What is Arrhythmia?
An arrhythmia is a disorder of the heart that affects the rate or rhythm at which the heart beats. It happens when electrical impulses that direct and regulate heartbeats don’t function properly. This causes the heart to beat:
. Too fast (tachycardia)
. Too slow (bradycardia)
. Too early (premature contraction)
. Too erratically (fibrillation)
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Nearly everyone will experience an abnormal heart rhythm at least once. It may feel like your heart is racing or fluttering.
Arrhythmias are common and usually harmless, but some are problematic. When an arrhythmia interferes with blood flow to your body, it can damage your:
. Other vital organs
If they’re not treated, arrhythmias may be life threatening.
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About Iranian Surgery
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For more information about the cost of Arrhythmia Treatment in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number +98 901 929 0946. This service is completely free.
Before Arrhythmia Treatment
What's a normal heartbeat?
Your heart is made up of four chambers — two upper chambers (atria) and two lower chambers (ventricles). Your heart rhythm is normally controlled by a natural pacemaker (sinus node) located in the right atrium. The sinus node produces electrical impulses that normally start each heartbeat. These impulses cause the atria muscles to contract and pump blood into the ventricles.
The electrical impulses then arrive at a cluster of cells called the atrioventricular (AV) node. The AV node slows down the electrical signal before sending it to the ventricles. This slight delay allows the ventricles to fill with blood. When electrical impulses reach the muscles of the ventricles, they contract, causing them to pump blood either to the lungs or to the rest of the body.
In a healthy heart, this process usually goes smoothly, resulting in a normal resting heart rate of 60 to 100 beats a minute.
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Certain conditions can lead to, or cause, an arrhythmia, including:
. A heart attack that's occurring right now
. Scarring of heart tissue from a prior heart attack
. Changes to your heart's structure, such as from cardiomyopathy
. Blocked arteries in your heart (coronary artery disease)
. High blood pressure
. Overactive thyroid gland (hyperthyroidism)
. Underactive thyroid gland (hypothyroidism)
. Sleep apnea
Other things that can cause an arrhythmia include:
. Drinking too much alcohol or caffeine
. Drug abuse
. Stress or anxiety
. Certain medications and supplements, including over-the-counter cold and allergy drugs and nutritional supplements.
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You may not have any symptoms of an arrhythmia. However, common signs can include:
. Feeling like your heart skipped a beat
. A fluttering feeling in your neck or chest
. Rapid heartbeat
. Slow or irregular heartbeat
Talk to your doctor about your symptoms so they can effectively diagnose and treat your arrhythmia. You may also develop more serious symptoms from your heart not working properly, including:
. Chest pain
. Difficulty breathing
. Dizziness or lightheadedness
. Fainting, or almost fainting
Seek medical care right away if you experience any of these symptoms.
Certain conditions may increase your risk of developing an arrhythmia. These include:
. Coronary artery disease, other heart problems and previous heart surgery. Narrowed heart arteries, a heart attack, abnormal heart valves, prior heart surgery, heart failure, cardiomyopathy and other heart damage are risk factors for almost any kind of arrhythmia.
. High blood pressure. This increases your risk of developing coronary artery disease. It may also cause the walls of your left ventricle to become stiff and thick, which can change how electrical impulses travel through your heart.
. Congenital heart disease. Being born with a heart abnormality may affect your heart's rhythm.
. Thyroid problems. Having an overactive or underactive thyroid gland can raise your risk of arrhythmias.
. Diabetes. Your risk of developing coronary artery disease and high blood pressure greatly increases with uncontrolled diabetes.
. Obstructive sleep apnea. This disorder, in which your breathing is interrupted during sleep, can increase your risk of bradycardia, atrial fibrillation and other arrhythmias.
. Electrolyte imbalance. Substances in your blood called electrolytes — such as potassium, sodium, calcium and magnesium — help trigger and conduct the electrical impulses in your heart. Electrolyte levels that are too high or too low can affect your heart's electrical impulses and contribute to arrhythmia development.
Other factors that may put you at higher risk of developing an arrhythmia include:
. Drugs and supplements. Certain over-the-counter cough and cold medicines and certain prescription drugs may contribute to arrhythmia development.
. Drinking too much alcohol. Drinking too much alcohol can affect the electrical impulses in your heart and can increase the chance of developing atrial fibrillation.
. Caffeine, nicotine or illegal drug use. Caffeine, nicotine and other stimulants can cause your heart to beat faster and may contribute to the development of more-serious arrhythmias. Illegal drugs, such as amphetamines and cocaine, may profoundly affect the heart and lead to many types of arrhythmias or to sudden death due to ventricular fibrillation.
To diagnose a heart arrhythmia, your doctor will review your symptoms and your medical history and conduct a physical examination. Your doctor may ask about — or test for — conditions that may trigger your arrhythmia, such as heart disease or a problem with your thyroid gland. Your doctor may also perform heart-monitoring tests specific to arrhythmias. These may include:
. Electrocardiogram (ECG). During an ECG, sensors (electrodes) that can detect the electrical activity of your heart are attached to your chest and sometimes to your limbs. An ECG measures the timing and duration of each electrical phase in your heartbeat.
. Holter monitor. This portable ECG device can be worn for a day or more to record your heart's activity as you go about your routine.
. Event recorder. For sporadic arrhythmias, you keep this portable ECG device available, attaching it to your body and pressing a button when you have symptoms. This lets your doctor check your heart rhythm at the time of your symptoms.
. Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on your chest uses sound waves to produce images of your heart's size, structure and motion.
. Implantable loop recorder. If your symptoms are very infrequent, an event recorder may be implanted under your skin in the chest area to continually record your heart's electrical activity and detect abnormal heart rhythms.
If your doctor doesn't find an arrhythmia during those tests, he or she may try to trigger your arrhythmia with other tests, which may include:
. Stress test. Some arrhythmias are triggered or worsened by exercise. During a stress test, you'll be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored. If doctors are evaluating you to determine if coronary artery disease may be causing the arrhythmia, and you have difficulty exercising, then your doctor may use a drug to stimulate your heart in a way that's similar to exercise.
. Tilt table test. Your doctor may recommend this test if you've had fainting spells. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up. Your doctor observes how your heart and the nervous system that controls it respond to the change in angle.
. Electrophysiological testing and mapping. In this test, doctors thread thin, flexible tubes (catheters) tipped with electrodes through your blood vessels to a variety of spots within your heart. Once in place, the electrodes can map the spread of electrical impulses through your heart.
In addition, your cardiologist can use the electrodes to stimulate your heart to beat at rates that may trigger — or halt — an arrhythmia. This allows your doctor to see the location of the arrhythmia, what may be causing it and what treatments may help. Your doctor may also use this test to assess the likelihood that you will develop an arrhythmia if you have certain conditions that increase your risk.
Certain arrhythmias may increase your risk of developing conditions such as:
. Stroke. Heart arrhythmias are associated with an increased risk of blood clots. If a clot breaks loose, it can travel from your heart to your brain. There it might block blood flow, causing a stroke. If you have a heart arrhythmia, your risk of stroke is increased if you have an existing heart disease or are 65 or older.
Certain medications, such as blood thinners, can greatly lower your risk of stroke or damage to other organs caused by blood clots. Your doctor will determine if a blood-thinning medication is appropriate for you, depending on your type of arrhythmia and your risk of blood clots.
. Heart failure. Heart failure can result if your heart is pumping ineffectively for a prolonged period due to a bradycardia or tachycardia, such as atrial fibrillation. Sometimes controlling the rate of an arrhythmia that's causing heart failure can improve your heart's function.
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Arrhythmias can develop from a variety of causes, some of which you may not be able to prevent. Still, you can work to avoid triggering your arrhythmia or making it worse.
First, it’s important to understand the cause of your arrhythmia so you can avoid triggers. Preventable triggers may include:
. Certain medications
. Some street drugs
Talk to your doctor if you think any medications are causing your arrhythmia. Don’t stop taking or change your medication on your own.
A healthy lifestyle is also helpful for preventing and managing arrhythmia. Do your best to:
. Follow a healthy diet with reduced salt and fat
. If you smoke, stop smoking
. Exercise regularly
. Stay within a healthy weight range
. Reduce stress
. Limit the amount of alcohol you drink
. Maintain healthy blood pressure and cholesterol levels
Develop a plan with your doctor to help you manage your arrhythmia, including steps you can take when you have symptoms.
When to see a doctor
Arrhythmias may cause you to feel premature heartbeats, or you may feel that your heart is racing or beating too slowly. Other signs and symptoms may be related to your heart not pumping effectively due to the fast or slow heartbeat. These include shortness of breath, weakness, dizziness, lightheadedness, fainting or near fainting, and chest pain or discomfort.
Seek urgent medical care if you suddenly or frequently experience any of these signs and symptoms at a time when you wouldn't expect to feel them.
Ventricular fibrillation is one type of arrhythmia that can be deadly. It occurs when the heart beats with rapid, erratic electrical impulses. This causes the lower chambers in your heart (ventricles) to quiver uselessly instead of pumping blood. Without an effective heartbeat, blood pressure plummets, cutting off blood supply to your vital organs.
A person with ventricular fibrillation will collapse within seconds and soon won't be breathing or have a pulse. If this occurs, follow these steps:
. If there's no one nearby trained in cardiopulmonary resuscitation (CPR), provide hands-only CPR. That means uninterrupted chest compressions at a rate of 100 to 120 a minute until paramedics arrive. To do chest compressions, push hard and fast in the center of the chest. You don't need to do rescue breathing.
. If you or someone nearby knows CPR, begin providing it if it's needed. CPR can help maintain blood flow to the organs until an electrical shock (defibrillation) can be given.
. Find out if an automated external defibrillator (AED) is available nearby. These portable defibrillators, which can deliver an electric shock that may restart heartbeats, are available in an increasing number of places, such as in airplanes, police cars and shopping malls. They can even be purchased for your home.
. No training is required. The AED will tell you what to do. It's programmed to allow a shock only when appropriate.
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During Arrhythmia Treatment
Types of arrhythmias
Doctors classify arrhythmias not only by where they originate (atria or ventricles) but also by the speed of heart rate they cause:
. Tachycardia (tak-ih-KAHR-dee-uh). This refers to a fast heartbeat — a resting heart rate greater than 100 beats a minute.
. Bradycardia (brad-e-KAHR-dee-uh). This refers to a slow heartbeat — a resting heart rate less than 60 beats a minute.
Not all tachycardias or bradycardias mean you have heart disease. For example, during exercise it's normal to develop a fast heartbeat as the heart speeds up to provide your tissues with more oxygen-rich blood. During sleep or times of deep relaxation, it's not unusual for the heartbeat to be slower.
Tachycardias in the atria
Tachycardias originating in the atria include:
. Atrial fibrillation. Atrial fibrillation is a rapid heart rate caused by chaotic electrical impulses in the atria. These signals result in rapid, uncoordinated, weak contractions of the atria.
The chaotic electrical signals bombard the AV node, usually resulting in an irregular, rapid rhythm of the ventricles. Atrial fibrillation may be temporary, but some episodes won't end unless treated.
Atrial fibrillation is associated with serious complications such as stroke.
. Atrial flutter. Atrial flutter is similar to atrial fibrillation. The heartbeats in atrial flutter are more-organized and more-rhythmic electrical impulses than in atrial fibrillation. Atrial flutter may also lead to serious complications such as stroke.
. Supraventricular tachycardia. Supraventricular tachycardia is a broad term that includes many forms of arrhythmia originating above the ventricles (supraventricular) in the atria or AV node. These types of arrhythmia seem to cause sudden episodes of palpitations that begin and end abruptly.
. Wolff-Parkinson-White syndrome. In Wolff-Parkinson-White syndrome, a type of supraventricular tachycardia, there is an extra electrical pathway between the atria and the ventricles, which is present at birth. However, you may not experience symptoms until you're an adult. This pathway may allow electrical signals to pass between the atria and the ventricles without passing through the AV node, leading to short circuits and rapid heartbeats.
Tachycardias in the ventricles
Tachycardias occurring in the ventricles include:
. Ventricular tachycardia. Ventricular tachycardia is a rapid, regular heart rate that originates with abnormal electrical signals in the ventricles. The rapid heart rate doesn't allow the ventricles to fill and contract efficiently to pump enough blood to the body. Ventricular tachycardia may not cause serious problems if you have an otherwise healthy heart, but it can be a medical emergency that requires prompt medical treatment if you have heart disease or a weak heart.
. Ventricular fibrillation. Ventricular fibrillation occurs when rapid, chaotic electrical impulses cause the ventricles to quiver ineffectively instead of pumping necessary blood to the body. This serious problem is fatal if the heart isn't restored to a normal rhythm within minutes.
Most people who experience ventricular fibrillation have an underlying heart disease or have experienced serious trauma.
. Long QT syndrome. Long QT syndrome is a heart disorder that carries an increased risk of fast, chaotic heartbeats. The rapid heartbeats, caused by changes in the electrical system of your heart, may lead to fainting, and can be life-threatening. In some cases, your heart's rhythm may be so erratic that it can cause sudden death.
You can be born with a genetic mutation that puts you at risk of long QT syndrome. In addition, several medications may cause long QT syndrome. Some medical conditions, such as congenital heart defects, may also cause long QT syndrome.
Bradycardia — A slow heartbeat
Although a heart rate below 60 beats a minute while at rest is considered bradycardia, a low resting heart rate doesn't always signal a problem. If you're physically fit, you may have an efficient heart capable of pumping an adequate supply of blood with fewer than 60 beats a minute at rest.
In addition, certain medications used to treat other conditions, such as high blood pressure, may lower your heart rate. However, if you have a slow heart rate and your heart isn't pumping enough blood, you may have one of several bradycardias, including:
. Sick sinus syndrome. If your sinus node, which is responsible for setting the pace of your heart, isn't sending impulses properly, your heart rate may alternate between too slow (bradycardia) and too fast (tachycardia). Sick sinus syndrome can also be caused by scarring near the sinus node that's slowing, disrupting or blocking the travel of impulses. Sick sinus syndrome is most common among older adults.
. Conduction block. A block of your heart's electrical pathways can occur in or near the AV node, which lies on the pathway between your atria and your ventricles. A block can also occur along other pathways to each ventricle.
Depending on the location and type of block, the impulses between the upper and lower halves of your heart may be slowed or blocked. If the signal is completely blocked, certain cells in the AV node or ventricles can make a steady, although usually slower, heartbeat.
Some blocks may cause no signs or symptoms, and others may cause skipped beats or bradycardia.
If you have an arrhythmia, treatment may or may not be necessary. Usually, it's required only if the arrhythmia is causing significant symptoms or if it's putting you at risk of a more serious arrhythmia or arrhythmia complication.
Treating slow heartbeats
If slow heartbeats (bradycardias) don't have a cause that can be corrected, doctors often treat them with a pacemaker because there aren't any medications that can reliably speed up the heart.
A pacemaker is a small device that's usually implanted near your collarbone. One or more electrode-tipped wires run from the pacemaker through your blood vessels to your inner heart. If your heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate your heart to beat at a steady rate.
Treating fast heartbeats
For fast heartbeats (tachycardias), treatments may include one or more of the following:
. Vagal maneuvers. You may be able to stop an arrhythmia that begins above the lower half of your heart (supraventricular tachycardia) by using particular maneuvers that include holding your breath and straining, dunking your face in ice water, or coughing.
These maneuvers affect the nervous system that controls your heartbeat (vagus nerves), often causing your heart rate to slow. However, vagal maneuvers don't work for all types of arrhythmias.
. Medications. For many types of tachycardia, you may be prescribed medication to control your heart rate or restore a normal heart rhythm. It's very important to take any anti-arrhythmic medication exactly as directed by your doctor in order to minimize complications.
If you have atrial fibrillation, your doctor may prescribe blood-thinning medications to help keep dangerous blood clots from forming.
. Cardioversion. If you have a certain type of arrhythmia, such as atrial fibrillation, your doctor may use cardioversion, which can be conducted as a procedure or by using medications.
In the procedure, a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses in your heart and can restore a normal rhythm.
. Catheter ablation. In this procedure, your doctor threads one or more catheters through your blood vessels to your heart. Electrodes at the catheter tips can use heat, extreme cold or radiofrequency energy to damage (ablate) a small spot of heart tissue and create an electrical block along the pathway that's causing your arrhythmia.
Treatment for heart arrhythmias also may involve use of an implantable device:
. Pacemaker. A pacemaker is an implantable device that helps control abnormal heart rhythms. A small device is placed under the skin near the collarbone in a minor surgical procedure. An insulated wire extends from the device to the heart, where it's permanently anchored.
If a pacemaker detects a heart rate that's abnormal, it emits electrical impulses that stimulate your heart to beat at a normal rate.
. Implantable cardioverter-defibrillator (ICD). Your doctor may recommend this device if you're at high risk of developing a dangerously fast or irregular heartbeat in the lower half of your heart (ventricular tachycardia or ventricular fibrillation). If you have had sudden cardiac arrest or have certain heart conditions that increase your risk of sudden cardiac arrest, your doctor may also recommend an ICD.
An ICD is a battery-powered unit that's implanted under the skin near the collarbone — similar to a pacemaker. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors your heart rhythm.
If it detects an abnormal heart rhythm, it sends out low- or high-energy shocks to reset the heart to a normal rhythm. An ICD doesn't prevent an abnormal heart rhythm from occurring, but it treats it if it occurs.
Surgery or other procedures
In some cases, surgery may be the recommended treatment for heart arrhythmias:
. Maze procedure. In the maze procedure, a surgeon makes a series of surgical incisions in the heart tissue in the upper half of your heart (atria) to create a pattern or maze of scar tissue. Because scar tissue doesn't conduct electricity, it interferes with stray electrical impulses that cause some types of arrhythmia.
The procedure is effective, but because it requires surgery, it's usually reserved for people who don't respond to other treatments or for those who are having heart surgery for other reasons.
. Coronary bypass surgery. If you have severe coronary artery disease in addition to arrhythmias, your doctor may perform coronary bypass surgery. This procedure may improve the blood flow to your heart.
After Arrhythmia Treatment
If you have been diagnosed and treated for arrhythmia, make sure to follow your treatment plan. Your ongoing care may focus on reducing the chance that you will have another episode or a complication. Keep your regular appointments with your doctor. Ask about heart-healthy lifestyle changes that you can make to keep your arrhythmia from happening again or getting worse.
Receive routine follow-up care
How often you need to see your doctor for follow-up care will depend on your symptoms and treatment.
. Get regular vaccinations, including a flu shot every year.
. Follow your doctor's recommendations for adopting lifelong lifestyle changes, such as heart-healthy eating, being physically active, quitting smoking, managing stress, and aiming for a healthy weight. Your doctor may also recommend that you reduce or stop drinking alcohol and consuming coffee, tea, soda, chocolate, or other sources of caffeine, to avoid triggering arrhythmia.
. Keep all of your medical appointments. Bring a list of all the medicines you take to every doctor and emergency room visit. This will help your doctors know exactly what medicines you are taking, which can help prevent medicine errors.
. See your doctor for regular checkups if you are taking blood-thinning medicines. Your doctor may recommend blood thinners to prevent stroke, even if your heart rhythm has returned to normal. You may need routine blood tests to check how the medicines are working or the effect they are having on your organs.
. Take your medicines as prescribed. Your doctor may also ask you to check your pulse regularly to monitor the effectiveness of the medicines.
. Tell your doctor if you have side effects from your medicines, such as depression, light-headedness, or palpitations. Some of the medicines can cause low blood pressure or a slow heart rate or can make heart failure worse.
. Tell your doctor if your symptoms are getting worse or if you have new symptoms. Over time, arrhythmias can become more common, last longer, or get worse. This can sometimes make arrhythmia resistant to medicines. Some arrhythmias can also make it more likely for other types of arrhythmia to develop.
Lifestyle and home remedies
Your doctor may suggest that, in addition to other treatments, you make lifestyle changes that will keep your heart as healthy as possible.
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These lifestyle changes may include:
. Eat heart-healthy foods. Eat a healthy diet that's low in salt and solid fats and rich in fruits, vegetables and whole grains.
. Exercise regularly. Aim to exercise for at least 30 minutes on most days.
. Quit smoking. If you smoke and can't quit on your own, talk to your doctor about strategies or programs to help you break a smoking habit.
. Maintain a healthy weight. Being overweight increases your risk of developing heart disease.
. Keep blood pressure and cholesterol levels under control. Make lifestyle changes and take medications as prescribed to correct high blood pressure or high cholesterol.
. Drink alcohol in moderation. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
. Maintain follow-up care. Take your medications as prescribed and have regular follow-up appointments with your doctor. Tell your doctor if your symptoms worsen.
Research is ongoing regarding the effectiveness of several forms of complementary and alternative medical therapies for arrhythmia.
Some types of complementary and alternative therapies may be helpful to reduce stress, such as:
. Relaxation techniques
Some studies have shown that acupuncture may help reduce irregular heart rates in certain arrhythmias, but further research is needed.
The role of omega-3 fatty acids, a nutrient found mostly in fish, in the prevention and treatment of arrhythmias isn't yet clear. But it appears as though this substance may be helpful in preventing and treating some arrhythmias.
Monitor your condition
To monitor your condition, your doctor may recommend the following tests.
. Blood tests to check the effects of medicines you are taking
. Echocardiography (echo) to check your heart function if you have underlying heart disease.
. EKGs to monitor changes in heart rhythm
. Holter or event monitors to record your heart’s electrical activity over several days.
. Smartphone-based monitors to record heart rhythms and detect when atrial fibrillation occurs. A band that can record a 30-second EKG has been approved by the U.S. Food and Drug Administration.