Summary

In today’s world, a healthy lifestyle is what everyone looking for. As they say: “Good health and good sense are two of life’s greatest blessings,” a healthy heart is also a great blessing.

The heart performs the vital function of pumping blood to every body part. In performing this vital role, it may get diseased or fall ill. One of these conditions is called an arrhythmia – also known as a “Cardiac Arrhythmia.” Certain arrhythmias occur in people with severe heart conditions and can cause sudden cardiac death. Some of these deaths could have been avoided if the arrhythmias had been diagnosed earlier. More than 600,000 people in the USA die every year due to heart failure or sudden cardiac death, as reported in Statistics from the Center for Disease Control and Prevention (CDC), Cleveland Clinic Reports, OH, USA, 2014. About 50 % of heart patients die of sudden death due to cardiac arrhythmias, but it can be controlled by an automatic external defibrillator device (AEDs) which can reduce the mortality rate when used quickly within a few minutes after the first heart attack. (1) So, it is crucial to know the basic features, signs, symptoms, and ways to prevent and treat these cardiac arrhythmias.

Essential | Causes  and Prevalence of Cardiac Arrhythmia:

An irregular heartbeat is called heart arrhythmia. Heart arrhythmias occur when the electrical impulses that normally coordinate the heartbeats do not work properly. The faulty signaling causes Heart rhythm problems – heart arrhythmias which can make the heart beat too fast, known as tachycardia, too slow, known as bradycardia, or irregular. However, sometimes it is very normal for a person to have a slow or fast heart rate. For example, the heart rate increases with exercise and decreases during sleep.

A normal heart beats 72 times per minute. If this number increases or decreases, you may have a problem to deal with.

The following conditions can be the cause of arrhythmias:

• Coronary artery disease.
• High blood pressure.
• Abnormal Pacemaker.
• Changes in the heart muscle (cardiomyopathy).
• Valve disorders.
• Electrolyte imbalances
• Injury from a heart attack etc.

Types of Cardiac Arrhythmias:

Generally, heart arrhythmias are grouped by the speed of the heart rate. For example:

• Tachycardia, in which the resting heart rate is greater than 100 beats a minute.
• In bradycardia, the resting heart rate is less than 60 beats a minute.

Tachycardia (Fast Heartbeat):

Tachycardia usually refers to an increase in the number of heartbeats per minute. It has the following types:

• Atrial fibrillation (A-fib): It might be temporary with fast, uncoordinated heartbeats. If it continues for a longer period, it becomes very dangerous.
• Atrial flutter: Atrial flutter is very similar to A-fib, but the heartbeats are more organized. It is an atrial arrhythmia caused by one or more rapid circuits in the atrium. Atrial flutter, like Atrial fibrillation, is also linked to stroke.
• Supraventricular tachycardia: it is a broad term that includes arrhythmias that start above the lower heart chambers (ventricles), mainly in the upper chambers (atria). Supraventricular tachycardia palpitations begin and end abruptly.
• Ventricular fibrillation. This type of arrhythmia occurs when a rapid, massive amount of electrical impulses cause the lower heart chambers (ventricles) to quiver instead of contracting in a well-coordinated way that pumps blood to the rest of the body parts. If not corrected within minutes, it can cause death.
• Ventricular tachycardia: This rapid but regular heart rate starts due to faulty electrical signals in the heart’s lower chambers, leading to improper blood flow to other parts of the heart and the rest of the body.

Bradycardia (Flow heartbeat) :

Although a heart rate below 60 beats per minute at rest is considered bradycardia, a low resting heart rate is not always a problem. If you are physically healthy, your heart may still pump enough blood to the rest of the body with fewer than 60 beats a minute at rest. But, If your heart rate is slow and your heart isn’t pumping enough blood, you may have bradycardia. If this continues for a while, it can be fatal for your health.

Premature heartbeats:

A premature heartbeat is an extra heartbeat that might get added to your normal heart rhythm. It may feel like your heart just skipped a beat. These extra beats are generally not very concerning or worrisome and often mean that you have a more serious condition. However, a premature beat can trigger a longer-lasting arrhythmia, mainly in people with heart disease.

Prevalence of Arrhythmias:

In North American and European populations, the age-adjusted incidence of AF has been estimated to be 1.5 to 2 times higher in men than in women. The lower AF incidence among women seems to be consistently observed outside North America and Europe, although fewer studies are available.1,16 AF incidence has been shown to increase disproportionately with increasing age in women and men, reaching as high as 30.4 per 1000 person-years in women and 32.9 per 1000 person-years in men by age 85–89 years. Similarly to incidence, the age-adjusted prevalence of AF has been reported to be lower in women than in men in North America and Europe (2). The elderly patient is susceptible to various cardiac rhythm disturbances that may or may not cause symptoms. It is incumbent on the physician who cares for geriatric patients to be familiar with the diagnostic criteria for each of these arrhythmias and the drugs and devices used to treat them (3).

Arrhythmia Symptoms:

Arrhythmias can be appropriately treated if diagnosed within time. To diagnose a disease, you must know its signs and symptoms. Thus, arrhythmia can be diagnosed based on the following signs and symptoms:

• A fluttering in the chest
• Chest pain
• Chest tightness
• Shortness of breath
• Pounding heartbeat (palpitations)
• A racing heartbeat (tachycardia)
• A slow heartbeat (bradycardia)
• Lightheadedness or dizziness
• Sweating
• Fainting

Diagnosis of Arrhythmia:

Patients with arrhythmias must undergo an appropriately thorough evaluation before decisions regarding prognosis and the need for therapy can be made. (4)

Suppose you have any symptoms of an arrhythmia. In that case, you should make an appointment with your cardiologist, who, after assessing your symptoms and performing a physical examination, may perform various diagnostic tests to confirm the presence of an arrhythmia and indicate its causes.

The following tests can be done:

• Electrocardiogram (ECG or EKG)
• Ambulatory monitors
• Echocardiogram
• Cardiac catheterization
• Electrophysiology study (EPS)

 When to See a doctor?

Usually, an increase or decrease in heart rate is not considered a major problem, as fluctuations in heart rate are normal. It increases with exercise, running, and the normal stressful daily life conditions. It decreases during sleep or at rest, or in cold temperatures. However, too much fluctuation in your heart rate poses a severe problem to your heart health. If you feel these major fluctuations along with other symptoms like palpitations, sweating, chest tightness, or chest pain, you need to see your healthcare professional immediately. Early diagnosis of these arrhythmias is beneficial in detecting and treating the underlying pathology, which would otherwise prove fatal to the patient’s life.

Prevention of Cardiac Arrhythmias:

Occasional heart arrhythmias might not be an alarming situation, but as they say: “prevention is better than cure”, Thus, prevention should be done to keep them from becoming serious.

Lifestyle changes:

Changes in the daily activities of your life prove very beneficial regarding your heart health. What you can do is to

• Limit smoking
• Exercise regularly
• Control your blood sugar levels
• Limit alcohol intake
• Limit the intake of caffeine
• Avoid stress

Treatment of Cardiac Arrhythmias:

Treatment usually depends on the type and severity of your arrhythmia. In some cases, no treatment is necessary. The probability of life-threatening ventricular arrhythmia correlates closely with underlying structural heart disease. In any patient presenting with ventricular arrhythmia, a careful search for underlying causes is required, and treatment should be considered primarily if it will prolong survival (5). Treatment options include medications and lifestyle changes. However, invasive therapies, electrical devices, or surgery might be opted for if the arrhythmias are severe.

Medications for Arrhythmias:

Invasive procedures:

A cardiologist may insert specific devices during an invasive procedure.

• A permanent pacemaker is a device that sends small electrical signals to the heart muscle to maintain a normal coordinated heart rate
• An implantable cardioverter-defibrillator (ICD) is a sophisticated device used primarily to treat ventricular tachycardia and ventricular fibrillation.
• Biventricular (B-V) pacemakers and defibrillators(also called cardiac resynchronization therapy or CRT) are used in people with heart failure who also have evidence of an out-of-sync left ventricular contraction.

Conclusion:

It is also generally accepted that patients with frequent or complex ventricular ectopy or nonsustained VT, in the absence of underlying heart disease, do not require treatment unless relief of symptoms is warranted. The concern is that these ventricular arrhythmias may be a precursor for sustained, potentially life-threatening ventricular tachyarrhythmias. Available data suggest that patients with underlying heart disease, particularly coronary artery disease and a previous myocardial infarction, who manifest frequent or complex ventricular ectopy or nonsustained VT are at increased risk for sudden cardiac death. (6)

Any arrhythmias from which a person suffers has a specific cause that must be undertaken during a diagnosis. Arrhythmias can become fatal for a patient’s health if left unattended, so it is important to diagnose them within time and plan out strategies to prevent further episodes.

If you ever feel your heart rate increasing or decreasing without any apparent cause, do not worry. Just remember that arrhythmias or irregular heartbeats are not a disease but a symptom of other underlying heart conditions. It tells us that there is some problem with the normal functioning of the heart, and you need to get yourself checked before it turns into something serious.

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