Arrhythmia

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Arrhythmia refers to an abnormal heartbeat pattern. Your heart may beat too fast, too slow or irregularly.

Arrhythmias can feel like a fluttering or racing heart, and they are often not a cause for worry. Usually treatment is required only if the arrhythmia causes symptoms or puts you at risk for more serious problems such as heart disease, stroke or sudden cardiac death.

The good news is that arrhythmia treatment can often control or eliminate irregular heartbeats. In addition, because arrhythmias can be caused or aggravated by a weak or damaged heart, you may be able to reduce your arrhythmia risk by adopting a heart-healthy lifestyle.

This section provides a guide on what arrhythmias are and what causes them. If you are concerned that you might be suffering from arrhythmias, you can find information about common arrhythmia symptoms and how arrhythmias are diagnosed.

If you have been diagnosed with having arrhythmia, there is a section dedicated to the treatment options available for this condition.

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Arrhythmias may cause a range of symptoms. These can include:

  • A fluttering in your chest
  • A racing heartbeat (tachycardia)
  • A slow heartbeat (bradycardia)
  • Chest pain or discomfort
  • Shortness of breath
  • Lightheadedness or dizziness
  • Fainting (syncope) or near fainting
  • In extreme cases, collapse or sudden cardiac arrest

Many of these symptoms can be confused with the effects of aging or with other diseases affecting the heart. However, seek urgent medical care if you suddenly or frequently experience any of these signs and symptoms at a time when you wouldn't expect to feel them.

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According to Harvard Health , a regular adult heart beats at a rate of 60 to 100 times per minute. An arrhythmia is a disorder that affects the heart rate, causing your heart to beat too fast, too slow or irregularly. Arrhythmias can affect the amount of blood pumped by the heart.

The beating of the heart is controlled by electrical impulses that normally travel on a smooth path through the heart, causing the various chambers of the heart to contract in a specific order, pushing blood through the lungs and body. These electrical impulses are controlled by the heart's sinus node, which acts as the heart's natural pacemaker.

Although many arrhythmias are harmless, they can cause troublesome symptoms such as dizziness or chest discomfort. Other, more dangerous arrhythmias can impact blood supply and if left untreated, may eventually lead to stroke, heart attack, heart failure, or sudden death.

Causes of Arrhythmias

The American Heart Association lists a variety of conditions and triggers, ranging from heart disease to specific substances, which can cause arrhythmias. These include:

  • Coronary heart disease
  • Past heart attack
  • High blood pressure
  • Valve disease
  • Some forms of congenital heart disease or cardiomyopathy
  • Genetic disorders, such as Long QT Syndrome
  • Diabetes
  • Endocrine disorders, such as problems with the thyroid gland
  • Certain prescription medications or dietary supplements
  • Excess alcohol and use of illegal drugs
  • Excess caffeine
  • Smoking
  • Stress
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To diagnose an arrhythmia, your doctor may review your family history of heart disease and your personal medical history to look for possible risk factors for arrhythmia, such as heart conditions, thyroid problems or certain medications. Your doctor may also perform any of the following tests, specific to arrhythmias:

  • Electrocardiogram (ECG): This test can often confirm the diagnosis of an arrhythmia. During an ECG, sensors are attached to your chest to detect the electrical activity of your heart. An ECG measures the timing and duration of each electrical phase in your heartbeat, and can identify problems with heart rhythm.
  • Holter monitor: A holter monitor is a portable electrocardiogram machine used to continuously monitor your heartbeat, typically over a period of 24 hours. You will be taught to press a button to record your heart’s activity whenever you experience symptoms. This approach is especially useful if your symptoms are infrequent.
  • Event monitor: An event monitor is similar to a holter monitor, but is used for weeks or months to record sporadic arrhythmias. This portable electrocardiogram device is kept at home, and only attached to your body and turned on when you have symptoms. This lets your doctor check your heart rhythm at the time of your symptoms.
  • Stress test: Some arrhythmias are triggered or worsened by exercise. In these cases, stress tests are used to determine whether arrhythmias occur when the heart is challenged to work harder than normal. During a stress test, you'll be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored. Your doctor may also use a drug to stimulate your heart if you have difficulty exercising.
  • Electrophysiological studies: During an electrophysiological test, electrodes are threaded through your blood vessels to a variety of spots within your heart. Once in place, they can map the spread of electrical impulses through your heart, allowing your doctor to see the location of the arrhythmia and what may be causing it. In addition, the electrodes can be used to stimulate your heart to beat at rates that may trigger or halt an arrhythmia. 
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If you have an arrhythmia, treatment may or may not be necessary. Usually it's required only if the arrhythmia is clinically significant – that is, it causes symptoms or puts you at risk for more serious arrhythmias or complications of arrhythmias in the future. A variety of approaches can be taken in treating and managing arrhythmias including:

  • Drug therapies: Many drugs are available for reducing the occurrence of arrhythmias or managing symptoms. These include:
    • Beta blockers and calcium channel blockers to slow the heartbeat
    • Anti-arrhythmic drugs to reduce episodes of fast heartbeats (tachycardia) and to slow down the heart when an episode occurs
    • Blood thinners, such as warfarin, to help prevent blood clots from forming
  • Implantable devices: Treatment for arrhythmias may also include the use of an implantable device to help the heart work properly.
    • Pacemaker: A pacemaker is a small device implanted near the heart, which helps to regulate slow heartbeats (bradycardia). The pacemaker monitors the electrical activity of the heart and delivers a small electrical pulse when the heart beats too slowly. This stimulates your heart to speed up or begin beating again.
    • Implantable cardioverter-defibrillator (ICD): An ICD is a battery-powered unit that's implanted near the left collarbone. It is similar to a pacemaker but can deliver an electrical shock to restore normal heart rhythms when needed. An ICD may be recommended if you're at high risk of developing a dangerously fast or irregular heartbeat in the lower half of your heart (ventricular tachycardia or ventricle fibrillation).
  • Ablation therapy: In this procedure, one or more catheters are threaded through your blood vessels to your inner heart. They're positioned on areas of your heart that your doctor believes are the sources of your arrhythmia. Electrodes at the catheter tips are heated with radiofrequency energy. Another method involves cooling the tips of the catheters, which freezes the problem tissue. Either method destroys a small spot of heart tissue and blocks the abnormal electrical signaling pathways in your heart.
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Not all arrhythmias can be prevented. Arrhythmias that are caused by coronary heart disease may be prevented by lifestyle changes that lessen coronary heart disease risk factors. Broadly, these are:

  • Controlling cholesterol and high blood pressure
  • Not smoking
  • Eating a heart healthy diet
  • Exercising regularly
  • Maintaining a healthy weight

For more details on preventing arrhythmias associated with coronary heart disease, see Coronary Heart Disease Prevention.

Certain substances and drugs are also known to contribute to arrhythmias. Avoiding the consumption of these substances or reducing the dosage of problem medication can help reduce arrhythmias. The American Heart Association provides a detailed list of these substances:

  • Caffeine
  • Alcohol
  • Tobacco
  • Cold and cough medications
  • Appetite suppressants
  • Psychotropic drugs, which are used to treat certain mental illnesses
  • Antiarrhythmic
  • Beta-blockers for high blood pressure
  • Illegal drugs such as cocaine, marijuana or methamphetamines

If you're being treated for arrhythmia and use any of these substances, be sure to discuss this with your doctor.

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