What is an irregular heartbaet or arrhythmia?

An Arrhythmia, or irregular heartbeat, is a heart disorder that occurs when the heart beats too quickly or slowly or follows an irregular rhythm. When the heart beats faster than its natural rhythm of 60 to 100 beats per minute, it is called tachycardia. When the heart beats too slowly compared to the average rate, it is called bradycardia.

Although an Arrhythmia doesn't generally exhibit any symptoms, symptoms like chest pains, fluttering chest, giddiness, skipping beats, shortness of breath, and excessive sweating can be considered indicators of an Arrhythmia during a diagnosis. An Irregular Heartbeat often occurs due to congenital diseases, smoking, and consumption of alcohol. The treatment options for an Irregular Heartbeat can include taking medicines or a pacemaker implant or through surgery.

Not all irregular heartbeats mean that there is a problem with the heart. Sometimes, after intense workouts, the heart tends to beat very fast and pump a lot of blood, and sometimes, when a person is in rapid eye movement (REM) sleep, it is not uncommon for the heart to beat at a relatively slow pace.

The sinus, also known as the heart's pacemaker, sends impulses to the atrium and ventricles in the heart. When these impulses are sent from the atria to the ventricles in a specified manner without any transmission loss, the heart pumps blood normally. The normal heart rate for an adult ranges from 60 to 100 beats per minute.

In a normal heartbeat, the sinus nodes send signals to the right atria, which are then transmitted in the atrium, after which the impulse passes down to the ventricles through a network of complex fibres called the 'His-Purkinje' system.

An Arrhythmia occurs when this natural progression of impulse occurs and causes the atrium and the ventricles to pump blood at the same time or causes the atrium and ventricles to pump blood rapidly or slow it down significantly or pump blood without any order in the atrium and ventricles.

Symptoms of Arrhythmia

More often than not, arrhythmia remains undetected by patients and sometimes presents itself in various forms. An Arrhythmia can either be completely harmless or fatal.

Symptoms of Arrhythmia include:

Skipped beats (also known as palpitations)
A fluttering or thumping sensation in the chest
Feeling constantly tired
Passing out constantly
Shortness of breath and chest pains
Racing heart

Causes of Arrhythmia

An arrhythmia can occur for various reasons. It can be a result of a genetic condition, a side effect of a previous condition a patient has suffered from, an individual's eating and drinking habits, and the consumption of tobacco, alcohol, and drugs, including amphetamines and cocaine, among others. An Irregular Heartbeat can also occur due to stress, herbal treatments, health supplements, structural changes to the heart, or as a side-effect of medicines.

The most common causes of Irregular Heartbeat include:

Stress and anxiety
Excessive exercise
Caffeine
Nicotine
Hormonal changes
A heart attack that is occurring now
Scarring of the heart as a result of a previous heart attack
Blocked blood vessels in the aortic region
High blood pressure and an imbalance in the body's blood sugar and salt levels
Hyper and hypothyroidism
Excessive consumption of alcohol
A hereditary condition
From over-the-counter (OTC) medications for colds, allergies, and other supplements

Most Arrhythmias are not fatal. However, there are a few conditions which, when left undiagnosed and untreated, can become life-threatening. These conditions include:

Coronary heart disease:

Previous heart surgeries due to a heart attack or narrowed walls can lead to Arrhythmias, which can subsequently be a cause of an offset of irregular heartbeats.

High blood pressure:

High blood pressure can stiffen the walls of the ventricles, which can cause an Arrhythmia in the heart. It can also increase the risk of developing coronary artery disease (narrowing of the arteries due to deposits of cholesterol-containing plaque).

Congenital conditions:

Certain conditions or deformities in the heart cause irregularities in how the heart pumps blood, leading to an irregular heartbeat.

Hormonal imbalance:

The thyroid glands are the body's hormone centres, and over- or under-secretion of these glands can cause irregular heartbeats.

Imbalance in electrolytes:

An imbalance in the body's sodium, potassium, calcium, and magnesium electrolytes can be a major cause of irregular heartbeats. These electrolytes help trigger electrical impulses through the sinusoidal artery, and an electrolyte imbalance can hamper the way the signals are sent to the atrium and ventricles in the heart, causing them to pump blood irregularly.

Types of conditions that cause irregular heartbeat:

On a broader spectrum, an arrhythmia can be classified into different types depending on the irregularity presented in the electrocardiogram. They are:

Tachycardia:

Tachycardia is a form of arrhythmia that occurs when the heart beats too fast without the patient participating in any excessive physical activities at that moment. For an average adult, anything above 100 beats per minute can be considered tachycardia.

Symptoms of Tachycardia include:

Breathlessness
Syncope (a sensation of fainting)
Chest pain
Lightheadedness
Dizziness and sudden weakness

Bradycardia:

Bradycardia occurs when the heart beats too slowly. In this case, the ECG identifies a rate of heartbeat less than 60 beats per minute.

Symptoms of bradycardia include:

Trouble concentrating
Angina
Confusion
Feeling of constant exhaustion
Excessive sweating or diaphoresis
Lightheadedness and syncope

Atrial Fibrillation:

Atrial fibrillation occurs when the sinus node sends irregular impulses to the atrium, and the upper valves pump blood irregularly or without any orientation to each other or the ventricles. It causes the atrium to flutter and twitch and the heart to beat irregularly and, more often than not, too fast, thus causing arrhythmia.

Atrial Flutter:

Atrial flutter occurs when the electrical imbalance causes the atrium to beat too fast, between 250 and 400 beats per second. This Irregular Heartbeat causes the heart to pump too quickly, and when the heart pumps too quickly, vital organs like the brain and the heart muscles might not get enough blood, thus resulting in heart failure or stroke.

Symptoms of atrial flutter include:

Syncopy
Lightheadedness
Shortness of breath
Anxiety
Severe chest pain

Ventricular Fibrillation:

Ventricular fibrillation occurs when the ventricles quiver but do not pump any blood. In this condition, just like in atrial fibrillation, an Irregular Heartbeat is presented, but the effects of ventricular fibrillation can be fatal. In this condition, the heart stops pumping blood and the heart, and the brain does not have access to oxygen-rich blood, thereby causing a stroke or heart failure. Unlike in atrial fibrillation, the ventricles will only quiver and pump no blood, thereby cutting the supply of oxygen-rich blood to the body and rendering the patient unconscious almost immediately.

Symptoms of ventricular fibrillation include:

Tachycardia
Nausea and dizziness
Syncope (feeling of fainting)
Shortness of breath

Long QT syndrome (LQTS):

Long QT syndrome is when the heart beats erratically for prolonged durations and causes the patient to experience seizures, unconsciousness or even death. LQTS is a genetic disorder and is generally passed on. A person is at risk of being affected by this disease right from birth. However, most people experience their first episode with LQTS after entering their 40s.

Symptoms to detect the presence of LQTS are:

Giddiness
Syncope
Seizures
Sudden death

Complications that may arise

Arrhythmias are common in most people who have undergone heart surgery or a coronary stent procedure or are genetically carrying a structural defect in the heart. Most of the time, these Arrhythmias can be non-threatening, but there are instances where they can cause a few fatal conditions. They are -

Aneurysms:

An aortic aneurysm occurs when the wall of the heart's arteries weakens and causes an uneven bulge. An arrhythmia can be a major cause of an aortic aneurysm.

Autoimmune diseases:

Lupus and rheumatoid arthritis can be triggered in a person due to irregular heartbeats.

Cardiomyopathy:

Irregular heartbeats cause the heart muscles to thicken, enlarge, and sometimes become stiff. Cardiomyopathy causes strokes, which causes fluid buildup in the lungs, heart, knees, and brain.

Heart Inflammations:

Inflammation is how the body handles injuries or infections. An arrhythmia, in its various forms, holds the potential to cause inflammation due to stiffening or enlarging of heart muscles. Heart inflammations can cause chest pain, shortness of breath, weakness, and a fast heartbeat.

Heart failure:

Heart failure can be caused by Vfibs (Ventricular fibrillation) or sometimes by Afibs (Atrial fibrillation).

COPD:

Chronic Obstructive Pulmonary Disease (COPD) is a disease that is caused by inhaling cigarette smoke directly or through secondhand channels. It also occurs due to prolonged exposure to chemical effluents and factory smoke. Patients diagnosed with COPD exhibit a high occurrence of Vfib, and this could result in a stroke and prove fatal.

Narrowed arteries and heart valves:

An arrhythmia in a person can cause tachycardia or bradycardia, which causes the heart to pump more blood to meet the body's demand for oxygen-rich blood. Also, when the heart valves and arteries around the aortic region are narrowed, the same effect is exhibited, thereby reducing the amount of blood reaching the heart muscles and brain.

Prevention Of irregular heartbeat or arrhythmia?

Irregular heartbeats can be prevented by taking a hands-on approach to living a healthy and active lifestyle. Channelling efforts to make conscious decisions to include a cholesterol-free diet, stay away from smoking or secondhand smoke, and work towards regular exercise to dissolve any excess fats from the body are the first steps towards prevention.

An extra layer of preventive measures that can avoid the occurrence of irregular heartbeats are:

Avoiding intake of caffeine, alcohol and other drugs
Avoid unnecessary stress like fear and anger, and avoid conditions/situations that could simulate stress in these forms.
Controlling the blood sugar and salt levels in the body to the optimum degree to avoid diabetes

Diagnosis of irregular heartbeat or arrhythmia?

An Irregular Heartbeat can be diagnosed through a series of physical tests and ECGs by a doctor in controlled simulations. Your doctor might look for abnormal activities in your thyroid glands or test the condition of the heartbeat by exposing it to different conditions. You may also be subjected to different heart monitoring tests, which include:

ECG:

An electrocardiogram (ECG) is a device attached to your chest to measure electrical activity in your heart. An ECG measures and times the duration of every electrical phase, thereby diagnosing any irregular heartbeat and the presence of an Arrhythmia.

Holter Monitor:

A Holter monitor is a portable version of an ECG. It can be worn daily to measure and monitor the heart's activity for longer durations. The readings from a Holter monitor can inform cardiologists about normal heartbeat and how impulses are transmitted through different parts of a person's body.

Event recorder:

An event recorder is a portable ECG machine that lets you record your heart's moments during an arrhythmia by pressing a button. It gives the doctor a streamlined data stream to read the heart's performance in specific conditions/events of occurrence(s), thus making it easier for the doctor to diagnose the person's condition.

Echocardiogram:

An Echocardiogram is a noninvasive test that uses sound waves to measure the heart's size, structure, and motion. It is a hand-held portable device generally placed on the chest that assesses the heart's functioning. An Echocardiogram can detect an Irregular Heartbeat and help the consulting cardiologist recommend treatment or prevention options depending on the type of arrhythmia.

Implantable loop recorder:

An implantable loop recorder is a device used to track occurrences of inconsistent arrhythmias. In this, the doctor plants a recorder under your skin that consistently records the electrical activity of the heart and records any anomalies.

Doctors use the above tests to identify the occurrence of Arrhythmias. However, in a few scenarios, when these tests do not work, a targeted approach is taken to trigger Arrhythmias in the form of:

Stress set:

Stress can trigger or worsen Arrhythmias in patients. A stress test is one such test conducted in a controlled environment. In this test, the patient is made to run on a treadmill or cycle until he is stressed out and an Arrhythmia appears. If the patient has difficulty exercising, doctors will induce an arrhythmia using a drug that simulates the same sensation and stress the patient experiences while exercising.

Tilt table test:

A tilt table test is recommended if the patient is experiencing syncope or fainting. In a tilt table test, the patient is exposed to inclines and declines in various angles, and their reactions to those conditions are monitored. In most cases, an Arrhythmia is triggered, enabling the doctors to monitor it while it occurs and find the cause of an irregular heartbeat.

Electrophysiological testing and mapping:

This is a process in which doctors connect multiple electrode-tipped catheters to various regions of your heart to see what is triggering and halting an Arrhythmia and which portion of the heart it's originating from. This test helps doctors diagnose the nature of the irregular heartbeat, understand its triggers, and foresee situations that can simulate these conditions.

Treatment Of irregular heartbeat or arrhythmia?

When patients take medications exactly as prescribed by the consulting physicians, they can do wonders. These medications can correct any irregularities in the heartbeat, prevent strokes, or delay or mitigate the chance of coronary heart disease. However, the course of medication prescribed mustn't be interrupted or deviated from without first consulting a doctor.

The most effective and sought-after treatment options for an Irregular Heartbeat are:

Antiarrhythmic drugs:

Antiarrhythmic drugs are either induced intravenously in emergencies or orally in the form of tablets for long-term medication to suppress irregular heartbeats caused by misfiring of the pacemaker or suppress the transmission of impulses that can cause rapid firing of the atrium or the ventricles.

Patients suffering from Afib are generally advised on long prescriptions of anticoagulants or blood thinners to battle the underlying causes.

However, antiarrhythmic drugs are known for their long medication periods and the chances of proarrhythmic conditions. In this case, the patient is on medication for life, and as a side effect, it can increase the occurrence of an Arrhythmia or cause new arrhythmias to occur, which can be worse than the previous ones.

Calcium channel blockers:

Calcium channel blockers work by limiting the flow of calcium into the heart. Calcium is an electrolyte that the Sinusoidal Artery uses to fire electric charge into the atrium and ventricles. Excess calcium can cause impulses to misfire. Calcium channel blockers are also used to treat angina, blood pressure, and other forms of irregular heartbeat.

Beta-blockers:

Beta-blockers are the most common form of medication prescribed for patients suffering from Afib. In this, the patient has been prescribed atenolol, bisoprolol, and metoprolol to reduce the adrenalin content in the blood. Consuming beta-blockers can make the patient drowsy and lethargic in the early stages; however, this changes as the body gets accustomed to the medication process.

Anticoagulants:

Anticoagulants are blood thinners prescribed to patients at risk of developing new blood clots due to atrial fibrillation or the narrowing of blood vessels. This medication keeps the blood from clotting and is not designed to break or dissolve existing clots. Anticoagulants can be an effective cure for irregular heartbeats caused in the atrium.

Inserting a pacemaker:

A pacemaker is a device implanted in the body near the collarbone. A wire tipped with a cathode is permanently extended and anchored near the heart. If the pacemaker detects any anomalies in the heart's functions, it sends electrical impulses to correct the heart's course and resume normal function.

Maze procedure:

It is a treatment option that involves surgery. Hence, it is always reserved for people who do not respond to other forms of treatment. In this, the surgeon makes a series of incisions on the heart to create scar tissue. Scar tissues do not conduct electricity and obstruct stray impulses that could lead to irregular heartbeats.

Road To Recovery:

Undergoing surgery to treat Irregular Heartbeat or taking medication to either treat it or cure it is the first step towards recovery. Complete recovery from this condition can be achieved by altering a few lifestyle elements to ensure that the chances of another Arrhythmia are brought down to zero. They are:

Eat healthy food:

Avoid eating junk food or mass-produced food from fast-food chains or roadside eateries. Eat home-cooked food which is rich in proteins, carbohydrates, and fats. And drink clean water as much as possible.

Exercise regularly:

If you don't exercise regularly, try to work out for at least 30 minutes every day or 3-5 times a week and slowly increase the intensity and duration of the workout with time. Please consult a physician to talk about this before increasing the intensity or duration of the workout.

Quit smoking:

Nicotine and tobacco smoke is a major contributor to causing an irregular heartbeat.

Check your weight:

Being overweight only increases your chances of developing coronary heart disease, arrhythmia, or any other heart-related complications. It is also advisable to keep your blood pressure and cholesterol in check, as these factors could affect the functioning of the arteries and the heart.

Alcohol consumption moderation:

Check with your doctor if consuming alcohol will affect the underlying condition. However, in most cases, if the patient is under 65, they are not advised to have more than two drinks a day; the number goes down to 1 drink a day if the patient is over 65.

Maintain follow-up care:

Following the instructions to the T in follow-up care can reduce the development of new Arrhythmias and heart diseases. Ensure that all your medications are consumed without any breaches.

If you experience new symptoms, note them and share them with your doctor. That way, the doctor can track your progress even between scheduled visits.

Practice alternative methods:

Yoga, meditation and other relaxation techniques have been working wonders in keeping new Arrhythmias from developing. These improve the heart and lungs function and reduce the risk of developing coronary artery disease.