Heart Rhythm Disorders

Abnormal heart rhythms are triggered by complications in the electrical system that controls the heartbeat. Disorders can be in to form of excessively slow or fast heart rate; it may also result in unusual fluctuation of blood pressure. Timely diagnosis and regular medication can prevent and cure heart rhythm disorders.

Host: 
Dr. Devi Shetty
Panellists: 
Dr. Kapil Kumawat, Dr. Shreesha Maiya

Understanding Heart Rhythm Disorders

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How does the electrical system of the heart work?

Our heart has four chambers. Our heart beats to generate its own electrical impulses. The impulses travel from the SA node (pacemaker of the heart) to the AV node that further supplies to the right and the left ventricle. That is how the electrical impulses of the heart are transmitted, allowing it to pump normally.

My heart beat and blood pressure fluctuates unusually. Please advise me on my condition.

Heart rate varies with age. Slowing down of the heart rate could happen while doing certain activities, like exercising. However, if your heart rate tends to go low or high in a usual position – sitting or walking – the condition is known as Arrhythmia.

People with arrhythmia often experience unusual fluctuation in their blood pressure. It can either get very low or very high.

What is a Heart Rhythm Disorder?

Any deviation from the normal heart rhythm is a heart rhythm disorder. Our heart generates its own electricity. At times, the electrical impulses generated are not in the regular fashion. The supposed wires transmitting these impulses could be shifted to the right or the left side. This could lead to the heart beating faster or slower than the usual.

At times, a part of the heart can beat faster than the pacemaker itself, i.e., the Sinoatrial or the SA node, leading to a faster heart rate. This condition is referred to as Tachycardia.

In some conditions the pacemaker may not function properly, which leads to a slower heart rate. This is referred to as Bradycardia.

How do you traditionally diagnose a fast heart rate?

The most traditional way to check your heart rate is to check your pulse. Nowadays, we also have the advanced techniques like ECG or Electrocardiogram, and the Echocardiogram to measure the heart rate of an individual.

In patients who experience these symptoms very infrequently, there are long term monitors known as the external loop recorders. The patient just needs to place it on his/her chest whenever he feels the heart beat getting unusual. The monitor automatically gives the reading, which can then be analyzed by the doctor.

A more advanced method to check one’s heart rate is the Electrophysiology Study. It is a minimal invasive procedure, wherein the electrically sensitive catheters are placed in one’s heart to study its electrical conduction.

My wife has been diagnosed with Drop Beat. What is it exactly?

A transient pause in the heart rhythm is called Drop Beat. There is nothing to worry about Drop Beat in most cases. However, in a few cases, if the other heart tests show any kind of abnormality, these drop beats can be an indicator of a serious problem and should be investigated further by a specialist.

Can heart rate become slow? What could be done for patients experiencing it?

Slow heart rate, also known as Bradycardia, is one of the aspects of the heart rhythm disorders. In many cases it is age-related, where nothing is done to correct it. However, in young adults if the heart rate goes below 60, we need to investigate the cause of it. No medication can help to improve the condition, but a pacemaker can be placed as the only solution to this problem. In patients with poor heart function or with a history of a heart attack, medication is given to better the condition.

How to evaluate patients with LBBB (Left Bundle Branch Block) or RBBB (Right Bundle Branch Block)?

There are special wires that carry the electrical impulses in the heart. The wires that go through the left ventricle are known as the left bundle, while those that go through the right one form the right bundle. If the conduction in either of these bundles is slow or is not there, it is termed as the Right Bundle Block or the Left Bundle Block respectively.

An LBBB or RBBB can be easily diagnosed through an ECG. In most cases the condition doesn’t lead to any disorder, but at times, it could be associated with serious disorders. In cases where the patients have poor heart function or low ejection fraction, and are diagnosed with LBBB or RBBB, heart function could be improved by placing a device, which is similar to the pacemaker. This is known as the Cardiac Resynchronization Therapy.

My ejection fraction is only 25%. Is ICD the only option?

Patients with an ejection fraction less than 35% tend to have sudden death. This happens in the unexpected surge of ventricular Tachycardia or Fibrillation.

The only effective treatment for such a condition is to give an electric shock to the heart. However, it is not practically possible to have a situation where a person is there to monitor the ejection fraction of a patient, and provide him or her electric shock at the time of need. Hence, to serve the similar purpose, ICD is placed under the patient’s skin. ICD or Implantable Cardiovascular Defibrillator is a device that benefits the patients with low ejection fraction, reducing the possibility of dying suddenly.

My heart beat is irregular at times. Doctors have diagnosed it as PSVT or Atrial Fibrillation. Could you suggest me the appropriate treatment for this condition?

Atrial Fibrillation is the abnormal, chaotic electrical current in the top left chamber or the left atrium of the heart. This leads to abnormal heart rhythm. In a situation where the upper chamber of the heart is beating too fast, the lower chamber would not receive the blood properly. This might cause symptoms like giddiness and breathlessness.

Atrial Fibrillation increases with age; thus age is one of the risk factors for this condition. Other risk factors include a history of hypertension, coronary artery diseases, diabetes, etc.

The irregular chaotic activity in the heart often leads to clot formation, which could go into the brain and cause stroke.

Medication is the primary way to treat AF. In case of relapse, Electrophysiology study and Radiofrequency Ablation is undertaken. These are minimal invasive procedures, wherein the electrically sensitive catheters are placed in one’s heart to study the electrical conduction of the heart. Once the study is conducted, radiofrequency energy, (something similar to the microwave heat), is used to destroy the part that is causing abnormal heart rhythm, in order to permanently cure and restore the normal rhythm of the heart.

25% of the strokes are caused due to the abnormality of the heart. Medication can help prevent patients of AF from having a stroke.

What are Syncopal Attacks and why do they occur?

Syncope is a situation where one undergoes a transient loss of consciousness. Syncopal attacks usually occur when our heart becomes slow at its functioning. It is a very common problem and is often ignored, being considered as falling unconscious. However, it is important to take the episode of fainting seriously. An ECG will help to find out if the fainting has been caused due to the abnormal activity of the heart. In case of Bradycardia or slow heart rate, a permanent pacemaker is required. On the other hand, if the heart rate is too high, a radiofrequency ablation and placement of an ICD are the two ways to prevent an individual from sudden death.

Why do patients who have undergone CABG or PPI, and children who have undergone a heart surgery suffer from abnormal heart rhythm later in life?

Children who have had a heart surgery tend to have an abnormal heart and an abnormal musculature. It is also important to note that the part of the heart where the surgeon had made an incision can have a scar, and will never be normal again. Similarly, a previous infection or a heart attack leaves the heart with certain areas with abnormal electrical currents. This can cause an abnormal heart rhythm.

Around 20-30% of patients post operatively could have abnormal heart rhythms. Thus, it is very important for the patients who have undergone any kind of heart surgery to get regular checkups done. This can help in timely diagnosis and prevent any major problem of the heart.