Everything You Want to Know About Arrhythmia


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What is arrhythmia?

An arrhythmia is a disorder of the heart that affects the rate or rhythm at which the heart beats.

It happens when electrical impulses that direct and regulate heartbeats don’t function properly. This causes the heart to beat:

  • too fast (tachycardia)
  • too slow (bradycardia)
  • too early (premature contraction)
  • too erratically (fibrillation)

Nearly everyone will experience an abnormal heart rhythm at least once. It may feel like your heart is racing or fluttering.

Arrhythmias are common and usually harmless, but some are problematic. When an arrhythmia interferes with blood flow to your body, it can damage your:

  • brain
  • lungs
  • other vital organs

If they’re not treated, arrhythmias may be life threatening.

Symptoms

You may not have any symptoms of an arrhythmia. However, common signs can include:

  • feeling like your heart skipped a beat
  • a fluttering feeling in your neck or chest
  • rapid heartbeat
  • slow or irregular heartbeat

Talk to your doctor about your symptoms so they can effectively diagnose and treat your arrhythmia. You may also develop more serious symptoms from your heart not working properly, including:

  • chest pain
  • difficulty breathing
  • weakness
  • dizziness or lightheadedness
  • fainting, or almost fainting
  • fatigue
  • sweating

Seek medical care right away if you experience any of these symptoms. Find out more about arrhythmia symptoms and when to seek care.

Causes

Arrhythmias can have medical, physical, emotional, or genetic causes. The cause may also be unknown.

Antibiotics and other medications can trigger arrhythmia in some people. These may include medications that treat:

  • high blood pressure
  • depression
  • allergies
  • colds

Changes in blood flow or physical alterations to the heart, such as scarring, can also cause arrhythmia. Other medical conditions may also be the source, including:

  • high blood pressure
  • dehydration
  • thyroid disorder
  • sleep apnea
  • diabetes
  • electrolyte imbalance, such as from low levels of calcium, potassium, or magnesium

Other physical or lifestyle factors can also cause arrhythmia in some cases. These include:

  • exercise
  • coughing
  • strong emotions like anger, stress, or anxiety
  • drinking alcohol
  • smoking

Treatment

Arrhythmias often don’t need specific treatment, but it’s important to have your arrhythmia medically evaluated to know if you do or don’t.

Your doctor will evaluate whether your arrhythmia may cause more serious symptoms or other conditions when deciding on treatment options.

It’s important to exercise, maintain a healthy diet, and manage your blood pressure and cholesterol levels when you have arrhythmia. This can lower your risk for complications like a heart attack or stroke.

If you experience a fast heart rate without any other symptoms, your doctor may suggest that you try vagal maneuvers. They can prompt your vagus nerve to slow your heart rate. Vagal maneuvers include:

  • soaking your face with cold water
  • coughing
  • gagging
  • holding your breath while straining

Other treatments for arrhythmia include medication and surgery.

Medication

Your doctor may give you medication to help you manage your arrhythmia and prevent complications like a heart attack.

Most of the medications come in pill form, but some come in intravenous form for use during an emergency.

The medication they prescribe depends on the type of arrhythmia as well as other conditions you may have. Common medication types include:

  • Antiarrhythmic drugs. These can treat tachycardia and premature heartbeats. They include amiodarone, propafenone, and more. However, they may cause the problematic side effect proarrhythmia, which can worsen your arrhythmia or cause a new arrhythmia.
  • Calcium channel blockers. Calcium channel blockers, which include amlodipine and diltiazem, help lower your blood pressure and heart rate. They can be used long term.
  • Beta-blockers. Beta-blockers slow your heart rate to treat tachycardia. Beta-blockers include acebutolol, metoprolol, and other medications.
  • Anticoagulants. Anticoagulants help prevent blood clots, which can result from atrial fibrillation. Blood-thinning medications include warfarin, rivaroxaban, and more. A side effect may be excessive or internal bleeding.

Make sure to take all medications as prescribed. Let your doctor know about any side effects, especially proarrhythmia.

Find out more about medications for arrhythmia.

Surgery

If medication or other treatments aren’t enough to help your arrhythmia, you may need a minor procedure or surgery. Several procedures and implantable devices can help treat arrhythmia:

  • Catheter ablation: During catheter ablation, your cardiologist threads flexible tubes called catheters through your blood vessels to the correct area of your heart. An electrode at the end of one of the catheters releases radiofrequency waves, heat, or very cold temperatures to create a small scar. The scar tissue blocks the electrical waves that cause arrhythmias.
  • Pacemaker: Your doctor can implant a pacemaker during minor surgery. After making a small cut near your shoulder, they guide small wires through your veins and place them in your heart. The wires connect to a small battery-powered generator implanted near your collarbone. If the generator detects an abnormal heart rhythm, it can send an electrical pulse through the wire to help regulate it.
  • Implantable cardioverter defibrillator (ICD): An ICD is similar to a pacemaker and may be implanted near your collarbone, breastbone, or ribs. It may help if your arrhythmias are life threatening or put you at risk of cardiac arrest. An ICD can send electric shocks to your heart to correct its rhythm or restart your heart if it stops beating.

Surgery can also treat serious types of arrhythmias, such as atrial fibrillation.

In the maze procedure, your surgeon makes small cuts on the upper half of your heart to create scar tissue. The scars block electrical activity that can cause irregular heart rhythms.

Types

Arrhythmias are named and categorized based on three points:

  • rate (whether it’s too slow or too fast)
  • origin (whether it’s in the ventricles or the atria)
  • regularity

In a properly beating heart, electrical impulses follow precise pathways through the heart. These signals coordinate the activity of the heart muscle so that blood pumps in and out of the heart.

Any interruption in these pathways or impulses can cause the heart to beat abnormally, leading to an arrhythmia. These can start in the sinus node, the ventricles (the heart’s lower chambers), or the atria (the upper chambers).

A premature heartbeat can also sometimes lead to arrhythmia.

Premature heartbeats feel like your heart has skipped a beat. In reality, your normal heart rhythm has been interrupted by a too-soon beat, and you’re experiencing an extra beat between two normal heartbeats.

Sinus arrhythmia

The sinus node uses electrical impulses to help regulate your heartbeat’s rhythm. If your sinus node doesn’t send the impulses properly, your heart may pump too slowly or irregularly. This results in sinus arrhythmia.

There are two types of sinus arrhythmia:

  • sinus tachycardia, when your heart rate rises to more than 100 beats per minute, and
  • sinus bradycardia, when your heart rate slows to under 60 beats per minute.

Sinus arrhythmia is one type of sick sinus syndrome, a group of disorders related to the sinus node.

Scarring near the sinus node from heart disease or a heart attack may slow down or block the electrical impulses as they travel through the heart. This can cause an arrhythmia and other disorders.

Sinus arrhythmia is a common condition in many people. However, it may cause heart complications for some.

Learn more about sinus arrhythmia.

Ventricular arrhythmia

Ventricular arrhythmia begins in the ventricles, or the lower chambers, of the heart.

There are two types:

  • ventricular tachycardia
  • ventricular fibrillation

Both may need to be treated immediately, especially if you have other heart conditions.

Ventricular tachycardia (VT) typically occurs in people who have had heart disease or heart-related issues, like coronary artery disease or a heart attack. It can cause a heart rate of 170 beats per minute or higher.

VT is dangerous when it lasts longer than a few seconds. It may also lead to more serious ventricular arrhythmias, such as ventricular fibrillation.

Ventricular fibrillation (VF) involves sudden, rapid, irregular, and chaotic heartbeats in the ventricle. These erratic electrical impulses, sometimes triggered by a heart attack, cause your heart’s ventricles to quiver.

When you have this kind of arrhythmia, your ventricles can’t pump blood into your body, and your heart rate drops quickly. This can cause sudden cardiac arrest and death without immediate treatment.

Atrial arrhythmia

Atrial arrhythmias, also known as supraventricular arrhythmias, begin in the atrium or upper chamber of the heart. They include:

  • supraventricular tachycardia
  • atrial fibrillation
  • atrial flutter

Supraventricular tachycardia (SVT) includes different forms of arrhythmias that begin above the ventricles. SVTs are usually identified by a burst of rapid heartbeats that may begin and end suddenly.

These bursts can last a few seconds or several hours and may cause your heart to beat more than 160 times per minute. The most common SVTs include:

  • atrial fibrillation
  • atrial flutter

If you have atrial fibrillation, also known as AF or AFib, your atria beat very rapidly, as fast as 400 beats per minute. The atria move so quickly that they aren’t able to contract completely. Instead, they quiver, or fibrillate.

Your risk of developing AF increases past age 65 and if you have other medical conditions. If left untreated, AF can lead to more serious conditions, such as stroke.

In atrial flutter (AFl), the heart beats more rhythmic and constant than in atrial fibrillation. You may not feel any symptoms with either type of arrhythmia.

Atrial flutter occurs most often in people with heart disease, though it’s less common than AF. It also often shows up in the first weeks after heart surgery. Like AF, atrial flutter can be life threatening.

Arrhythmia vs. dysrhythmia

Dysrhythmia is another name for arrhythmia. While there’s a slight medical distinction between the two, both are often used interchangeably to refer to an irregular heartbeat.

ECG

An electrocardiogram, also called an ECG or EKG, is frequently used to diagnose arrhythmia. Your doctor attaches electrodes to your chest, arms, or legs that measure and graph your heart’s electrical activity.

ECG measurements reveal if the electrical activity is unusually fast, slow, or irregular. The test can also show if your heart is enlarged or has poor blood flow.

Your doctor may take an ECG while you’re resting or when you’re exercising on a stationary bicycle or treadmill. A portable monitor can also take ECGs to look for irregularities over a longer period of time.

ECGs involve little or no risk.

Find out more about getting an ECG.

Diagnosis

To diagnose arrhythmias, your doctor can use:

  • your medical and family history
  • a physical exam
  • a range of tests to diagnose arrhythmias

In addition to an ECG, your doctor may also use a chest x-ray or echocardiography to check:

  • the size and shape of your heart
  • the condition of the valves that help regulate the flow of blood through your heart

Since arrhythmias can be irregular and may not occur while you’re at the doctor’s office, your doctor may have you use a heart monitor at home. Types of monitors include:

  • Holter monitor. A holter monitor is a portable monitor that records your heart’s rhythm over the course of one or two days.
  • Event recorders. Event recorders are handheld monitors that can be used to record your heartbeat when you feel an irregularity.
  • Implantable loop recorder. Your doctor may implant a loop recorder under your skin to continuously monitor your heartbeat and record infrequent arrhythmias.

Other tests can also check for an arrhythmia in various situations. These include:

  • Stress test. A stress test allows your doctor to monitor your heartbeat while you exercise to see if exertion causes an arrhythmia. They can also use medication to increase your heart rate for the test if you have trouble exercising.
  • Sleep study. A sleep study can show whether sleep apnea is the source of your arrhythmia.
  • Tilt table test. A tilt table test may be used if your arrhythmia has caused you to faint in the past. Your doctor will check your heart rate and blood pressure as you lie on a table that’s tilted between different positions.
  • Electrophysiological testing. Your doctor will insert thin electrode catheters through your veins to different areas on your heart to map electrical signals during electrophysiological testing. The electrodes can also cause arrhythmias, which may help your doctor diagnose them and suggest treatments.

Your doctor may also order blood tests to check the level of magnesium, calcium, thyroid hormone, and other substances in your blood that may affect arrhythmia.

Learn more about tests for arrhythmia.

Prevention

Arrhythmias can develop from a variety of causes, some of which you may not be able to prevent. Still, you can work to avoid triggering your arrhythmia or making it worse.

First, it’s important to understand the cause of your arrhythmia so you can avoid triggers. Preventable triggers may include:

  • stress/anxiety
  • smoking
  • caffeine
  • alcohol
  • certain medications
  • some street drugs

Talk to your doctor if you think any medications are causing your arrhythmia. Don’t stop taking or change your medication on your own.

A healthy lifestyle is also helpful for preventing and managing arrhythmia. Do your best to:

  • follow a healthy diet with reduced salt and fat
  • if you smoke, stop smoking
  • exercise regularly
  • stay within a healthy weight range
  • reduce stress
  • limit the amount of alcohol you drink
  • maintain healthy blood pressure and cholesterol levels

Develop a plan with your doctor to help you manage your arrhythmia, including steps you can take when you have symptoms.

Find out more about preventing arrhythmia.

Risk factors

Your family history, health conditions, age, lifestyle, and more can be risk factors for developing arrhythmia.

Medical conditions or events, particularly ones related to your heart, may increase your risk. They include:

  • coronary artery disease
  • heart valve disease
  • heart attack or heart failure
  • cardiomyopathy (heart muscle diseases)
  • endocarditis (heart inflammation)
  • high blood pressure
  • sleep apnea
  • chronic lung disease
  • overactive or underactive thyroid gland
  • kidney disease
  • eating disorders that cause an electrolyte imbalance or malnutrition
  • fever
  • diabetes

Other common risk factors include:

  • older age
  • certain medications, especially stimulants and antihistamines some of which can be found over the counter
  • air pollution
  • family history of arrhythmia
  • caffeine
  • alcohol
  • smoking
  • street drugs, particularly cocaine or amphetamines

Lifestyle changes may help lower your chances of developing an arrhythmia.

Learn more about arrhythmia risk factors and how to reduce them.

Complications

Different types of arrhythmias, especially when untreated, may lead to life threatening conditions. These complications include:

  • heart failure
  • stroke
  • dementia
  • cardiac arrest
  • arrhythmias that get worse or cause other symptoms

A 2014 study indicated that several conditions, including arrhythmia, were strongly associated with dementia in adults older than age 64.

Home remedies for arrhythmia

Making lifestyle changes at home, including getting regular exercise and eating healthy foods, can help improve your heart health and help you manage arrhythmia.

Other alternative or complementary treatments may help arrhythmia, though more research is needed. A 2013 study found that yoga reduced atrial fibrillation episodes and improved blood pressure and anxiety.

Acupuncture may also be an effective treatment for arrhythmia, according to a 2017 research review. However, the review noted that current research is limited.

Two research reviews published in 2017 suggested that magnesium and vitamin C supplements may reduce or prevent atrial fibrillation after heart surgery.

Still, there wasn’t enough evidence to recommend supplements for other arrhythmias.

Discuss any alternative treatments, especially supplements, with your doctor.

Find out more about alternative treatments to try and avoid for arrhythmia.

Outlook

There are many types of heart arrhythmias. Most are harmless, and nearly everyone has an arrhythmia at one time or another. Frequently, they go unnoticed.

It’s also normal to have an increased heart rate during exercise, when your heart is working hard to provide your tissues with oxygen-rich blood so you don’t get tired too quickly.

Some arrhythmias are not harmless, though. Your outlook depends on the type and severity of your arrhythmia. If you think you have an arrhythmia, see your doctor.

Even the most serious arrhythmias can often be treated successfully. Most people with arrhythmia can live a normal life.


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