Doctor's Notes on Arrhythmias (Heart Rhythm Disorders)
Arrhythmias are abnormal heartbeats. There are many types of arrhythmias, and they are sometimes classified by where they begin in the heart (the atria, AV node, or the ventricles). They may also be classified as one of four types - premature beats, supraventricular, ventricular, and bradyarrhythmias. Ventricular fibrillation and ventricular tachycardia are types of arrhythmias that can lead to death in minutes.
In many cases, arrhythmias cause minimal to no symptoms but in other cases, people can feel the arrhythmia when it happens. Symptoms of arrhythmias include palpitations, feeling "skipped beats," thumping or fluttering in the chest, a sensation of the heart racing, feeling faint or tired, lightheadedness or fainting, shortness of breath, and chest pain or discomfort. Many of these same symptoms may be due to anxiety, stress, or causes other than an abnormal heartbeat.
What Is the Treatment of Arrhythmias?
The treatment of arrhythmias depends on the cause and the type of arrhythmia. Some arrhythmias are self-limited and do not need treatment. Other arrhythmias are due to poor blood flow to the heart and require treatments for coronary artery disease to prevent them. The types and treatments of arrhythmias are listed below:
- Premature beats can be treated with medications to control the heart rate such as beta-blockers or anxiety medications like benzodiazepines.
- Supraventricular arrhythmias are usually “fast” or rapid heartbeats and can be treated with medications that slow the heart rate such as beta blockers or calcium channel blockers. A specific type of supraventricular arrhythmia called supraventricular tachycardia is treated with adenosine, an intravenous medication that helps reset the heart rhythm. Another specific type of supraventricular arrhythmia called atrial fibrillation can be treated medically with blood thinners and heart rate control medications (such as beta blockers or digitalis), electrical therapy (cardioversion), or procedural therapy with cardiac ablations.
- Ventricular arrhythmias can vary from benign premature ventricular contractions (PVC) which often do not need treatment, to severe and life-threatening ventricular tachycardia or ventricular fibrillation, which both need emergency treatment. The treatment for severe ventricular arrhythmias is electrical shocks (defibrillation or cardioversion) or in some cases antiarrhythmic drugs such as flecainide, amiodarone, or lidocaine.
- Bradyarrhythmias or “slow” arrhythmias are treated with medications such as atropine or epinephrine or require the use of a cardiac pacemaker.
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Atrial Fibrillation (AFib)Atrial fibrillation (AFib) describes a rapid, irregular heart rhythm. The irregular rhythm, or arrhythmia, results from abnormal electrical impulses in the heart. Atrial fibrillation may be treated with medications or surgery. There are many causes of atrial fibrillation, for example, pneumonia, heart disease, alcohol use, and thyroid problems. Symptoms of atrial fibrillation include chest pain and/or angina, nausea, dizziness, and heart palpitations. Atrial fibrillation is managed and treated with medication, medical procedures, and surgery.
Atrial FlutterAtrial flutter is a type of arrhythmia, that is, an irregularity in the beating of the heart. Symptoms of atrial flutter include heart palpitations, shortness of breath, anxiety, weakness, and a fluttering feeling in the chest. Causes of atrial flutter include heart disease, hypertension, heart muscle disease, heart abnormalities, substances, and diseases that affect other areas of the body. Treatment of atrial flutter includes defibrillation and medication.
Automated External Defibrillators (AED)Automated external defibrillators (AEDs) are used when a person has had a heart attack or sudden cardiac arrest. It is a machine that instructs the user through the steps to defibrillate the victim. As more and more AEDs are placed in public places, more lives are saved from sudden cardiac arrest.
Congestive Heart Failure (CHF)Congestive heart failure, or CHF, is a condition in which a person's heart is failing and it can't pump enough blood and oxygen to the body's tissues. Sometimes people with CHF don't know they have it. Early signs and symptoms symptoms are cough, shortness of breath, and having problems breathing; especially when lying down. And, if you have breathing problems like asthma, COPD, or emphysema and you think your condition is worsening. There are four stages of CHF. There's no cure for CHF, but treatments include drug therapy, diet, and lifestyle changes to relive symptoms and slow the progression of the disease. Life expectancy depends on existing medical problems, age, and overall health.
Electrocardiogram (ECG, EKG)An electrocardiogram (ECG, EKG) is a tool used to assist in diagnosing heart diseases and conditions, for example, atrial and ventricular fibrillation, heart attacks, and heart failure.
FaintingFainting or syncope, is a temporary loss of consciousness. Causes of fainting include vasovagal, situational, postural, cardiac, neurologic, and psychogenic. Treatment of fainting depends on the cause.
PalpitationsHeart palpitations are an abnormality of the normal heart beat and rhythm, and are a symptom of another disease or problem. Causes of heart palpitations include heart disease or other heart problems (mitral valve prolapse, atrial fibrillation), during pregnancy, perimenopause, menopause, postmenopause, anxiety, emotional stress, stimulants (caffeine, alcohol, drugs), and some over-the-counter and prescription medications. Other symptoms that may accompany heart palpitations include nausea, vomiting, sweating, shortness of breath, and angina (heart pain). Some types of heart palpitations can be fatal, for example, ventricular fibrillation or ventricular tachycardia.
StrokeStroke is a medical emergency. When a person has a stroke, part of the blood supply to the brain is cut off or greatly decreased. There are two main types of stroke, ischemic and hemorrhagic. Stroke symptoms include dizziness, sudden headache, weakness in an arm or leg on the same side, weakness in the muscles of the face, difficulty speaking, vision problems, and more. Treatment of stroke depends on the type and severity of the stroke suffered.
Sudden Cardiac ArrestSudden cardiac arrest (SCA) usually causes death if it is not treated within minutes. Some of the causes of sudden cardiac death include ventricular fibrillation, medication or drug abuse/overdose, heart attack, physical stress, inherited disorders, and changes in the structure of the heart. Automatic external defibrillator (AED), if available is the best immediate treatment for sudden cardiac arrest.
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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.