Explore the intricacies of arrhythmia and discover ways to manage heart rhythms. Meri Sehat provides expert insights for heart health.

Arrhythmia

A. JABBAR DENTAL CLINIC

Sadia Khan

Overview

Arrhythmia refers to an irregular heartbeat. 
&nbsp;

Arrhythmias are one of the most common cardiovascular complications encountered during the administration of anesthesia.<a href="#accordion">[1]</a>

Approximately 1.5-5% of people have arrhythmias.<a href="#accordion">[5]</a> More than 2 million people in the UK have arrhythmias, or heart rhythm problems.<a href="#accordion">[7]</a> However, it is believed that the numbers are much higher given that some people are symptomatic.

White people are more likely to be diagnosed with atrial fibrillation than Asian Americans or Hispanic individuals in the US.<a href="#accordion">[8]</a> 
&nbsp;

Arrhythmias are grouped into:<a href="#accordion">[6]</a>

<ul>
	<li>Tachycardia &ndash; A fast heartbeat, usually greater than 100 beats a minute</li>
	<li>Bradycardia &ndash; A slow heartbeat, usually less than 60 beats a minute</li>
	<li>Premature Or Extra Contractions &ndash; The signal to beat comes too early 
	&nbsp;</li>
</ul>

They are then further categorized into several types based on their origin and characteristics:

<ul>
	<li>Atrial Fibrillation &ndash; Refers to rapid, irregular electrical discharges in the upper chambers of the heart or atria; it is the most common type of arrhythmia, especially among the elderly</li>
	<li>Atrial Flutter &ndash; Refers to a regular but fast (often more than the ventricles) beating of the atria</li>
	<li>Atrial Flutter &ndash; Refers to a regular but fast (often more than the ventricles) beating of the atria</li>
	<li>Ventricular Tachycardia &ndash; Refers to a fast, abnormal heart rhythm that begins in the lower chambers of the heart or ventricles</li>
	<li>Ventricular Fibrillation &ndash; Refers to fast, abnormal electric signals that cause the ventricles to quiver rather than squeeze</li>
	<li>Supraventricular Tachycardia &ndash; Refers to a rapid heart rate originating at or above the atrioventricular node</li>
	<li>Sick Sinus Syndrome &ndash; Refers to heart rhythm problems, such as sinus arrest or sinus bradycardia, due to issues with the sinus node</li>
	<li>Conduction Block &ndash; Refers to an abnormality with the heart&rsquo;s electrical pathway 
	&nbsp;</li>
</ul>

Sign and Symptoms

The signs and symptoms of arrhythmia can vary depending on the type and severity of the condition. Common signs and symptoms include:

<ul>
	<li>Palpitations or a fluttering sensation in the chest</li>
	<li>Chest pain or discomfort</li>
	<li>Shortness of breath</li>
	<li>Dizziness or lightheadedness</li>
	<li>Fainting spells or syncope</li>
	<li><a href="https://merisehat.pk/disease/chronic-fatigue-syndrome">Fatigue</a></li>
</ul>

Note: Some people may experience a &ldquo;silent&rdquo; cardiac arrhythmia, i.e., without presenting any symptoms. 
&nbsp;

Causes

Most arrhythmias occur because of an issue with the heart&rsquo;s muscles, arteries, or valves. These include:

<ul>
	<li>Coronary artery disease</li>
	<li>Injury from a heart attack</li>
	<li>Changes in the heart muscle</li>
	<li>Underlying conditions, such as high blood pressure, thyroid disorders, and diabetes 
	&nbsp;</li>
</ul>

Diagnosis

The diagnosis of arrhythmia involves a thorough evaluation of the patient&#39;s medical history and physical examination. After assessing the symptoms, the doctor may order the following tests to confirm the diagnosis:<a href="#accordion">[2]</a>

<ul>
	<li>Electrocardiogram (ECG)</li>
	<li>Echocardiogram</li>
	<li>Stress test</li>
	<li>Tilt table test</li>
	<li>Electrophysiology study<a href="#accordion">[3]</a></li>
	<li>Blood tests to check for underlying conditions such as thyroid disorders or electrolyte imbalances 
	&nbsp;</li>
</ul>

Treatment

The treatment of arrhythmia aims to restore normal heart rhythm and prevent complications. Options include:<a href="#accordion">[4]</a>

<ul>
	<li>Medications &ndash; Antiarrhythmic drugs (e.g., amiodarone and flecainide) and anticoagulant drugs (e.g., warfarin and aspirin).</li>
	<li>Lifestyle Modifications &ndash; Avoiding tobacco, caffeine, and stimulants and maintaining a healthy weight.</li>
	<li>Therapies &ndash; Cardioversion, catheter ablation, and pulmonary vein isolation.</li>
	<li>Implantable Devices &ndash; Devices such as pacemakers or implantable cardioverter-defibrillators (ICDs).</li>
	<li>Surgical Interventions &ndash; Coronary artery bypass surgery, valve surgery, and maze procedure. 
	&nbsp;</li>
</ul>

Untreated arrhythmia can lead to serious complications, including stroke, cardiac arrest, dementia, and Alzheimer&rsquo;s disease. 
&nbsp;

Several risk factors increase the likelihood of developing arrhythmia, including:<a href="#accordion">[5]</a>

<ul>
	<li>Age; the risk increases with age, especially in individuals over 65 years old</li>
	<li>Genetics</li>
	<li>Lifestyle factors, such as smoking, caffeine drinks, excessive alcohol consumption, and a sedentary lifestyle</li>
	<li>Certain medications, such as stimulants</li>
	<li>BMI above 30 
	&nbsp;</li>
</ul>

The following preventive measures can help reduce the risk of developing arrhythmia:

<ul>
	<li>Engage in regular physical activity and follow a balanced diet</li>
	<li>Avoid triggers, for instance, by quitting smoking and managing stress</li>
	<li>Undergo regular screenings for early intervention</li>
	<li>Manage underlying conditions like sleep apnea, diabetes, and blood pressure 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li style="list-style-type: none;">Arrhythmia refers to an irregular heartbeat.</li>
	<li>The common types of arrhythmias include atrial fibrillation, ventricular tachycardia, and supraventricular tachycardia.</li>
	<li>The signs and symptoms of arrhythmia include palpitations, chest pain, shortness of breath, and dizziness.</li>
	<li>Most arrhythmias occur because of an issue with the heart&rsquo;s muscles, arteries, or valves.</li>
	<li>The diagnosis of arrhythmia includes medical history evaluation, physical examination, and tests like electrocardiogram, echocardiogram, stress test, electrophysiology study, and blood tests.</li>
	<li>The treatment options for arrhythmia include medications, lifestyle modifications, implantable devices, and surgery.</li>
	<li>The complications of arrhythmia include stroke, heart failure, dementia, and Alzheimer&rsquo;s disease.</li>
	<li>The risk factors for arrhythmia include age, genetics, certain medications, and BMI over 30.</li>
	<li>The preventive measures for arrhythmia include maintaining a healthy lifestyle, managing underlying conditions, avoiding triggers, and undergoing regular screenings.</li>
</ul>

[1] Altınbaş, A., Taş, N., & Bektaş, O. (2017). Perioperative arrhythmias. Middle Black Sea Journal of Health Science, 41-48.

[2] Priori, S., Napolitano, C., Memmi, M., Colombi, B., Drago, F., Gasparini, M., … & Delogu, A. (2002). Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation, 106(1), 69-74.

[3] Wieling, W. (2009). Guidelines for the diagnosis and management of syncope (version 2009): the task force for the diagnosis and management of syncope of the european society of cardiology (esc). European Heart Journal, 30(21), 2631-2671.

[4] Arnar, D., Boriani, G., Calkins, H., Chin, A., Coats, A., Deharo, J., … & Heinzel, F. (2019). Management of asymptomatic arrhythmias: a european heart rhythm association (ehra) consensus document, endorsed by the heart failure association (hfa), heart rhythm society (hrs), asia pacific heart rhythm society (aphrs), cardiac arrhythmia society of southern africa (cassa), and latin america heart rhythm society (lahrs). Ep Europace, 21(6), 844-845.