles.
2. ventricular fibrillation – ventricular fibrillation is a chaotic electrical activity and asynchronous contractions of the heart muscle fibers (ventricles), leading to a loss of the heart’s pump function. Ventricular fibrillation and pulseless ventricular tachycardia are the most common mechanisms of sudden cardiac arrest in adults,
3. Long QT syndrome (LQTS) – long QT syndrome is a heart disorder that carries an increased risk of rapid, chaotic heartbeats. Rapid heartbeat caused by changes in the heart’s electrical system can lead to fainting and can be life-threatening. In some cases, your heart rhythm can be so irregular it can even cause sudden death.

Cardiac arrhythmia — bradycardia

Although a heart rate below 60 bpm while resting is considered bradycardia, a low resting heart rate does not always indicate a heart problem. If you are physically fit, you may have a functioning heart that is capable of pumping an adequate amount of blood at less than 60 beats per minute at rest.

Moreover, some drugs used to treat conditions such as high blood pressure can lower the heart rate. However, if you have a slow heart rate and your heart is not pumping enough blood, you may have one of several bradycardias.

Sick sinus syndrome – occurs if your sinus node, which is responsible for setting your heart rate, is not sending pulses correctly, your heart rate may become too slow (bradycardia) and too fast (tachycardia). Sick sinus syndrome can also be caused by scarring near the sinus node that slows down, disrupts, or blocks the flow of impulses. Sick sinus syndrome is most common in the elderly,

Heart conduction block – a block of the heart’s electrical pathways may occur in or near the atrioventricular (AV) node, which lies in the pathway between the atria and the ventricles. The block may also occur along other paths to each compartment.

Depending on the location and type of block, the pulses between the upper and lower half of the heart may be slowed down or blocked. J.If the signal is completely blocked, some cells in the AV node or ventricles may produce a steady but usually slower heartbeat. Some blocks may be asymptomatic and others may cause bradycardia. There are three degrees of AV block:

1. XNUMXst degree AV block through which the signal passes, but it may take longer than usual to progress from the sinus node to the ventricles
2. second degree atrioventricular block, in which some heartbeat signals are lost between the atria and the ventricles
3. XNUMXrd degree atrioventricular block, in which no signals reach the ventricles, so the ventricles beat slowly by themselves, with no direction from above.

Some causes of AV block include cardiomyopathy, coronary artery disease, and medications such as beta blockers and digoxin.

Premature ventricular contractions – it is one of the most common arrhythmias. It arises as a result of the impulse spreading too quickly in the ventricles, which causes premature contraction. That is why it is sometimes called premature ventricular contractions. It is a premature contraction because it occurs before the heart’s normal rhythm.

Read: Cardiomyopathy – What Exactly Is It?

Heart arrhythmia – symptoms

Symptoms of certain arrhythmias include:

1. sinus node disorder – you may have no symptoms or may cause dizziness, fainting and extreme tiredness
2. supraventricular tachyarrhythmias – can cause palpitations (feeling your heart beating fast), low blood pressure and fainting
3. atrial fibrillation – Sometimes there are no symptoms. This can cause palpitations, dizziness, weakness, shortness of breath and angina, which is a chest pain caused by reduced blood flow to the heart muscle. Some people with atrial fibrillation alternate between irregular heartbeats and long periods of completely normal heartbeat.
4. AV block or heart block – First degree AV block causes no symptoms. Second degree AV block causes an irregular or slow pulse. Third degree AV block can cause a very slow heart rate, dizziness, and fainting.
5. VT – Unsustainable VT must not cause any symptoms or cause mild chest flutter. Long-term VT usually causes light-headedness or unconsciousness and can be fatal.
6. ventricular fibrillation – causes loss of heart rate, unconsciousness and death.

See: Dangerous causes of breathlessness

Heart arrhythmia – causes

The causes of cardiac arrhythmias are different for tachycardia and bradycardia. If we are dealing with physiological tachycardia (e.g. during exercise or stress) we are talking about sinus tachycardia. There are other causes for your heart rate to increase as well. It is often the result of taking various types of substances: caffeine, nicotine, but also drugs.

Arrhythmia may appear during fever, dehydration, anemia, hyperthyroidism or hypoglycaemia. The more serious causes of the increase in heart rate include: anaphylactic reaction, heart failure and even a heart attack.

In turn, bradycardia may result from hypothyroidism, ischemic disease or an increased amount of potassium in the body.

Some medical conditions can increase the risk of cardiac arrhythmias. This includes:

1. coronary artery disease and other heart problems – narrowing of the arteries, heart attack, abnormal heart valves, previous heart surgery, heart failure, cardiomyopathy and other heart damage are risk factors for almost any type of arrhythmia.
2. high blood pressure – this increases the risk of developing coronary heart disease. It can also cause the walls of the left ventricle to become stiff and thick, which can change the way electrical pulses travel across the heart.
3. congenital heart defect – being born with a heart disorder may affect the heart’s rhythm,
4. diabetes – the risk of developing coronary artery disease and hypertension increases significantly in the case of uncontrolled diabetes,
5. obstructive sleep apnea – a disorder where breathing is interrupted while you sleep may increase the risk of bradycardia, atrial fibrillation and other heart rhythm problems
6. electrolyte imbalance – substances in the blood called electrolytes such as potassium, sodium, calcium and magnesium – help to trigger and conduct electrical impulses in the heart. Electrolyte levels that are too high or too low can affect the heart’s electrical impulses and contribute to the development of arrhythmias.

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Other factors that may increase the risk of an arrhythmia include:

1. medications and supplements – some over-the-counter cough and cold remedies and certain prescription medications may contribute to the development of arrhythmias.
2. drinking too much alcohol – drinking too much alcohol can affect the electrical impulses in the heart and may increase the risk of developing atrial fibrillation.
3. caffeine, nicotine or drug use – caffeine, nicotine and other stimulants may make your heart beat faster and may contribute to the development of more serious arrhythmias. Illegal drugs such as amphetamines and cocaine can seriously affect the work of the heart and lead to many types of arrhythmias or sudden death from ventricular fibrillation.

See: Arrhythmia and a sporting performance

Heart arrhythmia – diagnosis

Diagnosing an arrhythmia is not trivial, as a stethoscope or pulse check only assesses whether a rhythm is too slow or too fast. The performance of an ECG is usually decisive. In some cases, it is necessary to perform Holetrow monitoring, i.e. ECG recording for 24 hours. This allows us to identify cases where cardiac arrhythmias occur suddenly for a short time.

Heart arrhythmia – treatment

Treatment of cardiac arrhythmias depends on its cause:

1. sinus node disorders – people with frequent, severe symptoms usually use a permanent pacemaker,
2. supraventricular tachyarrhythmias – specific treatment depends on the cause of the arrhythmia. For some people, massaging the cervical sinus in the neck will stop the problem, but you need to do it skillfully. Other people need medications like beta blockers, calcium channel blockers, digoxin (Lanoxin), and amiodarone (Cordarone). Some patients only respond to a procedure called radiofrequency catheter ablation. which destroys an area of ​​tissue in the AV node to prevent excess electrical impulses from the atria from being transferred to the ventricles
3. atrial fibrillation – atrial fibrillation resulting from an overactive thyroid gland can be treated with medication or surgery. Fibrillation resulting from mitral or aortic disease can be treated by replacing damaged heart valves. Medications such as beta-blockers (for example atenolol and metoprolol), amiodarone, diltiazem (Cardizem, Tiazac), or verapamil (Calan, Isoptin, Verelan) can be used to slow the heart rate.

Medicines like amiodarone can be used to reduce the chance of atrial fibrillation coming back. Other treatment options include radiofrequency catheter ablation or electrical cardioversion, a procedure that causes an electrical discharge over time to restore the heart to normal.

Block OFF – first degree AV block usually does not require treatment. People with second degree atrioventricular block may be monitored with frequent ECGs, especially if they have no symptoms and have a heart rate appropriate to their daily activities.

Some patients with second degree heart block may require permanent pacemakers. Third degree AV block is almost always treated with a permanent pacemaker.

VT – Unstable VT may not require treatment if there is no structural damage to the heart. Maintained VT always requires treatment with intravenous therapy or emergency electric shock (defibrillation), which can restore normal heart rhythm.

Ventricular fibrillation – this is treated with defibrillation, which causes the heart to measure an electric shock to restore a normal rhythm.

VF survivors and high-risk individuals are potential candidates for an automatic implantable cardioverter-defibrillator. The device is similar to a pacemaker, with wires attached to the heart that connect to an energy source placed under the skin. The procedure takes place in the operating room.

Heart arrhythmia – prevention

To prevent cardiac arrhythmias, it is important to lead a healthy lifestyle. First of all, remember about:

1. a healthy diet for the heart,
2. practicing physical activity,
3. maintaining a healthy body weight,
4. quitting smoking
5. limiting alcohol,
6. reducing caffeine,
7. reducing stressful situations.

Heart arrhythmia – complications

Certain types of arrhythmias can increase the risk of medical conditions, such as:

1. stroke – abnormal heart rhythms are associated with an increased risk of blood clots. If a clot breaks out, it can travel from the heart to the brain. There it can block blood flow, causing a stroke. If you are struggling with arrhythmia, other heart disease, or / and you are over 65, the risk of stroke increases several times,
2. Cognitive Impairment and Dementia – Alzheimer’s disease and vascular dementia are more common in people with arrhythmias. This may be due to reduced blood flow to the brain over time
3. heart failure – repetitive arrhythmias can lead to a rapid decline in the ability of the lower chambers to pump blood. Heart failure is especially prone to develop or worsen from arrhythmias when you already have heart disease.
4. sudden cardiac arrest – the heart may stop beating suddenly and unexpectedly due to ventricular fibrillation.

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