Arrhythmia - OT&P Knowledgebase

Arrhythmia (心律不正), also less frequently called dysrhythmia, is any change from the normal sequence of electrical impulses in the heart. These impulses may happen too fast, too slow, or irregularly, leading to the heart beating too quickly (tachycardia), too slowly (bradycardia), or erratically. Arrhythmias can be temporary or permanent and can arise from within the heart or result from external factors affecting the heart's electrical activity.

The Electrical Symphony of the Heart

To understand arrhythmias, one must first appreciate the heart's electrical system. The heart contains specialized cells that create and conduct electrical signals, triggering the coordinated contraction of the heart muscle. This electrical system ensures that blood is pumped efficiently to the rest of the body. When these signals and conduction systems become erratic, the harmony is disrupted, leading to an arrhythmia.

Types of Arrhythmias

Arrhythmias are classified based on their origin (atrial or ventricular) and their effect on heart rate. Common types of arrhythmias include:

Atrial Fibrillation (AFib): Characterized by rapid and irregular beating of the atrial chambers of the heart.
Atrial Flutter: Similar to AFib but typically more organized and less chaotic.
Supraventricular Tachycardia (SVT): An abnormally fast heartbeat originating above the heart's ventricles.
Ventricular Tachycardia (VT): A fast, regular beating of the heart's ventricles that can turn life-threatening.
Ventricular Fibrillation (VFib): A chaotic and rapid heartbeat leading to the heart's inability to pump blood effectively, requiring immediate medical intervention.

Causes of Arrhythmia

The causes of arrhythmias are as varied as the conditions themselves. They can be due to:

Heart disease or damage from a heart attack
Changes in heart muscle
Blocked arteries (coronary artery disease)

High blood pressure
Imbalance of electrolytes, such as sodium or potassium
Congenital heart defects
Overactive thyroid gland (hyperthyroidism)
Dehydration
Diabetes

Lifestyle factors can also contribute to arrhythmias, including:

Smoking
Excessive alcohol or caffeine consumption
Drug abuse
Stress or anxiety
Certain medications and supplements

Symptoms of Arrhythmia

The symptoms of an arrhythmia can be diverse, while in some cases, can be very subtle or nonexistent. When symptoms do occur, they may include:

Palpitations or a feeling of skipped heartbeats
Pounding in the chest
Dizziness or lightheadedness
Shortness of breath
Chest discomfort

Weakness or fatigue
Fainting (syncope) or near fainting
Easy fatigability
Disorientation
Cold sweats

Diagnosing Arrhythmia

To diagnose an arrhythmia, a healthcare provider will review your symptoms, medical history, and perform a physical examination. They may also request tests such as:

Electrocardiogram (ECG or EKG): The primary tool for diagnosing arrhythmia, which records the electrical activity of the heart.
Holter monitor: A portable ECG device worn for a day or more to record the heart's activity over an extended period.
Event monitor or implantable loop recorder (ILR): Similar to a Holter monitor, but only records at certain times for a few minutes at a time.
Echocardiogram: An ultrasound of the heart that can show structural heart disease.
Stress test: Monitoring the heart while you're asked to perform increasing physical activity levels.

Treatment Options for Arrhythmia

Treatment for arrhythmia depends on the type and severity of the condition. Options include:

Medications: known as anti-arrhythmic drugs/medications are chemical products prescribed to control the heart rate or restore a normal heart rhythm.
Electrical Cardioversion: Delivering an electrical shock to the heart to reset its rhythm commonly accomplished with a defibrillator.
Catheter Ablation: Using radiofrequency heat energy to destroy heart tissue causing the arrhythmia.
Pacemaker: A device that sends electrical impulses to the heart to keep it beating normally.

Implantable Cardioverter Defibrillator (ICD): A device similar to a pacemaker that can also deliver shocks (defibrillation-capable) to correct life-threatening arrhythmias.

Managing Arrhythmia with Daily Habits

For many individuals, living with arrhythmia involves a combination of medical treatment and lifestyle adjustments. Regular follow-ups with a cardiologist are essential for monitoring the condition and making necessary changes to the treatment plan. Additionally, patients may need to:

Adopt heart-healthy habits: This includes eating a balanced diet, engaging in regular exercise, maintaining a healthy weight, and quitting smoking.
Limit caffeine and alcohol: These substances can trigger or worsen arrhythmias in some people.
Avoid use of illicit/recreational drugs.
Know the side-effects of prescription medications and interactions with other medicines.
Manage stress: Techniques such as meditation, yoga, and deep breathing can help reduce the heart's workload and alleviate arrhythmia symptoms.
Stay informed: Understanding and managing your condition can empower you to take an active role in your care.

When to Seek Emergency Care

Certain arrhythmias, particularly those that are sudden and cause severe symptoms, require immediate medical attention. If you or someone you're with experiences chest pain, severe shortness of breath, fainting, or palpitations that don't resolve quickly, it's imperative to call emergency services or go to the nearest hospital.

References

NIH. What Is an Arrhythmia? 16 Feb 2024 Retrieved from https://www.nhlbi.nih.gov/health/arrhythmias
Mayo Clinic. Heart arrhythmia. 16 Feb 2024 Retrieved from https://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/symptoms-causes/syc-20350668
Heart.org. What is an Arrhythmia? 16 Feb 2024 Retrieved from https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia

Arrhythmia (abnormal heart rhythm)