ARRHYTHMIA/IRREGULAR HEART BEAT

definition :

·         malfunction of the heart's electrical system (electrical impulses that coordinate heartbeats don't work properly)  improper beating of the heart

sign & symptoms:

·         feel like  racing heart (Tachycardia) or slow  heartbeat(Bradycardia)

·         fluttering in the chest , chest pain , fainting(syncope)/nearly fainting or dizziness , lightheadedness

·         feeling pauses between heartbeats

·         THERE'S POSSIBILITY THAT NO SYMPTOMS AT ALL

Risk Factors for Arrhythmia

The heart normally beats at a regular rhythm or pace to supply the heart, lungs, and other tissues of the body with a steady, predictable supply of blood and oxygen. When the heartbeat is irregular, this is called an arrhythmia, or a dysrhythmia. The many different types of arrhythmias include:

·         bradycardia (slower than normal heartbeat)

     tachycardia (faster than normal heartbeat)

·         atrial fibrillation, a condition in which there is an irregular heartbeat caused by an issue with the electrical signal in the heart, causing the atrium to contract.

·         ventrical fibrillation, a condition in which there is an irregular heartbeat caused by an issue with the electrical signal in the heart, causing the ventricle to contract

·         premature contraction, a condition in which the heart has an extra early beat that makes the normal rhythm irregular  atrial flutter.

Many people live everyday with arrhythmias. Some don’t even know it because there aren’t always symptoms or signs. While anyone can develop an arrhythmia, there are certain factors that place people at risk for developing them.

ADDITIONAL Risk Factors for Arrhythmia

People who already have a heart condition are at risk for developing an arrhythmia. This is because some heart conditions change the way the heart works, and over time this will in turn cause the heart to change its beat or pace.

Coronary Heart Disease

Scarring on the heart or the blood vessels or a buildup of plaque make it more difficult for the heart to pump blood. This can slow the rate of the heart, causing an arrhythmia.

Heart Attack or Heart Failure

People who have had heart attacks or heart failure are at increased risk for arrhythmias because this can change the heart’s electrical impulses.

Endocarditis

This is an inflammation of the heart muscle, and people with this condition often have atrial fibrillation.

Heart Valve Disease

Leaky or weak heart valves can cause changes in the way the heart beats.

Congenital Heart Disorders

Sometimes people are born with heart conditions that affect the way the heart works, and the heart is unable to produce a normal heartbeat.

In addition, if you have ever had heart surgery, you are at increased risk for developing an arrhythmia.

Risk Factors for Arrhythmia

Other conditions can also place you at an increased risk for an arrhythmia. This includes:

·         diabetes

·         chronic lung disease

·         pulmonary embolism (a clot that develops in the lungs)

·         emphysema (a disorder of the lungs cause by smoking)

·         asthma

·         sleep apnea

·         thyroid disorder

·         high blood pressure

·         chemical imbalance (lack of potassium, magnesium, calcium or other chemicals in the body necessary for maintaining a regular rhythm)

 

 

 

 

 

Risk Factors for Arrhythmia

Age, gender, and lifestyle factors can also play a role in the development of arrhythmia. People over 60 are more likely to develop an arrhythmia than younger people. This is because they are at increased risk for heart disease and often take medications that affect the heart’s rhythm. In addition, some types of arrhythmia are more common in certain genders. For example, men are more likely to develop atrial fibrillation than women.

What you eat and drink can also have an effect on your heart’s rhythm. People who consume alcohol and other stimulants, like caffeine, are more likely to develop an arrhythmia. Drugs, including some cardiac medications that treat heart conditions, can cause an arrhythmia. If you smoke, you are more likely to have an arrhythmia.

Risk Factors for Arrhythmia

Some people with arrhythmias live active, healthy lives, and in some cases, don’t even know they have an irregular heartbeat. However, sometimes if these conditions are not detected and treated, serious and life-threatening problems like cardiac arrest or a stroke can happen.

Fortunately, there are things you can do to reduce risk of developing an arrhythmia. Be sure to check your blood pressure regularly. Exercise on a regular basis to reduce weight gain, and eat a healthy diet that promotes lower cholesterol levels.  Make a commitment to start a smoking cessation program, as smoking is a major risk factor for arrhythmia.

How Are Arrhythmias Diagnosed?

Arrhythmias can be hard to diagnose, especially the types that only cause symptoms every once in a while. Doctors diagnose arrhythmias based on medical and family histories, a physical exam, and the results from tests and procedures.

Medical and Family Histories

To diagnose an arrhythmia, your doctor may ask you to describe your symptoms. He or she may ask whether you feel fluttering in your chest and whether you feel dizzy or light-headed.

Your doctor also may ask whether you have other health problems, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems. He or she may ask about your family's medical history, including whether anyone in your family:

·         Has a history of arrhythmias

·         Has ever had heart disease or high blood pressure

·         Has died suddenly

·         Has other illnesses or health problems

Your doctor will likely want to know what medicines you're taking, including over-the-counter medicines and supplements.

Your doctor may ask about your health habits, such as physical activity, smoking, or using alcohol or drugs (for example, cocaine). He or she also may want to know whether you've had emotional stress or anger.

Physical Exam

During a physical exam, your doctor may:
·         Listen to the rate and rhythm of your heartbeat

·         Listen to your heart for a heart murmur (an extra or unusual sound heard during your heartbeat)

·         Check your pulse to find out how fast your heart is beating

·         Check for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure

·         Look for signs of other diseases, such as thyroid disease, that could be causing the problem

 

 

 Diagnostic Tests and Procedures

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart's electrical activity. It's the most common test used to diagnose arrhythmias.

An EKG shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through the heart.

A standard EKG only records the heartbeat for a few seconds. It won't detect arrhythmias that don't happen during the test.

To diagnose arrhythmias that come and go, your doctor may have you wear a portable EKG monitor. The two most common types of portable EKGs are Holter and event monitors.

Blood tests. Blood tests check the level of substances in the blood, such as potassium and thyroid hormone. Abnormal levels of these substances can increase your chances of having an arrhythmia.

CHEST XRAY

Chest x ray. A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show whether your heart is enlarged.

Echocardiography. This test uses sound waves to create a moving picture of your heart.Echocardiography (echo) provides information about the size and shape of your heart and how well your heart chambers and valves are working.

ECHOCARDIOGRAM

The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

There are several types of echo, including stress echo. This test is done both before and after a stress test (see below). A stress echo usually is done to find out whether you have decreased blood flow to your heart, a sign of coronary heart disease (CHD).A transesophageal echo, or TEE, is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the passage leading from your mouth to your stomach

Stress test. Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicine to make your heart work hard and beat fast.The heart tests done during stress testing may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart.

Electrophysiology study (EPS). This test is used to assess serious arrhythmias. During an EPS, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart's electrical signals.Your doctor can use the wire to electrically stimulate your heart and trigger an arrhythmia. This allows your doctor to see whether an antiarrhythmia medicine can stop the problem.

Coronary angiography. Coronary angiography uses dye and special x rays to show the inside of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization .

A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.

Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. This helps your doctor find blockages that can cause a heart attack.

Implantable loop recorder. This device detects abnormal heart rhythms. Minor surgery is used to place this device under the skin in the chest area.

An implantable loop recorder helps doctors figure out why a person may be having palpitationsor fainting spells, especially if these symptoms don't happen very often. The device can be used for as long as 12 to 24 months.

 

 

 

 

 

 

 

 

 

 

 

Treatment of arrhythmia

Your treatment will depend on the type, cause and severity of the arrhythmia that you have.

Self-help

Sometimes, such as with ectopic beats, you may not need any treatment because your arrhythmia is unlikely to cause serious problems. To reduce palpitations (an unpleasant awareness of your heartbeat), try to steer clear of anything that triggers your arrhythmia such as alcohol or caffeine. Keeping a diary can help you monitor this. Ask your GP for advice about exercising.

Medicines

Your doctor may prescribe medicines to help control your heart rhythm. These can include medicines to slow down your heart rate, such as beta-blockers or antiarrhythmic medicines, such as amiodarone . These work in different ways to control your heartbeat.

If you have atrial fibrillation, you may be advised to take anticoagulant medicines. These are known as blood-thinning medicines, such as warfarin. They can reduce your risk of having a blood clot that could cause a stroke.

Some medicines are given to stop an arrhythmia, while others are used to prevent them occurring. The medicine you take and how long you need to take it for will depend on the type of arrhythmia you have.

Cardioversion

A cardioversion may be carried out if you have atrial fibrillation. Your doctor will apply a controlled electric shock to your chest from a machine called a defibrillator. This aims to help restore your heart to its usual rhythm. Cardioversion is usually done under general anaesthetic, so you’ll be asleep during the procedure. However, it can sometimes be done using only a sedative. The sedative helps relieve any anxiety you may have and helps you relax.

Pacemaker

Your doctor may suggest fitting a pacemaker if you have heart block or sinus node disease. A pacemaker is a small device that’s usually implanted under your skin, in the upper part of your chest. Electrical signals are sent from the pacemaker to your heart to stimulate it to beat at a specific rate. Your doctor will usually fit your pacemaker using local anaesthetic. This will block pain from your chest area. You’ll stay awake during the operation, but may have a sedative to help you relax.

Implantable cardioverter defibrillator

An implantable cardioverter defibrillator (ICD) is similar to a pacemaker. If your doctor thinks you may be at risk of ventricular arrhythmia, you may be fitted with an ICD. This can monitor your heart rhythm and will deliver a small electric shock to correct your heartbeat if it detects a problem. ICDs are usually fitted under local anaesthetic and sedation in the same way as a pacemaker.

LATEST INFORMATION OF ARRHYTHMIA:

http://www.medicalnewstoday.com/articles/252083.php

REFERENCES:

https://www.bupa.co.uk/health-information/Directory/A/arrhythmia

http://medical-dictionary.thefreedictionary.com/Arrhythmia