Arrhythmia - Meaning, Types, Causes, Symptoms & Treatment

Heart palpitations refer to the feeling of your heart skipping a beat, fluttering, or beating rapidly. They are felt in the neck or chest during activity or lying down. Palpitations may occur due to hormonal changes, fear, stress, anxiety, medications, or the consumption of alcohol and caffeine. Usually, heart palpitations aren’t serious and may go on their own. 

On the other hand, arrhythmias are conditions when your heart beats too fast, too slow, or irregularly. They are caused due to issues with your heart’s electrical system. Unlike palpitations, arrhythmia results from serious heart problems such as electrolyte imbalances, coronary artery disease, or injury from a heart attack.

The electrical impulses follow specific pathways through a properly beating heart. These signals coordinate the heart muscle’s activities so that the blood pumps in and out of the heart. The average heart rate in children and adults are as follows:

1. Infants (to 12 months): 100-160 beats per minute
2. Toddler (1-3 years): 90-150 beats per minute
3. Preschooler (3-5 years): 80-140 beats per minute
4. School-aged child (5-12 years): 70-120 beats per minute
5. Adolescents (12-18 years) and Adults (above 18 years): 60-100 beats per minute

Any interruption in this pathway can lead to the heart beating abnormally, causing an arrhythmia. Arrhythmias can be categorised based on three factors:

1. Rate (too slow or too fast)
2. Origin (in the ventricles or atria)
3. Regularity

The types of arrhythmia include:

Bradycardia

Bradycardia is a slow heart rate below 60 beats per minute. Types of bradycardia include:

1. Conduction block: A block in the heart’s electrical pathways can cause the electrical impulses to slow down or stop.
2. Sick sinus syndrome: It is a heart rhythm disorder that affects the sinus node (the heart’s natural pacemaker, located in the upper chamber) and slows, disrupts or blocks the travel of impulses. 
   However, a slow heart rate does not always signal a problem. If you are physically fit, your heart may still be able to pump enough blood with fewer than 60 beats a minute. 

Tachycardia

Tachycardia is a heart rate of over 100 beats a minute. Often this condition lasts only a few minutes and may not be serious. However, if it lasts longer than 30 minutes or you experience chest pain, seek medical care immediately. 

Ventricular Arrhythmias

Ventricular arrhythmias refer to an irregular heartbeat in the ventricles (the heart’s lower chambers). Types of ventricular arrhythmias include:

1. Ventricular Tachycardia: A heart rate of 100 beats per minute in the heart’s lower chambers. 
2. Ventricular Fibrillation: These are sudden, erratic, irregular, and rapid heartbeats in the ventricles. It can cause sudden cardiac arrest if not treated immediately. 

Supraventricular Arrhythmias

Also known as atrial arrhythmias, supraventricular arrhythmias begin in the atrium (the heart’s upper chamber, above the ventricles). Types of supraventricular arrhythmias include:

1. Atrial Fibrillation: The atria beat as fast as 400 beats a minute. If not treated in time, atrial fibrillation can lead to a stroke.  
2. Atrial Flutter: The condition is similar to fibrillation, but the heart beats more constantly and rhythmically. Like atrial fibrillation, atrial flutter can be life-threatening. 
3. Atrial Tachycardia: It refers to a rapid heart rhythm that starts in the atria. 
4. Wolff-Parkinson-White syndrome: It is a condition in which an extra electrical pathway between the heart’s upper and lower chambers leads to a rapid heartbeat. 
5. Atrioventricular nodal reentrant tachycardia (AVNRT): It refers to the presence of more than one pathway through the AV node leading to a fast heart rhythm. 
6. Paroxysmal supraventricular tachycardia (PSVT): A rapid but regular heart rhythm that begins in the atria. 

Premature Heartbeat

Premature heartbeats or premature ventricular contractions (PVCs) are extra heartbeats that begin in one of the heart’s lower chambers (ventricles). These extra heartbeats disrupt the regular rhythm, causing a sensation of a skipped heartbeat. Usually, these extra beats are not concerning, and they rarely mean that you have a severe condition. 

An arrhythmia may not cause any symptoms. Your doctor may examine irregular heartbeat during examination for another health condition. The common signs of arrhythmia include:

1. Palpitations (a feeling like your heart skipped a beat)
2. A pounding or fluttering in your neck or chest
3. A slow heartbeat (bradycardia)
4. A rapid heartbeat (tachycardia)

If you do experience symptoms of arrhythmia, these include:

1. Shortness of breath
2. Chest pain or tightness
3. Lightheadedness or dizziness
4. Weakness
5. Fatigue
6. Sweating
7. Anxiety
8. Fainting or near fainting

Arrhythmia can have several medical, genetic, physical, and emotional causes. In some cases, the cause of an arrhythmia may be unknown. Antibiotics and other medications for high blood pressure, depression, allergies, and colds can trigger arrhythmia in some people. 

Changes in blood flow or other medical conditions can also cause arrhythmia. The causes of arrhythmia include:

Congenital

1. Congenital heart deformities can cause irregularities in pumping blood, leading to arrhythmia. 

Acquired

1. Genetic
   1. Heart attacks cause damage to the heart muscles, disrupting electrical signals that control the heart.
   2. Coronary artery disease can weaken the heart muscles, leading to arrhythmia. 
   3. High blood pressure causes stiffening of the ventricular walls, leading to heart arrhythmia. 
   4. The oversecretion (hyperthyroidism) or under secretion (hypothyroidism) of thyroid glands can cause hormonal imbalances, resulting in irregular heartbeats. 
   5. Imbalances in electrolytes such as sodium, potassium, magnesium, and calcium can hamper the electrical signals, causing blood to pump irregularly. 
   6. Diabetes impacts the heart’s electrical conduction system, causing an irregular heartbeat. 
   7. Frequent drops in oxygen levels during sleep (sleep apnea) can damage the heart’s blood vessels. Each time the oxygen drops, your body instructs the heart to beat faster, causing an arrhythmia. 
   8. Valve disorders can restrict the blood flow to the left ventricle, causing irregular heartbeats. 
   9. Dehydration causes your electrolyte levels to fall, causing abnormal heart rhythm. 
   10. When infected with Covid-19, you may experience hypoxia (low oxygen in your blood) or electrolyte abnormalities. Both these conditions contribute to the development of arrhythmias. 

 

1. Lifestyle-Related 
   1. Coughing can change intrathoracic pressure surrounding the lungs and affect the blood flow to the heart. 
   2. Exercise increases adrenaline, causing your blood pressure and heart rate to increase. 
   3. Drug abuse can change the electrical structure of the heart, promoting arrhythmias.
   4. Smoking slows the conduction of electrical impulses in the cardiac tissue. 
   5. Drinking too much alcohol can stimulate the internal nervous system, leading to an irregular heartbeat. 
   6. Stress, anxiety, or anger results in a sudden surge of adrenaline, leading to an arrhythmia. 

Risk Factors associated with Arrhythmia can be categorised into two parts: Controllable Factors and Uncontrollable Factors. Let's read more about these:

Controllable Factors

1. High blood pressure
2. Eating disorders leading to electrolyte imbalance or malnutrition
3. Smoking
4. Alcohol consumption
5. Thyroid disease
6. Diabetes

Uncontrollable Factors

1. Heart valve disease
2. Coronary artery disease
3. Heart attack or failure
4. Congenital heart disease
5. Heart muscle diseases (cardiomyopathy)
6. Heart inflammation (endocarditis)
7. Sleep apnea
8. Chronic lung disease
9. Kidney disease
10. Old age
11. Family history of arrhythmia

Reducing the risk of heart disease can help you prevent heart arrhythmias. These involve the following lifestyle changes:

1. Stay physically active
2. Eat a heart-healthy diet
3. Quit smoking
4. Limit the intake of alcohol and caffeine
5. Maintain a healthy weight
6. Reduce stress
7. Take medications as directed by your doctor

If you experience the symptoms of an arrhythmia, you may need to consult a cardiologist to diagnose the condition. The healthcare provider will ask about the symptoms you are experiencing, examine your medical history, and conduct a physical exam by checking your heart rate and listening to your heart sound. He/she may perform further tests to confirm arrhythmia or conditions that can cause arrhythmia. 

The tests to diagnose irregular heartbeat include:

1. Electrocardiogram (ECG): During an ECG, the doctor attaches electrodes to your chest, arms, and legs to detect the heart’s electrical activity. 
2. Echocardiogram: In this non-invasive test, the doctor places a hand-held device on your chest. By using sound waves, the device creates images of the heart’s structure, size, and motion. 
3. Event recorder: This wearable ECG device can detect sporadic arrhythmias. You need to press the button when the symptoms occur. 
4. Holter monitor: This wearable ECG device can be worn for a day or more to record your heart’s activity as you go about with your routine. 
5. Implantable loop recorder: A heart monitoring device implanted under the skin in the chest area to continually record the heart’s electrical impulses and detect irregular heart rhythms. 

If the doctor cannot diagnose arrhythmia during these tests, he/she may conduct tests to diagnose the conditions that trigger arrhythmia. These tests include:

1. Stress Test: The test detects arrhythmia that starts or worsens with exercise. Your provider will ask you to walk on a treadmill or ride a stationary bicycle to monitor the heart’s activity. It may also be used to determine an underlying heart disease associated with arrhythmia. 
2. Electrophysiological Study (EPS): A special heart catheterisation evaluates your heart’s electrical system. The doctor inserts a catheter into your heart to record its electrical activity. The test is used to find the cause of arrhythmia and determine the best treatment approach. 
3. Tilt Table Test: During this test, your blood pressure and heart rate are monitored as you lie flat on the table. The table is then tilted in a head-up position at different levels. The doctor then examines how your blood pressure, heart rhythm, and the nervous system respond to these angle changes. 

How to Prepare for the Doctor Consultation?

While preparing for your doctor’s consultation, make sure to:

1. Take a prior appointment
2. Write down the symptoms you are experiencing
3. Make a list of all the medications, herbs, and supplements you take
4. Enlist your key medical information
5. Write down the questions for the doctor

Here’s what you can expect from your doctor:

1. When did you first experience these symptoms?
2. How severe are your symptoms?
3. Are the symptoms occasional or continuous?
4. Does anything improve or worsen the symptoms?
5. Do you have a family history of arrhythmia?
6. Do you have other health conditions?

Here’s what you can ask the doctor about your condition:

1. What is the cause of my symptoms?
2. Are there other possible causes of this condition?
3. What diagnostic tests do I need?
4. What treatment approach do you recommend?
5. What is the appropriate level of physical activity?
6. How often should I be screened for heart disease and other complications of an arrhythmia?
7. How do I manage my other health conditions with arrhythmia?

In some cases, no treatment for arrhythmia may be necessary. When treatment is required, it depends on the type and severity of arrhythmia. Treatment options include:

Medications

Several medications are available to treat an irregular heartbeat. The doctor will prescribe medications depending on the type of your arrhythmia and its potential complications. The drugs for treating arrhythmia include:

1. Antiarrhythmic drugs: Medications such as amiodarone and flecainide can treat tachycardia and premature heartbeats. 
2. Anticoagulants: Medications such as warfarin and aspirin can help prevent blood clots or strokes.  
3. Beta-blockers: Beta-blockers such as acebutolol and metoprolol can slow your heart rate and treat tachycardia. 
4. Calcium channel blockers: Medications such as diltiazem and amlodipine can help lower your blood pressure and heart rate. 

Therapies

Therapies to treat arrhythmia include:

1. Electrical cardioversion: The therapy is recommended for people with persistent arrhythmia (such as atrial fibrillation). A shock is delivered to your heart through your chest wall during the procedure, synchronising the heart and restoring a normal rhythm. 
2. Vagal manoeuvres: This therapy is recommended when you have a very fast heartbeat resulting from supraventricular tachycardia. It affects the vagus nerves that control the heartbeat, causing your heart rate to slow. 

Surgery and Other Procedures

Other procedures and surgeries used to treat severe arrhythmia include:

1. Catheter ablation: The doctor threads one or more catheters to the heart during catheter ablation. Electrodes at the end of the catheter use cold or heat energy to create scars in the heart and block abnormal electrical signals. 
2. Pacemaker: If unknown reasons cause bradycardias, the doctor may recommend treating them with a pacemaker. A pacemaker is a permanent implantable device that sends small electrical impulses to the heart muscle, maintaining a normal heart rate. 
3. Implantable cardioverter-defibrillator (ICD): The doctor may recommend implanting an ICD if you are at a high risk of developing an irregular heartbeat that is too fast or slow in the lower heart chambers. It is a battery-powered unit similar to a pacemaker, implanted under the skin near the collarbone. The device continuously monitors your heart rhythm. 
4. Maze procedure: The surgeon makes several incisions in the atria to create a pattern or maze of scar tissue. The process is usually reserved for people who don’t get better with other procedures. 
5. Coronary bypass surgery: If you have severe coronary artery disease coupled with arrhythmia, your doctor may recommend coronary bypass surgery. The surgery can improve the blood flow to the heart. 

Yoga or Meditation

1. Managing your stress is an essential part of keeping your heart healthy. Stress-relief activities like yoga, meditation, or relaxation techniques can help prevent and reduce arrhythmias. 

Please note: The selection of the treatment approach for arrhythmia depends on your condition and your doctor’s opinion.

Without treatment, arrhythmia can cause problems such as:

1. Heart failure
2. Cardiac arrest
3. Stroke
4. Sudden death
5. Alzheimer’s disease or dementia (these cognitive disorders occur because the brain doesn’t get enough blood over time)

When to See a Doctor?

If the heart beats too slow, too fast, or skips a beat, you should call your healthcare professional. Other symptoms that require medical attention include:

1. Dizziness
2. Shortness of breath
3. Lightheadedness
4. Weakness
5. Chest pain
6. Discomfort
7. Fainting or near fainting