Arrhythmia


What is Arrhythmia?

Arrhythmia refers to irregular cardiac rhythm, i.e. abnormal cardiac rhythm. In other words, it means rhythm disturbances, irregular heartbeat. Arrhythmia can be abnormally fast (tachycardia) or abnormally slow (bradycardia). Arrhythmias may have an internal order or totally be irregular at normal, fast, or slow heart rate.

What are complaints of patients with arrhythmia?

  • Complaints of tachycardia often include heart-throb, flattering, rolling of a tire, or a sensation of flopping in the chest.
  • Complaints of bradycardia often include dizziness, lightheadedness, fainting, slowed pulse, tiredness, fatigue, or weakness.

If bradycardia or tachycardia has an internal irregularity, both heartbeats and pulse are irregular in addition to the above symptoms.

Some arrhythmias can be simple and insignificant while some can be alarming and fatal. Can result in a sudden death.

What are the causes of Arrhythmia?

Ones related to heart:

  • Coronary heart disease (ischemic heart disease), heart attack (acute or previous myocardial infarction) or generally atherosclerosis,
  • Congenital heart disease (Long QT syndrome),
  • Deformation or dysfunction of the heart, e.g. cardiomyopathy,
  • Valve diseases,
  • Heart failure,
  • Effect of drugs.

Other causes of arrhythmia unrelated to heart:

  • Smoking,
  • Alcohol consumption,
  • Drinking caffeinated beverages (too much tea, coffee, chocolate, coke, and energy drinks),
  • Sleeplessness,
  • Severe stress,
  • Influenza, e.g. cough, and catarrhia,
  • Electrolyte disturbances,
  • Hyperthyroidism (overactive thyroid gland, toxic goiter),
  • Reflux oesophagitis (gastric hernia and reflux to esophagus),
  • Medications (drugs for asthma, catarrh and influenza, over-the-counter drugs for losing weight),
  • Drug/substance abuse (e.g. cocaine and marijuana).

The patients with arrhythmia must be examined for

  • coronary artery disease,
  • valvular disorders,
  • heart failure.

One of the causes of arrhythmia that should be investigated especially in young is that whether there are any cardiac abnormalities. Using any drugs, drug abuse, caffeinated or energy drinks, and stress should not be overlooked.

How is Arrhythmia diagnosed?  

If you suspect this disease you should initially visit a cardiologist. After listening to your complaints, the doctor will auscultate your heart and check your pulse during examination to detect irregular heartbeats.

Then some tests are required, which starts with electrocardiography (ECG). ECG provides general information on the heart’s electrical system and arrhythmias. ECG can be totally normal or capture current arrhythmia. If ECG does not reveal any signs of arrhythmia, this is completely normal because the patient does not have arrhythmia, or because they have arrhythmia which was unable to capture at the time.

If arrhythmia is suspected despite ECG being normal, your doctor will ask you to carry the holter device for 24 hours to measure your cardiac rhythm. Since the holter device will be attached to your body for at least 24 hours, it is highly possible to detect any arrhythmias during this period and shows the course of current arrhythmias during daily life, and whether arrhythmias are associated with your symptoms. A 24-hour record is taken by 7 electrodes via 3 channels.

If 24-hour period is not enough to detect your arrhythmia, long-term holter devices, or event recorders, e.g. event-loop recorders, and transtelephonic ECG are used to record required cardiac rhythms.

What are Event Recorder, Loop Recorder and Transtelephonic ECG system?

Event Recorder; records the events for one month only when the button is pressed at the time of symptom

Loop Recorder; records constantly and automatically for 8 days via one channel and stores in loop memory.

Transtelephonic ECG; transmits the instant events as well as events in the memory for 1 day – 1 month via telephone.

What is Vitaphone 3300 BT Loop Recorder-Transtelephonic ECG?

It is a device which automatically records all events for 1 day to 1 month via 3 channels and events indicated at the time of symptom and stores in the loop memory. In the meantime it instantly transmits each event recorded via telephone through mail to the Center then to doctor’s office through mail again.

  • Also, blood minerals, elements, thyroid hormones and blood counts are examined by blood tests.
  • With effort test, your response to effort, if your arrhythmia is provoked, and your effort state are examined.
  • Echocardiography provides information on structural state and functions of your heart.
  • Coronary angiography and ventriculography is performed by cardiac catheterization to derive information on the state of coroners and ventricles.
  • For further examination, Electrophysiological Study (EPS) is performed to obtain information on electrical function of your heart.

The patient with arrhythmia have the followings respectively:

  • Electrocardiogram (ECG)
  • Rhythm Holter for 24-72-hour or 1 week
  • Event-Loop Recorder or Transtelephonic ECG
  • Effort Test
  • Echocardiogram
  • Cardiac catheterization
  • Electrophysiological Study (EPS)

Atrial Fibrillation (AF):

AF is a very common irregular heartbeat causing atria to contract abnormally. The upper chambers (atria) are unable to contract regularly and remain vibrated. Nor the lower chambers function normally. The heart rate increases, and the pulse intensity is palpated. The heart might pump less blood. The most important and feared adverse effect is that it predisposes formation of clot in the heart, and that these clots come loose and travel to different locations of the body (especially to the brain), resulting in serious problems. Atrial fibrillation can be rarely seen in healthy individuals but the incidence increases in cases of followings:

  • Cardiovascular disease
  • Overactive thyroid gland
  • Hypertension
  • Heart valve diseases (particularly mitral stenosis)
  • Heart failure
  • Incidence of atrial fibrillation increases with age.

Atrial Fibrillation: The waves in the ECG are irregular and the pulse is irregular too.

Atrial flutter: An arrhythmia caused by one or more fast circulations in atria. Atrial flutter is often more organized and more regular than atrial fibrillation. This type of arrhythmia mostly presents in those with a heart problem within one week after the operation. It usually turns into atrial fibrillation.

Why is atrial fibrillation important?

Atrial fibrillation is the most common clinical rhythm disturbance. Structural heart diseases, e.g. rheumatic heart disease, hypertension, cardiac failure, are important risk factors for development of atrial fibrillation.

In addition to symptoms reducing the quality of life, atrial fibrillation leads to complications such as systemic emboli, hemodynamic disturbance, and myopathy associated with tachycardia.

How do we correct atrial fibrillation?

There are three ways to ensure sinus rhythm in patients with atrial fibrillation:

  • By medication: A group of drugs is successful in restoring sinus rhythm in patients who have recently experienced atrial fibrillation (AF). The success rate is decreased by duration of AF period and presence of a concomitant heart disease.
  • By angiographic methods: Performing “catheter ablation” during angiography, specific transmission ways of the heart are inactivated.
  • By surgery: Electrical transmission system of the heart causing arrhythmia is disabled by a surgery to constitute normal sinus rhythm.

Both catheter ablation and surgery for AF (including all types of arrhythmias) are successfully performed at our Heart Center.

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