What is Arrhythmia?

Overview

The heart usually beats following a constant rhythm – which is controlled by the electrical signals. The sinoatrial mode present in the heart keeps a track of the body’s blood requirements and thereon with the help of electrical impulses, fulfils the body’s blood requirements. These electrical signals transmitted to the heart – controls the pacing – causing the chambers of the heart to contract faster to meet the body’s blood requirements. While most individuals have a resting heart rate in the range of 60 to 100 BPM (beats per minute), when the body’s exercises or experiences a stressful situation, it can accordingly lead to an increase in the BPM. While this is completely normal, an arrhythmia, on the other hand, is said to occur when the heart beats too quickly, too slowly or at an irregular pace. 

An arrhythmia – also known as irregular heartbeat or cardiac dysrhythmia – is characterized by the occurrence of a series of irregular heartbeats. It's said to occur when the electrical signals which are sent to the heart & responsible for controlling the pacing of the heartbeats stop functioning correctly. Most arrhythmias tend to be harmless and don’t require the need for any treatment. However, in certain cases, where arrhythmias feel particularly out of sync arising from a damaged or a weak heart, they can prove to be serious, and sometimes even fatal. Arrhythmias can severely impair an individual's ability to function as a lack of blood flow can result in the brain, heart, and other organs getting critically damaged. Arrhythmias can be further categorized as:

  • Bradycardia – Where the heartbeat is too slow (less than 60 BPM) resulting in an inability to supply enough blood to the body.
  • Tachycardia – where the heartbeat is too fast (more than 100 BPM) resulting in the heart rate being faster than normal even when in a resting position. 

While most arrhythmias are not considered to be serious, there are some which can put an individual at risk to a stroke or cardiac arrest. According to the NHS, arrhythmias are experienced by more than 2 million people and account for the deaths of nearly 100,000 people annually in the UK. 

Different types of Arrhythmia

The various types of arrhythmias can be further classified according to their source of the origins in the heart and whether they result in the heart beating too slow or too quickly. They can be either ventricular – meaning they originate from the lower ventricles of the heart – or supraventricular – arising from the upper part of the heart. Some of the common types of arrhythmia are as under:

Premature atrial contractions: also referred to as atrial premature complexes (APC) or PACs, are characterized by the presence of additional beats in the heart's upper chambers causing heart palpitations. With every extra or additional beat, the resultant beat tends to be more forceful causing the individual to have an unusual awareness of their heartbeat rhythm. 

Premature ventricular contractions: Also known as PVCs, these are extra, abnormal heartbeats that are very common. They tend to originate in the ventricles or lower pumping chambers and are caused by the ventricles contracting too soon. The individual experiences a skipped beat or palpitations as a result of the disruption of the regular heart rhythm.

Supraventricular tachycardia or paroxysmal supraventricular tachycardia: Abbreviated either as SVT or PSVT, this condition is characterized by the occurrence of an abnormally fast heartbeat – in the region of 150-250 BPM – and originates in the part of the heart which is situated above the ventricles. This is usually caused by improper electrical impulses in the atria.

Ventricular tachycardia: Also referred to as V-tach, this is a rapid heart rate that originates from the lower chambers of the heart – caused by abnormal electrical signals – resulting in the heart being unable to fill up with enough blood before it starts contracting again. This can result in the blood flow getting affected to the rest of the body.  

Atrial fibrillation: Also referred to as AFib or AF, this condition is characterized by an irregular and often rapid heart rhythm where the muscles or fibres present in the atria twitch and contract causing the affected individual to experience an irregular heartbeat or pulse.

Ventricular fibrillation: or V-fib can be described as a serious heart disturbance requiring the need for immediate medical attention. V-fib causes the heart to beat with irregular & erratic electrical signals and occurs where the heart’s lower chamber muscles can’t contract to pump blood effectively. 

Long QT syndrome (LQT): results in abnormal or uncoordinated heartbeats which can cause the occurrence of sudden, uncontrollable and fatal arrhythmias.

Atrial flutter: This originates in the atrial chambers of the heart and is quite similar to atrial fibrillation, but being more regular in occurrence. Classified as a type of supraventricular tachycardia, this condition is usually associated with a fast and irregular heart rate caused by misfired electrical impulses and can often lead to atrial fibrillation. Atrial flutter is usually more regular than atrial fibrillation.

Accessory pathway tachycardia: This condition is characterized by rapid heartbeats owing to the presence of an additional pathway between the heart's upper and lower chambers.

Sinus node dysfunction – characterized by slow heart rhythms caused due to an abnormal sinoatrial node.

Heart block: can be described as an abnormal heart rhythm where the heart beats too slowly or irregularly caused by a disruption in the heart's electrical system.

Causes of Arrhythmia

Any disruption caused as a result of the electrical imbalances can cause the heart to contract, causing arrhythmia. Thereafter, Arrhythmias can be usually caused by:

  • Coronary artery disease
  • Heart valve disease or valve disorders
  • Accidental electrical shocks
  • Changes in the heart muscle (cardiomyopathy)
  • Electrolyte imbalances present in the blood including sodium or potassium.
  • Previous injury or scarring arising as a result of a heart attack
  • Healing from a heart surgery
  • Medical conditions such as hyperthyroidism (an overactive thyroid gland) or Underactive thyroid gland (hypothyroidism)
  • Problems with your heart’s electrical system
  • Excessive consumption of substances such as alcohol, nicotine, caffeine, and cocaine
  • Certain medications such as beta-blockers, dietary supplements, and herbal treatments
  • Illicit drug abuse
  • Smoking 

It needs to be mentioned that most healthy individuals will never face the risk of being diagnosed with long-term arrhythmia as long as they don’t have any external triggers like the ones mentioned above. However, in the case there’s an underlying issue, there might be an issue as the electrical impulses will be unable to travel quickly through the heart increasing the chances of arrhythmia.

Risk factors for Arrhythmia

Some of the possible risk factors for arrhythmia are listed below:

  • Advancing or old age
  • hypertension (high blood pressure)
  • Taking needless or unnecessary stress, such as feelings of anger, anxiety, or fear
  • Inherited gene defects / congenital heart defects
  • Eating a high-fat diet  
  • Heart problems
  • Excessive consumption of alcohol (more than 2 drinks per day)
  • Obesity/overweight
  • Uncontrolled diabetes
  • Obstructive sleep apnea

Symptoms of Arrhythmia

Not all arrhythmias showcase signs or symptoms and in certain instances, an individual might not even exhibit any symptoms. Chances are a doctor might detect the presence of arrhythmia during a routine examination or an ECG test. It also needs to be mentioned that even if an arrhythmia is detected, it need not always mean that there’s a serious issue. For instance, certain life-threatening arrhythmias don’t display any symptoms while other non- threatening arrhythmias can showcase symptoms. Some of the symptoms that an individual can experience are listed below:

  • Heart palpitations, which feel like a sensation of fluttering, in the chest
  • Breathlessness (dyspnea)
  • Light-headedness
  • Fatigue coupled with shortness of breath 
  • A slow heartbeat (bradycardia)
  • A pulsating heartbeat (tachycardia)
  • Pain in the chest (angina)
  • A pounding sensation in the chest
  • A feeling of tightness in the chest
  • Fainting (syncope)
  • A feeling of confusion/disorientation 
  • Sweating or diaphoresis
  • A feeling of weakness

It needs to be reiterated that some of these symptoms may resemble other health problems or disorders. Which is why it makes sense to visit your nearest healthcare professional for an accurate diagnosis.

Diagnosis of  Arrhythmia

An individual suffering from arrhythmias regularly should immediately visit their nearest health care professional. Arrhythmias can prove to be difficult to diagnose, especially the types which only cause symptoms now and then. In that regard, any case of arrhythmia – no matter how severe or small – should always be immediately reported to the doctor.

To confirm an accurate diagnosis of arrhythmias, the concerned doctor will review the patient’s medical history, conduct a physical examination, take a look at the symptoms and accordingly confirm the diagnosis after ordering a series of diagnostic tests and procedures to analyze the heart's function and to find out why the heart is not performing optimally. These tests may include:

An electrocardiogram: Also known as an EKG or ECG, this is a test that measures the electrical activity occurring in your heart. The doctor will then analyse the patterns recorded by the electrocardiograph and identify any abnormal concerns.

An echocardiogram: can be described as a type of ultrasound that makes use of sound waves to capture images of the heart and thereon evaluate the structures of the heart.

A cardiac exercise stress test: Sometimes doctors might ask the patient to walk or run on a treadmill or exert themselves in a way that allows the doctors to monitor and record heart rhythm, blood pressure and breathing patterns. The results allow the doctors to analyse how well the heart is functioning during physical activity and thereon, determine the risk of having heart disease.

A cardiac catheterisation: This procedure involves the insertion of a long thin tube called a catheter through an artery or vein present in the groin, neck or arm that leads to the heart. A contrast dye is then injected through this tube into the heart followed by the capture of a series of X-ray images of the heart and the blood vessels around it which are then viewed on an ultrasound.

At-home monitoring:  Sometimes, doctors might recommend the patient to wear a monitoring device such as a Holter monitor (heart monitor) for a while to record how the heart functions daily. This monitor contains electrodes, wires and a small machine that’s attached to the waistband and records your heartbeats.

An electrophysiology (EPS) study – An EPS is used to analyse the electrical activity of the heart and thereon, identify the source of abnormal or irregular heartbeats.

Nuclear heart scan: Sometimes, nuclear cardiology imaging tests such as a positron emission tomography (PET) scan, may also be used as part of the diagnostic routine. A PET makes uses of a safe dose of radioactive material to evaluate the flow of blood through the heart.

Complications of  Arrhythmia

If an arrhythmia isn't treated on time, it can lead to a bunch of health issues over time, including:

Blood clots: An abnormal heart rhythm means that the heart isn't functioning properly and thereon unable to pump blood optimally. This can cause blood to back up into the heart, causing the formation of clots. Blood clots increase the risk of having a stroke which, in turn, can lead to brain damage or sometimes even have fatal consequences.

Heart failure - prolonged cases of AFiB, tachycardia or bradycardia can weaken the heart’s chambers resulting in the heart not pumping enough blood to the body and its organs. This condition is also called heart failure.

Treatment of  Arrhythmia

Time and time again, we have heard the importance of keeping our hearts healthy by way of exercising, eating the right foods, ditching vices such as alcohol consumption, smoking, etc.  Even if a person is not experiencing any heart issues, it’s vital to take care of the heart by keeping the heart as healthy as possible. While it’s equally crucial that everyone takes care of their heart, in case of people suffering from arrhythmias, the significance of keeping the heart healthy is even more important.

In most cases, treatment is deemed necessary only if symptoms are severe or depending on the severity of the patient’s complications. Possible treatments the doctor may recommend include:

Medications such as heart rate-control drugs, anticoagulant or antiplatelet drugs to stop, prevent or control the rate of arrhythmia.

Pacemaker: The use of pacemaker implanted in the chest which sends small electrical impulses to the heart muscle to maintain a normal heart rate and to improve synchronization of the heartbeats.

Catheter ablation – a minimally invasive procedure – performed under local or general anaesthetic – in which the doctor inserts a catheter through the blood vessels into the heart to stop abnormal electrical signals in the heart tissue. The catheter emits radiofrequency energy which destroys the diseased tissue in the heart that causes the arrhythmia while also correcting the irregular heartbeat.

Cardioversion – a technique used to restore normal heart rhythm by sending electric shocks to the heart with the aid of electrodes placed on the chest.

Implantable cardioverter-defibrillator (ICD) –a device implantable inside the body that keeps track of the heart rate while also helping detect any life-threatening, rapid or abnormal heartbeats. 

When arrhythmias can’t be corrected or controlled by medications or other devices, then surgery is recommended: 

The Maze procedure – also known as a surgical ablation – disrupts electrical patterns in the heart to correct atrial fibrillation. This form of surgery helps in correcting heart rhythm almost painlessly and is considered to be far more effective than medications.

Prevention of  Arrhythmia

There are a bunch of ways to keep the heart healthy and prevent the onset of arrhythmia. Always be aware of the risk factors that can cause heart disease and arrhythmia. Even if you do have an arrhythmia, you can follow these guidelines to ensure your heart remains in the pink of health.

Monitor your caffeine intake – Don’t go overboard with your caffeine intake and keep it limited to a cup a day. Remember energy drinks also contain a lot of caffeine so make sure to track your energy drink intake as well. It needs to be mentioned that certain triggers affect people differently. For instance, while you might not feel any different after a few cups of coffee, in certain people, even one cup can trigger arrhythmia. Be mindful of what can cause an arrhythmia to flare up in your case.

Stay Active – To keep your heart as healthy as possible, make sure to exercise regularly. Exercising is great for your heart but you shouldn't go overboard either. There are certain exercises which can cause the arrhythmias to get worse owing to a spike in adrenaline. Care should be taken to exercise moderately, especially if you have an arrhythmia. Cardio exercises or yoga can help in this regard as compared to heavy lifting. Most importantly, you should speak to your doctor before beginning a new exercise regime to check if the exercise doesn’t negatively impact your health.

Keep alcohol intake to a minimum – Excessive alcohol consumption is never advisable as it can give birth to a multitude of health issues. As per research published in the Journal of the American College of Cardiology, even moderate drinking (two glasses a day for men and one glass for women) can increase the risk of irregular heartbeat. Further, every drink consumed daily increases the risk of atrial fibrillation by 8 percent.

While consuming moderate amounts of alcohol has been previously proven to be effective in the case of certain people as it reduces the risk of heart disease, these benefits do not apply to the electrical parts of the heart. Regular drinkers might notice their heartbeats becoming frequently abnormal over time. If left unchecked, it could even cause serious complications including stroke and heart failure.

Maintaining a healthy weight –Maintaining a healthy weight and eating a balanced diet should always be your top priority if you want to ensure your heart stays in top condition. Being overweight or obese is one of the main risk factors for not only developing arrhythmia but also a myriad of other heart and health disorders.

It also needs to be reiterated that if you’re trying to lose weight, you should plan on doing it the healthy way. Thereafter, you should avoid going on a crash diet or resort to taking diet pills and deceptive fat burners as it can lead to arrhythmias as well a plethora of other health issues. Instead, focus on changing your eating habits, incorporate physical activity in your routine and make some healthy lifestyle changes.

Similarly, you should include plenty of vegetables, fruits and whole grains in your diet while consciously making an attempt to reduce fat dairies such as unflavoured milk and yoghurt, and cheese. Avoid using salt while cooking while restricting excessive intake of processed foods loaded with unhealthy saturated fat, trans fat, and cholesterol as it ultimately wreaks havoc on your heart in the long run. By including healthy protein sources such as fish and seafood, lean meat and poultry, legumes, nuts and seeds, you will ensure that your heart`s health is not compromised.

Sleep Well  -  According to the National Heart, Lung, and Blood Institute, (NHLBI), you should look at getting at least 7 – 8 hours of sleep daily as it can optimize both mental and physical energy levels. Skimping on sleep can make you feel fatigued which is a risk factor for certain arrhythmias. Further, getting enough sleep can help lower your stress levels and thereon prevent arrhythmias. In case you suffer from a condition called as sleep apnea – a serious sleep disorder where your breathing is interrupted during sleep – you need to make sure you see a specialist and get it checked immediately as it can put undue stress on your heart and weakens the heart muscle.

Don’t smoke – As per the European Journal of Preventive Cardiology, a European Society of Cardiology (ESC) journal, it has been reported that the risk of atrial fibrillation increases by 14 percent for every ten cigarettes smoked daily. Smokers are at a higher risk of atrial fibrillation, but when the person quits smoking, the risk is reduced considerably.

In addition to the above-mentioned steps, follow these tips to ensure your heart stays disease-free at all times

  • Go for regular check-ups.
  • Don’t ignore arrhythmia symptoms even if they don’t occur frequently. Report symptoms to your doctor if they appear immediately.
  • Limit or reduce stress.
  • In case you already have an arrhythmia, follow all your treatment plans and make sure never to skip on your medications.

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