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Irregular Heartbeat or Arrhythmia:
Symptoms, Treatment, Risks and Recovery

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1.What is an Irregular Heartbeat or Arrhythmia?

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

Although an Arrhythmia doesn’t generally exhibit any symptoms, however, symptoms like chest pains, fluttering chest, giddiness, skipping beats, shortness of breath, and excessive sweating can be considered as 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 in 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, which is 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 ‘His-Purkinje’ system.

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

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2.Symptoms of Arrhythmia

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

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3.Causes of Arrhythmia

An Arrhythmia can occur due to various reasons. It can be a result of a genetic condition, a side-effect to a previous condition a patient has suffered from, eating and drinking habits of an individual, and consumption of tobacco, alcohol, drugs, including amphetamines, 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 cold, 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 cause stiffening of the walls in the ventricles and this can cause an Arrhythmia in the heart. It can also increase the risk of developing coronary artery (narrowing in the arteries due to deposits of cholesterol-containing plaque).

Congenital conditions:

Certain conditions or deformities in the heart which is causing irregularities in the way the heart pumps blood in turn leading to an irregular heart beat.

Hormonal imbalance:

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

Imbalance in electrolytes:

Imbalance in the amount of sodium, potassium, calcium and magnesium electrolytes in the body can be a major driving force causing 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.

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4.Types of conditions that cause Irregular Heartbeat:

Causes of 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 an Arrhythmia that occurs when the heart is beating too fast without the patient’s participation in any excessive physical activities at that moment. For an average adult, anything above 100 beats per minute can be considered as Tachycardia.

Symptoms for Tachycardia include:

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

Bradycardia:

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

Symptoms for 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 to the ventricles. This causes the atrium to flutter and twitch. This is called fibrillation. This causes the heart to beat irregularly and more often than not causes the heart to beat too fast, thus causing an Arrhythmia.

Atrial Flutter:

Atrial flutter occurs when the electrical imbalance causes the atrium to beat too fast at a pace that ranges between 250-400 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 for 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 do 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

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6.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 arteries in the heart weaken and cause an uneven bulge. An arrhythmia can be a major reason for an aortic aneurysm.

Autoimmune diseases

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

Cardiomyopathy:

Irregular Heartbeat causes the muscles of the heart to thicken, enlarge and sometimes become stiff. Cardiomyopathy causes strokes and this, in turn, causes fluid buildup in the lungs, heart, knees, and brain.

Heart Inflammations:

Inflammation is the body’s way of handling injuries or infections. An Arrhythmia in its various forms holds the potential to cause inflammations due to stiffening of heart muscles or enlarging them. Heart inflammations can chest pain, shortness of breath, weakness, and fast heartbeat.

Heart failure:

Heart failure can be caused due to 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 second-hand channels. It also occurs due to prolonged exposure to chemical effluents and factory smoke. Patients diagnosed with COPD exhibit 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, thereby causing 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.

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7.Prevention

Irregular heartbeats can be prevented from occurring by taking a hands-on approach in working towards a healthy and active lifestyle. Channelling efforts to make conscious decisions towards including a cholesterol-free diet, staying away from smoking or second-hand smoke, and working 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
  • Avoiding unnecessary stress like fear, anger, stress and staying away from 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

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8.Diagnosis:

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 that is 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 irregularity in the heart beat and the presence of an Arrhythmia.

Holter Monitor:

A Holter monitor is a portable version of an ECG. It can be worn all day to measure and monitor the activity of the heart for longer durations. The readings from a Holter monitor can present the cardiologists of normal heartbeat and the way 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 the moments of your heart at the time of the Arrhythmia by pressing a button. This gives the doctor a streamlined data stream to read the performance of the heart in specific conditions/event of occurrence(s), thus making it easier for the doctor to diagnose the condition of the person.

Echocardiogram:

An Echocardiogram is a non-invasive way that uses sound waves to measure the size, structure and motion of the heart. It is a hand-held portable device that is generally placed on the chest which uses sound waves to assess the functioning of the heart. 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 be used to trigger or worsen Arrhythmias in patients and a stress test is one such test conducted in a controlled environment where the patient is made to run on a treadmill or cycle till he is stressed out and an Arrhythmia appears. If the patient has difficulty in exercising, doctors will then induce a drug that simulates the same sensation and stress like the one a patients experiences while exercising to induce an Arrhythmia.

Tilt table test:

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

Electrophysiological testing and mapping:

This is a process in which doctors connect multiple electrodes tipped catheters to various regions of your heart. This is done 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, to understand its triggers and foresee situations that can simulate these conditions.

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9.Treatment

When medications are taken by the patients exactly as prescribed by the consulting physicians, it can do wonders. These medications can correct any irregularities in heartbeat, prevent the occurrence of strokes or delay or mitigate the chance of an occurrence of coronary heart diseases. However, it is imperative that the course of medication prescribed is not 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 a rapid-firing of the atrium or the ventricles.

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

However, antiarrhythmic drugs are known for their long duration of medication period and the chances of proarrhythmic conditions. In this, 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. Excessive calcium content can cause misfiring of impulses. 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 prescribed atenolol, bisoprolol and metoprolol for reducing 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 who have the risk of developing new blood clots either due to atrial fibrillation or due to narrowing of blood vessels. This form of medication keeps the blood from clotting and is not designed to break/dissolve existing clots. Anticoagulants can be an effective cure to irregular heartbeats caused in the atrium.

Inserting a pacemaker:

Pacemaker for irregular heartbeat

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

Maze procedure:

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

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10.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. And 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 work out 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 condition or an Arrhythmia or any other complications related to the heart. 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 years, he/she is not advised to have more than 2 drinks a day and the number goes down to 1 drink a day if the patient is over 65 years.

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 there are any new symptoms that you are experiencing, make a note of them and share them with your doctor. That way, the doctor is able to 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 way the heart and lungs function and reduce the risk of developing coronary artery disease.

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11.Arrhythmia FAQs: All your concerns addressed.

Q.   Can an Arrhythmia be life threatening?

  1. Yes, Sometime Arrhythmias can be harmless but more than often when left untreated, these can cause major health complications including, strokes, heart valve diseases, and death.

Q.   Can Arrhythmias be cured?

  1. Yes, most forms of Arrhythmias can be cured and extensive medical surveys say that 80% of patients diagnosed with arrhythmias reported of getting cured after following the medication regime.

Q.   Is it safe to indulge in physical exercises if i have an arrhythmia?

  1. It is best to consult a doctor to evaluate your condition and determine whether the body is in a position to safely withstand the effects of physical workouts

Q.  Can I smoke or drink if I am diagnosed with an irregular heartbeat?

  1. It is advised to stay away from all tobacco and tobacco based products as active and passive smoking have adverse ways of triggering the condition.
    It is advised to consult a medical practitioner to speak about alcohol consumption.

Q.   Will I be allowed to drive if i have an irregular heartbeat?

  1. It depends on the type of arrhythmia and the condition of adversity. As long as the condition does not affect your driving and does not put you or others around you in harm's way, you will be allowed to drive.

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