Arrhythmia

An arrhythmia is an irregular heartbeat or heart rate. Normal heart rates are around 50-100 beats per minute. Some people have problems with both heartbeats and heart rates, while others have just one or the other. More than 850,000 Americans are hospitalized with arrhythmia each year.

Types of Arrhythmias

Accessory Pathway Tachycardia: Fast heart rhythm; caused by an extra pathway between the upper and lower heart chambers
Atrial Fibrillation: Common; caused by the upper heart chambers contracting abnormally
Atrial Flutter: Linked to heart disease; can happen in the first week after heart surgery; commonly progresses to atrial fibrillation
AV Nodal Reentrant Tachycardia: Fast heartbeat; can cause fainting, palpitations and heart failure; treated with medication
Bradyarrhythmia: Slow heart rhythm; caused by a problem with the electrical impulses that control the heart’s pumping action.
Heart Block: Irregular, slow heartbeat; caused by an obstruction or delay of electrical impulses; treated with a pacemaker
Long QT Syndrome: Dangerous arrhythmias linked to sudden death; treated with defibrillators and drugs
Sinus Node Dysfunction: Slow heart rhythm; may be treated with a pacemaker
Paroxysmal Supraventricular Tachycardia (PSVT): Fast heart rate; starts in the part of the heart above the ventricles
Premature Atrial Contractions: Extra heartbeats; usually no treatment is necessary
Premature Ventricular Contractions (PVCs): Skipped heartbeats; one of the most common types of arrhythmias; caused by stress, excessive exercise, caffeine, nicotine or heart disease
Ventricular Fibrillation: Heart chambers quiver instead of contracting, causing blood to not be pumped to the body; emergency situation that requires CPR and defibrillation
Ventricular Tachycardia (V-tach): Fast heart rhythm which prevents the heart from filling with blood; dangerous condition

In addition to the those listed above, the following can also cause arrhythmias:

Electrolyte imbalance (usually sodium or potassium)
Healing after cardiac surgery
Injury from a heart attack
Heart disease or cardiac muscle change

Arrhythmias can also happen when the heart is healthy and there are no risk factors.

Palpitations
Chest pain, tightness or pounding
Dizziness, faintness
Shortness of breath
Extreme fatigue or weakness

Doctors and Specialists

Patients with arrhythmia may see a variety of doctors and specialists, each focused on a different aspect of care. The following providers may make up the care team for treating this condition:

Cardiologist: Doctor specializing in treatment and care of the heart and its associated conditions like heart attacks, abnormal rhythms, and congenital heart defects.
Interventional Cardiologist: Doctor who performs angiograms, catheter and stent insertions. Patients are referred to this doctor if a blood vessel leading to the heart or heart damage is suspected.
Cardiovascular/Cardiothoracic Surgeon: Doctor who operates on the heart, lungs and blood vessels.
Vascular and Interventional Radiologist: Doctor who uses radiologic imaging systems (ultrasound, MRI, CT scans, x-rays, fluoroscopy) to study and treat conditions of the vascular system. Once a diagnosis is made, this doctor participates in stent placement and shunts.
Electrophysiologist: Doctor specializing in the diagnosis and treatment of abnormal heart rhythms. This doctor will evaluate the heartbeat with diagnostic tests and make recommendations for further treatment.
Physical Therapist: Health professional who deals with rehabilitation after heart attacks and surgery. This professional creates and executes exercise programs that help patients improve endurance, coordination, muscle strength and motor skills.
Nutritionist: Health professional who creates diet plans to help address a medical problem and achieve maximal health.
Endocrinologist: Doctor who specializes in the glands and hormones within the body. If arrhythmias occur, glandular problems that may be responsible for abnormal rates or rhythms, like thyroid conditions, are diagnosed and treated.

Preparing for Your Appointment

After you make an appointment for arrhythmia treatment, there are some steps you can take to make your visit a smooth one:

Bring a list of all medications you’re currently taking, including vitamins and herbal supplements. Include dosage for each.
Bring a list of all symptoms you’re experiencing, with a time line and any activities that make them better or worse.
Make a list of any allergies you have.
Bring your past medical history including any surgeries or medical conditions. Include dates where applicable.
If you will be having a procedure, make arrangements for a ride home.
If you wear a pacemaker, notify the doctor before you have any exams done and ask if there are any specific instructions.

Echocardiograms: You can eat, drink and take all medications as usual. A hospital gown will be worn for the exam, so you should wear loose, comfortable clothing from the waist up.

Stress Echocardiogram: Don’t eat or drink anything for four hours before the exam. Don’t have any caffeine or non-prescription drugs for a full day before the exam, or the following prescription medications:

Beta blockers
Nitroglycerin
Isosorbide dinitrate
Isosorbide mononitrate

Head-up Tilt Table Test: Don’t eat or drink anything after midnight the night before the exam. Medications can be taken with sips of water. Arrange for a ride home after the exam.

Follow any additional instructions from your doctor before having any tests.

Questions to Ask

After you receive an arrhythmia diagnosis, you’ll probably have a lot of questions. Review this list of common concerns about the condition before your next doctor appointment, or print it out to bring with you.

What is causing my abnormal heart rate or rhythm?
How will the diagnosis be confirmed? What tests will be done?
Are there other medical conditions that can cause this?
How dangerous is this?
Can this lead to a heart attack or stroke?
Can this be fatal?

Can this be cured?
What can I do to prevent it from happening or coming back?
Will I need surgery?
How frequently will I need follow-up exams?
Will I need to take medication forever or for a limited time? What are the side effects of the treatment?
What if I choose not to be on the medication?
Is there a natural supplement or holistic approach for this?

Does this run in families?
What exercises can I do? What activities must I avoid?
Will I need to stay on bed rest? If so, for how long?
Will I be able to work? If not, when can I return?
Can I engage in sexual activities?
Can I still drink alcoholic beverages?

Tests and Diagnosis

The first steps for diagnosing arrhythmia are reviewing your medical history and having a complete physical examination. Your doctor may be able to detect abnormal rates and rhythms using a stethoscope. Further tests are often done to determine the cause or severity of arrhythmia.

Electrocardiograms (EKGs) and echocardiograms (echo) are the most common tests used to diagnose any type of heart disease or abnormality. EKGs are simply measurements of the heart’s electrical activity, while an echo is a detailed ultrasound of the heart that allows doctors to see how the blood flows through it. The echo also measures the size and shape of the heart, how well the valves are functioning, how the left and right side communicate, and the speed of the blood leaving it.

There are several types of echocardiograms:

Stress echocardiogram: You exercise on a treadmill while a device attached to the chest sends out high frequency sound waves. Images are generated from the echoes to show any heart damage.

Transthoracic echocardiogram:A hand-held device placed on the chest send ultrasonic sound waves. The echoes produce an image on a monitor to show cardiac disease or damage.

Transesophageal echocardiogram (TEE): A tourniquet is applied to your arm, and a needle is inserted into the vein. Three sticky patches are attached to an EKG to record cardiac activity. A blood pressure cuff is placed on your arm to record blood pressures during the exam. A small clip placed over your finger records the oxygen level in your blood during the exam. An ultrasound probe is placed into the esophagus to create clear images of the heart. You will remain under observation for 30 minutes after the exam.

Dobutamine stress echocardiogram: An IV line is inserted into an arm vein after a tourniquet is applied. Stress is produced through drugs inserted through the IV, rather than exercise, to measure heart function with stress. The test takes about an hour and when done, you will be asked to remain in the waiting room until you are symptom-free.

Intravascular ultrasound: An ultrasound wand is attached to the top of a thin tube called a catheter. This ultrasound catheter is inserted into an artery in your groin area and moved up to the heart. A computer measures how the sound waves reflect off blood vessels, and changes the sound waves into pictures.

Holter Monitor: Measures cardiac electrical activity continually over a 24-48 hour period
Stress Test: Measures and records the heart and lung responses during exercise. It measures shortness of breath, abnormal change in heart rhythm, rate and pattern, abnormal blood pressure and chest pain.
Cardiac Catheterization: Shows any blockages to the vessels of the heart
Head-up tilt table test: Pinpoints the cause of fainting episodes
Electrophysiology study (EPS): Monitors electrical pathways and activity of the heart; results help decide cause and treatment of arrhythmia

Medications and Treatment

How your arrhythmia is treated is determined mainly by the type and cause of it. Treatment may include medication, lifestyle chances and surgery.

Antiarrhythmic drugs: Regulate heart rate
Anticoagulants: Blood thinners that decrease blood clot formation and risk of strokes

Electrical Cardioversion: Electrical shock is given under anesthesia to sync up the heart and restore normal rhythms
Pacemaker: Insertion of a device which sends electrical impulses to the heart to steady heart rates.
Implantable Cardioverter-Defibrillator (ICD ): Device fixes fast and irregular heartbeats by sending impulses to the cardiac muscle.
Ablation: High-frequency electrical energy is delivered through a catheter to treat fast and irregular heartbeats.
Maze Procedure: Series of incisions are made into the left and right atria, directing electrical impulses to the right pathways. A pacemaker may be inserted afterward.

Taking the following positive steps will help to promote overall heart health:

Cardiac rehab: A program involving swimming, treadmill running, low-impact aerobics and pedaling on a stationary bike
Quitting smoking: If you’re unable to quit on your own, speak to your doctor about your options.
Healthy diet: No trans fats, no caffeine, and low in cholesterol and saturated fats
Limiting alcohol: One drink per day for men and none for women
Maintaining a healthy weight: Obesity can make arrhythmia worse.