Have you ever felt like your heart was beating very fast, or very slow, or maybe skipping beats without a beat? It's normal to feel a little scared when you feel something like this. Most people have had this experience at some point in their lives. In medicine, we call this abnormality in the heart's rhythm 'Arrhythmia' (pronounced 'arrhythmia'). So don't be afraid, today we will talk about everything in a simple way that you can understand.
What exactly is arrhythmia?
Simply put, arrhythmia is an irregular heartbeat. This is also called 'dysrhythmia'.
Imagine that our heart is like a drummer in a band. The song only sounds good if he beats the drums to the right tune and at the right speed. The same is true of our heart. It needs to beat in a proper, organized rhythm. Only then can it pump the right amount of oxygen-rich blood to the entire body.
In an arrhythmia, this rhythm becomes disrupted.
- Maybe the heart is beating very fast .
- Maybe the heart beats very slowly .
- Or it can be played irregularly , without a single beat.
These conditions can start in different parts of the heart.
Is this a serious condition to be afraid of?
It's natural for this question to come to your mind. There are actually many types of arrhythmia. Some types are harmless and don't require treatment. However, others are more serious. They can even cause a sudden cardiac arrest. There are also different types of arrhythmia that fall between these two extremes.
The most important thing is that only your doctor can tell you exactly what type of arrhythmia you have, whether it needs treatment, and what to do if necessary. Therefore, it is very important to seek medical advice rather than self-diagnosing.
What are the main types of arrhythmia?
Doctors classify arrhythmias based on where in the heart they start. Let's put this simply. The heart has four main chambers, two on the top and two on the bottom.
| Type of arrhythmia | Simply put... |
|---|---|
| Supraventricular Arrhythmias | These begin in the upper chambers of the heart (atria) . 'Supraventricular' means 'above the lower chambers'. |
| Ventricular Arrhythmias | These begin in the lower chambers (ventricles) of the heart. |
| Bradyarrhythmias | These are caused by problems with the heart's electrical signaling system, causing the heart to beat too slowly . These can be caused by problems with the heart's natural pacemaker (SA node) or with the pathways that carry signals (such as the AV node). |
Atrial Fibrillation is the most common type of arrhythmia seen in Sri Lanka and around the world. It belongs to the Supraventricular type.
What symptoms does someone with arrhythmia experience?
Some people can have arrhythmia without any symptoms. We call this a "silent" arrhythmia. However, if symptoms do occur, they may include:
| Symptom | How it feels |
|---|---|
| Heart Palpitations | Feeling your heart beating hard, your chest pounding, your chest jumping. |
| Dizziness or Lightheadedness | Dizziness or vertigo . |
| Fainting episodes | Suddenly losing consciousness and falling. |
| Shortness of breath | Feeling short of breath, like when climbing stairs. |
| Chest discomfort | Feeling of pain or discomfort, like a tightness in the chest. |
| Weakness or fatigue | Feeling extremely tired and lifeless for no reason. |
Why does this happen? What are the risk factors?
It is difficult to pinpoint one specific cause of arrhythmia. There are many possible causes. Let's look at the main causes and risk factors.
Causes of arrhythmia
- Coronary artery disease ( blockage of the heart's blood vessels )
- High blood pressure
- Changes in the heart muscle (`Cardiomyopathy`)
- Heart valve disorders
- Injury from a previous heart attack
- Electrolyte imbalances in the blood
- The recovery process after heart surgery
- Other illnesses (for example, thyroid problems)
Factors that increase risk
- Use of tobacco products (smoking)
- Excessive drinking
- Excessive consumption of caffeine-containing drinks and foods (tea, coffee, cola)
- Use of stimulants, such as some cold medicines
- High blood pressure
- Overweight (BMI greater than 30)
- Diabetes or high blood sugar levels
- Snoring and sleep apnea
What are the possible serious consequences if left untreated?
If not treated properly, some types of arrhythmia can cause serious complications.
- Weakening of the heart muscle (`Cardiomyopathy`): When the heart beats irregularly over a long period of time, the heart muscle may weaken and its ability to pump blood may decrease.
- Cardiac arrest: Some severe ventricular arrhythmias can cause the heart to suddenly stop beating.
- Stroke: In some arrhythmias, such as atrial fibrillation, blood clots can form in the heart. If this blood clot travels to the brain and blocks a blood vessel, it can cause paralysis.
How does a doctor detect this?
When you go to see a doctor, he or she will first ask about your symptoms and examine you. They may check your pulse and listen to your heart with a stethoscope to check for any irregular heartbeats.
After that, various tests may be ordered to confirm the diagnosis and find the cause.
| Test | Simply... |
|---|---|
| ECG (Electrocardiogram) | A test that records the electrical activity of the heart. This is the most basic test used to detect arrhythmia. |
| Blood tests | Check things like body salt levels and thyroid hormones. |
| Ambulatory Monitors (eg, Holter monitor) | A small device is implanted in your body to continuously record your heart rhythm for 24 hours or more. |
| Echocardiogram (Echo) | A heart scan. This can look at things like the size, shape, and function of the valves. |
| Stress Test | Taking an ECG while you exercise (walking on a treadmill). This helps detect arrhythmias that occur during exercise. |
| Electrophysiology Study (EPS) | A specialized test that studies the heart's electrical system in great depth. |
What are the treatments for this?
Treatment depends on the type of arrhythmia you have and its severity. Sometimes no treatment is needed. If treatment is needed, there are several options.
1. Medications
There are several types of medications. Not all medications are the same. Your doctor will help you find the right medication and dosage for you.
- Antiarrhythmic drugs: Medications given to restore an irregular rhythm to normal (sinus rhythm) or to prevent the occurrence of an arrhythmia.
- Heart rate control medicines: Medicines given to control a fast heartbeat.
- Anticoagulant/antiplatelet drugs: Medications given to reduce the risk of blood clots (e.g. warfarin, aspirin).
2. Lifestyle Changes
These are very important.
- Controlling blood pressure and diabetes.
- Quitting smoking completely.
- Limiting alcohol consumption.
- Reduce or stop the use of caffeine and stimulants.
- Maintaining a healthy weight.
3. Specific Therapies
- Cardioversion: The delivery of a controlled electrical shock to the heart to restore normal heart rhythm.
- Catheter Ablation: A thin tube (catheter) is passed through a vein in the leg or arm to the heart and a small section of heart tissue causing the arrhythmia is deactivated with high-frequency electrical energy.
4. Devices that are worn on the body
- Permanent Pacemaker: A device given to people with very slow heartbeats (bradycardia). It sends small electrical signals to keep the heart rate at a normal level.
- Implantable Cardioverter Defibrillator (ICD): This is a device that continuously monitors the heart's rhythm. If it detects a very fast, abnormal rhythm (ventricular tachycardia/fibrillation) that can be life-threatening, it delivers a shock to the heart to restore the rhythm.
5. Surgery
In some cases, surgery may be required to treat the underlying heart disease (valve disease, blocked arteries) that is causing the arrhythmia. The Maze procedure is a specific surgery for atrial fibrillation.
When should I see the doctor? What time should I go to the ETU?
If you have arrhythmia, it's important to go to the clinic on time and get checked out as your doctor recommends. However, sometimes you need to seek medical advice sooner.
Call your doctor if your symptoms (e.g., chest pain, dizziness) are getting worse or are occurring more frequently, rather than waiting until the day you usually go to the clinic.
Situations when you should go to the Emergency Treatment Unit (ETU) immediately:
If you experience any of the following symptoms, do not waste time and immediately go to the ETU (Emergency Treatment Unit) of the nearest hospital.
- Severe difficulty breathing
- Chest pain
- Severe dizziness
- Fainting
Take-Home Message
- Arrhythmia is an irregular heartbeat. These are not always serious, but some types can be dangerous.
- If you have symptoms such as chest pain, dizziness, difficulty breathing, or loss of consciousness, be sure to see a doctor.
- Simple lifestyle changes (quitting smoking, limiting alcohol, and controlling weight) can greatly help control arrhythmia.
- If you have been prescribed medication, never stop taking it or change the dosage without your doctor's advice.
- In case of emergency (severe chest pain, difficulty breathing, loss of consciousness), go to the ETU immediately.
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