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Cardiac Arrhythmia

Arrythmia

Cardiac arrhythmia is characterized by abnormal heart rate or rhythm. It typically refers to a condition, where in the electrical activity that regulates heartbeat is irregular, slow or fast.


Presentation

In many instances, cardiac arrhythmia may not produce any signs or symptoms. An abnormal heart rhythm gets diagnosed during a routine checkup, much before signs and symptoms appear. However, when symptoms are experienced, they include pain in chest, dyspnea, onset of tachycardia or bradycardia, flutter in chest, lightheadedness accompanied by dizziness and fainting.

Condition such as ventricular tachycardia can be life threatening causing cardiac arrest, or sudden death and increasing risks for embolisation and stroke [6].

Coronary Artery Disease
  • METHODS: We measured HRV and arrhythmia with ambulatory electrocardiograms in a cohort panel study for up to 235 hr per participant among 50 nonsmokers with coronary artery disease who were 71 years of age and living in four retirement communities in[ncbi.nlm.nih.gov]
  • The patients with active coronary artery disease, end stage organ failure and not expected to survive or 48 hours were excluded.[ncbi.nlm.nih.gov]
  • Finally, cigarette smoking may induce coronary artery disease and chronic obstructive pulmonary disease, which also might cause arrhythmia independently.[ncbi.nlm.nih.gov]
  • Diagnosis Your doctor will ask about your family history of coronary artery disease, cardiac arrhythmias, fainting spells or sudden death from heart problems.[womenshealthmag.com]
Congestive Heart Failure
  • ) heart failure I50.20 Unspecified systolic (congestive) heart failure I50.21 Acute systolic (congestive) heart failure I50.22 Chronic systolic (congestive) heart failure I50.23 Acute on chronic systolic (congestive) heart failure I50.3 Diastolic (congestive[icd10data.com]
  • The advanced heart rhythm management equipment and technology in our cath lab allows us to diagnose and care for conditions including: Atrial fibrillation (A-Fib) Heart arrhythmia Sudden cardiac arrest Congestive heart failure Nationally renowned cardiac[dignityhealth.org]
  • Secondary analyses were subset to men without calcium channel/β-adrenergic medication usage, and stratified by congestive heart failure or myocardial infarction history.[ncbi.nlm.nih.gov]
  • Individuals who have developed arrhythmia due to underlying condition such as, congestive heart failure or valvular disease have a poor prognosis if the condition is not effectively managed.[symptoma.com]
  • AFib is not usually life-threatening but can cause stroke or congestive heart failure if not properly diagnosed or treated with medication.[mercyhealth.org]
Falling
  • Abstract In 2 patients cardiac rhythm disturbances clearly caused falls and hip fractures.[ncbi.nlm.nih.gov]
  • Conversely, potassium concentrations fall during each hemodialysis, and sometimes reach hypokalemic levels by the end.[ncbi.nlm.nih.gov]
  • Others feel: Palpitations or a galloping or sluggish heartbeat; Shortness of breath; Chest pain or discomfort; Fatigue or weakness; Dizziness; or Unexplained falls or fainting.[augustahealth.org]
  • This could cause the electrodes to becomelooseor fall off.You should also not take a shower or swim while wearing a a Holter monitor. Event monitor.[cedars-sinai.edu]
  • Such action potentials cause extra systoles (extra heart beats that fall in between the normal beats). Early depolarizations are typically seen during bradycardia, hypokalemia, hypoxia, acidosis, hypocalcemia and in drug side effects.[ecgwaves.com]
Dyspnea
  • In case 1, a 44-y-old previously healthy male presented with chest tightness, dyspnea, diaphoresis and palpitation immediately after chewing 1 betel quid. He soon became breathless and died despite immediate cardiopulmonary resuscitation.[ncbi.nlm.nih.gov]
  • However, when symptoms are experienced, they include pain in chest, dyspnea, onset of tachycardia or bradycardia, flutter in chest, lightheadedness accompanied by dizziness and fainting.[symptoma.com]
  • Symptoms depend on the type of arrhythmia; we will explain the most common below: Symptoms of tachycardia Tachycardia is when the heart beats quicker than normal; symptoms include: breathlessness (dyspnea) dizziness syncope (fainting, or nearly fainting[medicalnewstoday.com]
  • Prodromal symptoms are often nonspecific, and even those taken to indicate ischemia (chest pain), a tachyarrhythmia (palpitations), or congestive heart failure symptoms (dyspnea) can only be considered suggestive.[doi.org]
Heart Disease
  • Abstract Cardiac arrhythmia and sudden death are most frequently caused by preexisting heart disease. Rarely, cardiac arrhythmia is a first symptom of an acute neurological event.[ncbi.nlm.nih.gov]
  • RESULTS: Only five subjects showed signs of heart disease during the resting ECG; none of the exercise ECGs revealed any abnormalities, even after further cardiological examinations.[ncbi.nlm.nih.gov]
  • Continue Learning about Arrhythmia Arrhythmia A type of heart disease, arrhythmia causes our hearts to beat too fast, too slow or with an irregular rhythm.[sharecare.com]
  • On the other hand, heart disease - the filling of the coronary arteries with plaques which lead to an increased risk of heart attacks - definitely does have some familial correlation.[zocdoc.com]
Chest Pain
  • The authors describe a young Indo-Asian man with cardiac sarcoidosis who presented acutely with chest pain and malignant cardiac arrhythmias.[ncbi.nlm.nih.gov]
  • When to Call a Doctor EMERGENCY Call an ambulance if you experience severe chest pain, shortness of breath, or prolonged palpitations. EMERGENCY Call an ambulance if someone loses consciousness.[healthcommunities.com]
  • Tachycardias can cause symptoms such as palpitations, chest pain, shortness of breath and fatigue, which reduce the quality of life. Fast tachycardias can cause hemodynamic collapse and sudden cardiac d...[intechopen.com]
  • Diagnosis Tell your doctor if you experience any of the following symptoms: Irregular heart beat or heart fluttering Heart palpitations or rapid thumping inside the chest Dizziness, sweating and chest pain or pressure Shortness of breath Excessive tiredness[midmichigan.org]
  • pain Rate This Content: Back Next July 1, 2011[web.archive.org]
Mitral Valve Prolapse
  • CM incidates cardiomyopathy; HD, heart disease; MVP, mitral valve prolapse; and LVH, left ventricular hypertrophy. Reproduced with permission from Maron BJ, Epstein SE, Roberts WC. Causes of sudden death in competitive athletes.[doi.org]
Anxiety Disorder
  • The incidence of SCD is higher in regions with lower socioeconomic status, and this gradient in risk is more exaggerated below age 65. 144 Chronic psychological stressors such as anxiety disorders and depression have also been associated with SCD in population-based[doi.org]
Dizziness
  • However, when symptoms are experienced, they include pain in chest, dyspnea, onset of tachycardia or bradycardia, flutter in chest, lightheadedness accompanied by dizziness and fainting.[symptoma.com]
  • Cardiac arrhythmia: Symptoms Possible symptoms of cardiac arrhythmia include: palpitations, rapid heartbeat, dizziness, drowsiness, confusion, fainting, brief loss of consciousness, seizures, chest pain and angina.[ims.uniklinik-freiburg.de]
  • Symptoms Symptoms of specific arrhythmias include: Sinus node dysfunction - There may not be any symptoms, or it may cause dizziness, fainting and extreme fatigue.[womenshealthmag.com]
  • Complaints such as: lightheadedness dizziness quivering shortness of breath chest discomfort heart fluttering or pounding and forceful or painful extra beats are commonly reported with a variety of arrhythmias Beats are generated by electrical impulses[healthguidance.org]
Confusion
  • Are you confused as to their similarities and differences? This lesson describes the practical and the more subtle similarities and differences between the two. Practically Similar Words Elevator and lift. Apartment and flat.[study.com]
  • Symptoms of Cardiac Arrhythmias Palpitations or irregular-feeling heartbeats Shortness of breath Chest pain Dizziness, lightheadedness, and fainting Mental confusion Loss of consciousness In some cases there may be no symptoms Prevention of Cardiac Arrhythmias[healthcommunities.com]
  • Cardiac arrhythmia: Symptoms Possible symptoms of cardiac arrhythmia include: palpitations, rapid heartbeat, dizziness, drowsiness, confusion, fainting, brief loss of consciousness, seizures, chest pain and angina.[ims.uniklinik-freiburg.de]
  • Its confusion with psychiatric disorders has led to incorrect diagnoses including anxiety neurosis and panic attacks.[womensheart.org]
  • […] dizziness syncope (fainting, or nearly fainting) fluttering in the chest chest pain lightheadedness sudden weakness Symptoms of bradycardia Bradycardia is when the heart beats slower than normal; symptoms include: angina (chest pain) trouble concentrating confusion[medicalnewstoday.com]
Guillain-Barré Syndrome
  • Abstract We report a case of cardiac arrhythmia occurring in a Guillain-Barré syndrome (GBS) patient after succinylcholine administration during third endotracheal intubation, on day 13 of illness.[ncbi.nlm.nih.gov]

Workup

A preliminary physical examination, along with a careful review of medical history would be done. This will be followed by various tests, which include:

  • Electrocardiogram: With the help of electrocardiogram, the time and duration of each and every electrical activity in the heart can be measured.
  • Holter monitor: This portable device is meant for recording the heart beats and is worn for a 24 hour period, which would help in determining the heart beat as one carries out daily routine tasks.
  • Event monitor: This is useful for individuals experiencing sporadic episodes of arrhythmia. The device is kept handy, and used for recording the heart beats when one is experiencing the symptoms.
  • Echocardiogram: This is a non-invasive procedure, wherein a transcuder is placed in the chest for determining the size of the heart, its motion and structure.

In cases, when arrhythmia cannot be diagnosed with the above mentioned tests, then additional methods may be required. These include stress test, tilt table test and electrophysiological testing [7].

Abnormal ECG
  • Because arrhythmia represents abrupt and abnormal ECG beats, physicians diagnose arrhythmia based on long-term ECG data using an ECG recording system like the Holter recorder.[dx.doi.org]

Treatment

Often, arrhythmia would not require any treatment, unless the condition is causing severe symptoms which can eventually lead to serious complications. Treatment would depend on the type of arrhythmia that has set in. The following methods are employed:

Treatment for bradycardia: This is treated with pacemaker, if an underlying condition cannot be found. There are no medications for improving the heart beats and therefore pacemaker is the best option [8].

Treatment for tachycardia: Vagal maneuvers such as coughing, holding breath and straining, can help in normalizing the fast heartbeat. If this does not work, medications may be administered for lowering the heartbeat. Anti-arrhythmic medications are given to prevent onset of complications. In case of atrial fibrillation, cardioversion can be employed [9].

In addition to these methods, catheter ablation can also be conducted. In this, with the help of radiofrequency energy, a small part in heart tissue is ablated in order to destroy the point of arrhythmia origination [10].

Prognosis

Prognosis of the condition significantly depends on the type of arrhythmia that has set in. In addition, if prompt treatment is not initiated then cardiac arrhythmia can give rise to life threatening conditions. Individuals who have developed arrhythmia due to underlying condition such as, congestive heart failure or valvular disease have a poor prognosis if the condition is not effectively managed. When there is no structural deformity present, the prognosis is excellent [5].

Etiology

Cardiac arrhythmia can be caused by several factors, which include hypothyroidism, hyperthyroidism, myocardial infarction, congenital heart disease, scarring of the myocardium due to myocardial infarction, cardiomyopathy and electrolyte imbalance [2].

In addition to these factors, some other conditions can favor cardiac arrhythmia. These include stimulant drugs, overuse of products containing caffeine, alcohol consumption, medications taken for management of hypertension and other heart problems, smoking and drugs used for treatment of psychiatric disorders. Medications used for treating a type of arrhythmia can also pave way for development of another type of arrhythmia.

Epidemiology

Cardiac arrhythmia is a common phenomenon and strikes the majority of the population across the globe. According to the statistics provided by the Center for Disease Control and Prevention, it was found that more than 600,000 sudden cardiac deaths are recorded each year. It has also been estimated that, about 50% of patients experienced sudden death as a preliminary manifestation of heart disease.

Sex distribution
Age distribution

Pathophysiology

Irrespective of the type of arrhythmia that has set in, the pathophysiology follows any one of the 3 mechanisms; which include triggered activity, enhanced or suppressed automaticity and re-entry. Under normal conditions, the rhythm of heart is controlled by the sinus node, situated in the right atrium. The electrical impulses produced by the sinus node initiate each heart beat. Factors that interfere with the production of electrical impulses, favor the development of arrhythmia [3].

Tachycardias that originate in the atria include supraventricular tachycardia, atrial fibrillation, Wolff-Parkinson-White syndrome and atrial flutter. The ones which originate in the ventricles include long QT syndrome, ventricular tachycardia and ventricular fibrillation [4].

Prevention

Adopting a healthy lifestyle can help in preventing occurrence of cardiac arrhythmia. Individuals can improve their heart health by following an active lifestyle, along with consuming a healthy diet and maintaining healthy weight. Avoiding smoking, alcohol and limiting consumption of caffeine can also reduce the risk of developing cardiac arrhythmias.

Summary

In cardiac arrhythmia the heart may beat either too fast, too slow or it might beat irregularly. When the heart beat is more than 100 beats per minute, the condition is termed as tachycardia; when the rate is slower than 60 beats per minutes, the condition is termed as bradycardia. In majority of instances, arrhythmias are not life threatening; however, if it causes impairment of cardiac function it can lead to cardiac arrest [1].

Patient Information

Definition: Cardiac arrhythmia is defined as onset of abnormal heart rhythm or rate that occurs when there is some problem with the electrical impulses of the heart. In such a type of condition, the heart can either beat too fast, too slow or can be irregular.

Cause: Several factors that favor the development of arrhythmia include conditions of hyperthyroidism, hypothyroidism, diabetes, and heart attack, damage to heart tissue due to heart attack, alcohol abuse, stress, medications and hypertension.

Symptoms: Symptoms include pain in chest, followed by shortness of breath along with dizziness and lightheadedness.

Diagnosis: Cardiac arrhythmia is usually diagnosed with help of electrocardiogram. In addition, devices such as holter monitor and event monitor can also help detect abnormal heart beats for a 24 hour period or when symptoms are occurring. Echocardiogram is indicated to determine the size, motion and structure of heart.

Treatment: Bradycardia is treated with pacemaker, as no medications are available to treat slow heartbeat. Tachycardia is treated with help of vagal maneuvers, medications and cardioversion techniques. In many cases, catheter ablation can also be carried out.

References

Article

  1. Seferović PM, Ristić AD, Maksimović R, et al. Cardiac arrhythmias and conduction disturbances in autoimmune rheumatic diseases. Rheumatology (Oxford) 2006; 45 Suppl 4:iv39.
  2. Francis GS. Development of arrhythmias in the patient with congestive heart failure: pathophysiology, prevalence and prognosis. Am J Cardiol 1986; 57:3B.
  3. Podrid PJ, Fogel RI, Fuchs TT. Ventricular arrhythmia in congestive heart failure. Am J Cardiol 1992; 69:82G.
  4. Newman BJ, Donoso E, Friedberg CK. Arrhythmias in the Wolff-Parkinson-White syndrome. Prog Cardiovasc Dis 1966; 9:147.
  5. Holmes J, Kubo SH, Cody RJ, Kligfield P. Arrhythmias in ischemic and nonischemic dilated cardiomyopathy: prediction of mortality by ambulatory electrocardiography. Am J Cardiol 1985; 55:146.
  6. Teerlink JR, Jalaluddin M, Anderson S, et al. Ambulatory ventricular arrhythmias in patients with heart failure do not specifically predict an increased risk of sudden death. PROMISE (Prospective Randomized Milrinone Survival Evaluation) Investigators. Circulation 2000; 101:40.
  7. Milner PG, Dimarco JP, Lerman BB. Electrophysiological evaluation of sustained ventricular tachyarrhythmias in idiopathic dilated cardiomyopathy. Pacing Clin Electrophysiol 1988; 11:562.
  8. McMullan J, Valento M, Attari M, Venkat A. Care of the pacemaker/implantable cardioverter defibrillator patient in the ED. Am J Emerg Med. Sep 2007;25(7):812-22.
  9. Mason JW. A comparison of seven antiarrhythmic drugs in patients with ventricular tachyarrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring Investigators. N Engl J Med 1993; 329:452
  10. Morady F. Radio-frequency ablation as treatment for cardiac arrhythmias. N Engl J Med 1999; 340:534.

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Last updated: 2018-06-22 05:17