What is Arrhythmia – Irregular heartbeat -Causes-Symptoms-Types

A Heart Arrhythmia – Irregular heartbeat

Arrhythmia, commonly referred to as irregular heartbeat, is an abnormal rhythm of the heart. The pattern and the timing of the heartbeat will be aberrant.

The heart rate is likely to elevate while exercising and performing physical activity. The rate slows down during rest and sleep. The heart also tends to skip a beat once in a while, which is normal. 

However, a persistent irregular rhythm might indicate that the heart is not supplying the body with enough blood. Dizziness, faintness and other symptoms could manifest.

Types of Arrhythmias

Bradycardia

Bradycardia is a resting heart rate of less than 60 beats per minute. People who are young or physically fit may experience lower heart rates in some cases.

Tachycardia

Tachycardia is a resting heart rate of more than 100 beats per minute. The heartbeats may be erratic at times.

Supraventricular arrhythmias

Supraventricular arrhythmia commences in the upper chambers of the heart or atria.

Paroxysmal supraventricular tachycardia (PSVT) 

The malfunction in the electrical signals that start in the upper chambers and move to the lower chambers of the heart gives rise to paroxysmal supraventricular tachycardia (PSVT). This results in extra heartbeats, causing tachycardia. 

PSVT starts and stops abruptly. It may occur while engaging in strenuous physical activity. It frequently affects young people and is typically not dangerous.

Accessory pathway tachycardia (bypass tract tachycardia) 

A rapid heartbeat is brought on by an abnormal electrical connection or pathway between the atria and ventricles. 

Impulses pass through both usual and additional pathways, enabling the impulses to move through the heart quickly and making it beat erratically.

AV nodal re-entrant tachycardia (AVNRT) 

A rapid heartbeat is brought on by multiple pathways passing through the atrioventricular (AV) node.

Atrial tachycardia 

Atrial tachycardia is a fast and rapid heart rate that witnesses more than 100 beats per minute.

Atrial fibrillation 

Atrial fibrillation is the most frequent form of arrhythmia. The heart beats more than 400 times per minute for a person with this condition. 

Additionally, coordination is lacking between the upper and lower chambers of the heart. The lower chambers do not fill completely or do not pump enough blood to the body and lungs when this occurs.

Atrial flutter 

The upper chambers of the heart beat 250–350 times per minute due to atrial flutter. 

Scar or damage to the tissue may block the signal that alerts the atria to beat. The upper and lower chambers may begin to beat at various rates due to this.

Ventricular arrhythmias

Ventricular arrhythmia initiates in the ventricles, also known as the lower chambers of the heart. This type of arrhythmia is risky and calls for medical attention immediately.

Ventricular tachycardia

Ventricular tachycardia is a rapid, regular heartbeat that can last anywhere from a few seconds to several minutes. Many times, ventricular tachycardia that lasts only a few beats is not harmful.

Severe arrhythmias like ventricular fibrillation can result if it persists for longer than a few seconds.

Ventricular fibrillation

Electrical signals that cause the ventricles to palpitate rather than pump normally result in ventricular fibrillation.

When the ventricles are not pumping blood to the body, a fatal cardiac arrest can occur within a few minutes.

Symptoms of Arrhythmia

Palpitations 

Palpitation is a type of arrhythmia—a skipped or irregular heartbeat. It happens when an electrical signal is sent at the wrong moment from the incorrect location, throwing off the heart’s rhythm.

Pounding in the chest 

Heart palpitation gives a pounding or racing sensation in the chest.

Dizziness or feeling lightheaded 

Lightheadedness or dizziness is most likely to happen when the heart is beating too quickly or slowly during arrhythmia. 

This occurs as a result of the heart’s inability to pump blood efficiently when it beats too quickly or too slowly.

Fainting 

Arrhythmia may lower the blood flow to the brain and the body. The decreased oxygen levels cause fainting.

Shortness of breath 

The inability of the heart to pump efficiently causes a decrease in the oxygen supply essential for vital activities. The person may gasp for air to compensate for the lack of oxygen, resulting in shortness of breath.

Chest pain or tightness 

When the heart rhythm is unusual, a person may experience chest pain. The heart might feel like it is fluttering, skipping or adding a beat. It might appear to be beating too slowly (bradycardia) or too quickly (tachycardia).

Weakness or fatigue 

Persistent arrhythmia gives rise to fatigue or weakness. Untreated bradycardia can result in extreme tiredness.

Anxiety 

An increase in heart rate is noticeable during stressful situations or when a person has an anxiety disorder.

Blurry vision 

The parts of the body that require blood, particularly the brain, don’t receive it when the heart isn’t pumping properly. Insufficient blood during atrial flutter brings about lightheadedness, blurry vision and fainting.

Sweating 

In addition to chest pain and palpitations, people with ventricular arrhythmias may also have trouble breathing and excessive sweating.

Causes of Arrhythmia 

Alcohol abuse 

Alcohol abuse over a long period of time thins and weakens the heart muscle, which affects the heart’s capacity to pump blood. This causes irregular heartbeat. The risk of atrial fibrillation is also high for alcoholics.

Diabetes 

Low blood sugar levels can cause heart rhythm problems or even fatal heart attacks. In older patients with Type 2 diabetes and related heart issues, abnormally low blood sugar levels at night frequently go undetected, resulting in protracted periods of heart rhythm disturbances.

Substance use disorder 

Alcohol, tobacco, certain foods, over-the-counter, prescription medications and illicit drugs have the potential to alter the electrical signals that cause the heartbeat. 

According to an analysis, adults who use cocaine, opiates, methamphetamines or cannabis (marijuana) may be 35 per cent to 86 per cent more likely to experience atrial fibrillation or an irregular heartbeat.

Drinking too much coffee 

Caffeine affects both the heart and the central nervous system in different ways. Generally, an increase in heart rate is experienced by the majority of people, though to varying degrees.

 Heart disease, such as congestive heart failure 

Arrhythmia can develop when the heart weakens. Atrial fibrillation is a dangerous arrhythmia that can result from coronary artery disease. It causes a quick, trembling heartbeat that increases the risk of blood clots, heart attacks and strokes.

High blood pressure 

Elevated and uncontrolled blood pressure with improper lifestyle or not treated with medication can give rise to atrial fibrillation.

Hyperthyroidism, or an overactive thyroid gland 

The body’s metabolism may speed up due to hyperthyroidism, resulting in unintentional weight loss and a swift or irregular heartbeat. 

Tachycardia, or a resting heart rate greater than 90 to 100 beats per minute, can occur in people with hyperthyroidism. This rise in heart rate can be made worse by exercise.

Stress 

A sudden and unexpected surge of adrenaline that the body produces when it is under stress most likely triggers an arrhythmia.

Scarring of the heart, often due to a heart attack. 

Heart attacks currently occurring or scarring from previous heart attacks are two examples of things that can cause an irregular heartbeat.

Smoking 

Cardiovascular fibrosis, or the scarring of the heart muscle, is brought on by smoking. This may result in tachycardia, a fast or irregular heartbeat. 

Nicotine in cigarettes and elevated blood pressure also speed up heart rate, which can cause tachycardia.

Certain dietary and herbal supplements

Dietary and herbal supplements have components that are known to trigger palpitations and irregular heartbeat. 

Some medications 

Antibiotics, dobutamine, adenosine and certain cardiovascular medications are over-the-counter or prescription drugs that are known to cause arrhythmias.

These medications are also likely to trigger Atrial Fibrillation (AF). In addition, it has been reported that drugs like ondansetron, corticosteroids and anticancer drugs like mitoxantrone, paclitaxel and anthracyclines can cause AF.

Structural changes in the heart 

Recent heart attacks or scarring from previous heart attacks are both likely to cause an irregular heartbeat (arrhythmia). 

Heart artery blockages (coronary artery disease), heart structure changes due to cardiomyopathy may cause arrhythmia.

The heart weakens with worsening cardiomyopathy. Blood pumping capacity reduces, and there is a compromise in the heart’s ability to keep a regular electrical rhythm, resulting in arrhythmias or abnormal heartbeat.

Diagnosis  

Electrocardiogram (ECG or EKG) 

An electrocardiogram (ECG), which records the heart’s electrical activity, is the most accurate way to identify an arrhythmia. Further monitoring of the heart becomes necessary if the ECG shows no signs of a problem which will require wearing a small, portable ECG recording device for at least 24 hours.

Event recorder 

The purpose of this wearable ECG device is to diagnose sporadic irregular heartbeats. Event monitors don’t keep track of everything constantly. Instead, it keeps track of when the person using the device turns it on.

Some event monitors will begin recording right away if there is an abnormal heart rhythm. It is advisable to wear event recorders for a month or more.

Ambulatory monitors 

A Holter monitor is a kind of heart monitor that documents the activity of the heart over the course of 24 or 48 hours. 

A cardiac monitor can help identify the issue if one experiences an irregular heartbeat or heart palpitations that goes unnoticed in an ECG. The test involves performing daily activities while wearing the Holter monitor.

Stress test 

Sensors or electrodes taped to the chest during an exercise stress test record the heartbeat. While using a treadmill or stationary bike to exercise, a healthcare professional keeps an eye on the patient’s heart rate. A stress test is usually done completely within an hour.

Echocardiogram 

Echocardiogram is a specific kind of ultrasound that gives a view of the heart and reveals any heart muscle or valve disease which could be the source of an arrhythmia. This test can be performed either while moving or lying still.

Cardiac catheterisation 

Cardiac catheterisation is a procedure that diagnoses or treats heart conditions, including blocked arteries or irregular heartbeats, by guiding a thin, flexible tube (catheter) through a blood vessel to the heart.

Electrophysiology study (EPS) 

An EP study can assist in identifying the primary cause of abnormal heart rhythms in a person. It is occasionally carried out to estimate the risk of sudden cardiac death. 

Cardiologists with special training in heart rhythm disorders (electrophysiologists) perform the EP study in a hospital setting.

Tilt table test 

The tilt table test determines if abnormal blood pressure or heart rate control brings about fainting. A very slow heart rate or bradycardia can induce fainting in a person.

A nurse or doctor will monitor the blood pressure, and heart rate as the patient lies on a special table while elevating the head to a height of 60 to 80 degrees above the rest of the body. An IV insertion is essential to take blood or administer medication.

Implantable loop recorder 

An Implantable Loop Recorder (ILR) is a recording device of the heart when implanted under the chest skin. 

The applications of the ILR include diagnosing the causes of palpitations, fainting and rapid or slow heartbeats. The implantation requires a minor procedure, after which the recorder works as an ECG. 

As an electrocardiogram (ECG), the device continuously gathers electrical signals from the heart. This can assist in identifying abnormal heart rhythms that may be the root cause of a number of issues, including fainting.

Treatment  

Pacemaker 

Pacemakers treat arrhythmias or irregular heartbeats. The pacemaker sends electrical signals to the heart to adjust the beat if it beats too slowly (bradycardia) and only functions when necessary. 

A few more recent pacemakers also have sensors that notice changes in breathing or body motion and alert the devices when it is necessary to raise heart rate during exercise. 

Vagal manoeuvres 

Vagal manoeuvres help diagnose and treat different types of arrhythmias. These are techniques to increase vagal parasympathetic tone. 

The treatment focuses on stopping episodes of stable supraventricular tachycardia (SVT). They also distinguish SVT from ventricular tachycardias.

Heart surgery for arrhythmias 

Cardioversion

Cardioversion corrects irregular heartbeats in an outpatient procedure that exposes the chest wall to a planned and controlled electrical shock. 

The procedure involves the use of sedation or anaesthesia. An anti-arrhythmic medication course is essential post-procedure.

Implantable Cardioverter Defibrillator (ICD)

ICD necessitates surgical implantation of an electronic device to monitor heart rhythm constantly. Slowing down a fast-beating heart is the purpose of the device.

It can pace your heart to slow the rhythm down and, if necessary, shock your heart with electricity to get it back to normal. Along with a pacemaker, an ICD can also be implanted, and some ICDs come equipped with a pacemaker that can be used.

Maze procedure

The doctor might suggest a maze procedure for a person with atrial fibrillation when other treatments fail to resolve the condition. This open-heart procedure requires three hours for completion, and the recovery period could last six to eight weeks.

With the help of this technique, electrical impulses can now travel from the top to the bottom of the heart through a maze of new pathways. 

The procedure restores the regular heartbeat, eliminating atrial fibrillation and regulating pumping to the heart’s upper chambers.

Conclusion

Arrhythmia is an abnormal rhythm of the heart in which the pattern and the timing of the heartbeat are irregular. Constant irregular heart rate may signify an inadequate supply of blood to the heart and the body.

The symptoms start with weakness, shortness of breath, dizziness, and fainting and can be fatal in extreme cases. Medications, artificial pacemakers and surgeries work best to restore normal heart rhythm.

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