Does your heart rhythm sometimes go in strange ways? Let's talk about Idioventricular Rhythm!

Do you sometimes feel like there's something slightly different about the way your heart beats? Maybe it's a little too fast, or it feels like it's beating in a very strange way? Don't worry, most of the time these aren't serious problems. However, it's important for you to be aware of this condition we're going to talk about today, called `Idioventricular Rhythm`.

What is `Idioventricular Rhythm`? Let's understand it simply!

Simply put, an ``Idioventricular Rhythm`` is a heart rhythm in which the lower chambers of your heart, the ``ventricles`` , beat more slowly than normal. Think about it, the upper chambers of our heart (the ``atria``) are where the ``natural pacemaker``, or more precisely the ``sinoatrial node``, is located. If this pacemaker is not working properly, the cells in the lower part of the heart think, "Okay, let's make the heart beat." But, they can only make it beat a little slower.

Normally, in this ``Idioventricular Rhythm'', the heart beats less than 50 times per minute .

However, there is another small difference, it is called `Accelerated Idioventricular Rhythm (AIVR).` Then the heart rate is between 50 and 110 beats per minute. This is different from the condition called `Ventricular Tachycardia` (Ventricular Tachycardia), where the heart beats faster (more than 100 beats per minute), right?

This shouldn't be confused with other heart rhythm problems, right?

Yes, there are many other conditions related to heart rhythm. Therefore, this `Idioventricular Rhythm` can be confused with another one. That is `Junctional Rhythm`.

• Idioventricular Rhythm: This begins in the lower chambers of the heart, the ventricles.
• Junctional Rhythm: This begins at the junction between the upper and lower chambers of the heart (associated with the AV node).

Did you see the difference? Even though both rhythms start in the wrong place in the heart, the two starting points are different.

Who is most likely to be affected by this situation?

Although anyone can develop a condition called ``Idioventricular Rhythm,'' some people are more likely to develop it. They are:

• People with complete or severe heart block.
• People with problems with the heart's natural pacemaker, such as `sinus arrest` or `sinoatrial nodal block`.
• People who have had a `heart attack`.
• People who use certain medications (especially those for heart disease) and illegal drugs.
• Very rarely, it can also occur in people with congenital heart problems.

Accelerated Idioventricular Rhythm (AIVR) can sometimes occur in healthy athletes. However, it is most often seen in people with other underlying heart conditions, such as:

• Ischemic cardiomyopathy (ICM) is a weakening of the heart muscle due to blockage of the blood vessels supplying the heart.
• `Rheumatic heart disease` (damage to the heart valves after a throat infection).
• Dilated cardiomyopathy (dilated cardiomyopathy - the heart muscle becomes weak and enlarged).
• `Acute coronary syndromes` (acute coronary syndromes - sudden interruption of blood supply to the heart).
• `Acute myocarditis` (acute inflammation/swelling of the heart muscle).

What are the symptoms? Or do you feel nothing at all?

Here's a surprising fact! Most of the time, people with `Idioventricular Rhythm` don't experience any symptoms . Yes, it's true. Imagine, some people don't even know they have this condition, and it's discovered by chance when they have an `ECG` done for something else.

However, some people may develop symptoms. If so, they may experience:

• Fatigue: You may just feel tired.
• Dizziness: You may feel like your head is spinning and you may feel like you are losing your balance.
• Fainting/Loss of consciousness: Some people may suddenly lose consciousness and fall. This is a more serious sign.
• Heart palpitations: You may feel your heart beating faster, like it's pounding loudly inside your chest.

Remember, these symptoms don't happen to everyone. However, if you experience these symptoms frequently, it's best to see a doctor.

Why does this `Accelerated Idioventricular Rhythm (AIVR)` occur? What are the causes?

There are several specific causes of the `Accelerated Idioventricular Rhythm (AIVR)` that we discussed earlier, which is a condition where the heart beats at a rate between 50-110 beats per minute. These are:

• Myocarditis (inflammation of the heart muscle).
• After a heart attack.
• Some types of `cardiomyopathies` (cardiomyopathy - heart muscle disease).
• After resuscitation (for example, after a heart attack, when resuscitated with `CPR`).
• A very high level of the electrolyte potassium in the body.
• Toxicity caused by taking too much of the heart medication `Digoxin (Digitek® or Cardoxin®)`.

How does a doctor find this?

If you have these symptoms, or for any other reason, when you see a doctor, he or she will first examine you thoroughly (`physical exam`). Then he or she will ask about your medical history and family history.

In addition, the following tests can be performed to determine exactly whether this `Idioventricular Rhythm` condition exists:

• Electrocardiogram (ECG/EKG): This is the most important test. It records the electrical activity of the heart. In Idioventricular Rhythm, the ECG shows that the lower chambers of the heart are beating in a regular rhythm, but the upper chambers (atria) are irregular or absent.
• `Holter monitor`: This is like a small `ECG` machine. But you have to wear it for 24 or 48 hours. It can monitor how your heart rhythm changes while you go about your daily activities. Sometimes, these abnormal rhythms may not show up during the short time it takes to get an `ECG`.

What are the treatments? Is this really something to be afraid of?

Here's the good news! For most people, a condition called ``Idioventricular Rhythm'' is not dangerous (``benign``) and doesn't require any special treatment. In most cases, it just goes away on its own.

However, if your doctor decides to treat it, it will often be by treating the underlying problem that caused the condition. For example:

• If this condition was caused by a medication, stop or change that medication.
• If there is a problem with the functioning of the heart (e.g. heart block), treat it.

Now, if the `Accelerated Idioventricular Rhythm (AIVR)` persists, and your blood pressure is also dropping, then the doctor can do the following to restore normal heart rhythm:

• Administering medications such as `Atropine (Atreza® or Sal-Tropine®)` or `isoproterenol`.
• Using a special device (e.g., a temporary pacemaker) to restore the rhythm of the upper chambers of the heart.

What can we do to reduce this risk?

Although Idioventricular Rhythm is not harmful in most cases, the risk of developing such conditions can be somewhat reduced by taking steps to keep our hearts healthy.

• Exercise regularly and eat a heart-healthy diet (low in oil, salt, and sugar, high in fruits and vegetables).
• Try to keep your body's electrolyte levels (especially potassium) normal . A balanced diet is important for this.

What happens if you have `Idioventricular Rhythm`? What to expect?

Again, for most people, this is not a dangerous condition and will resolve without treatment. However, if you are experiencing frequent heart palpitations and this abnormal rhythm persists without returning to normal, you should definitely seek medical attention.

When should you seek medical advice?

In most cases, you don't need to do anything special for `Idioventricular Rhythm`. It will go away on its own. However, if this condition doesn't get better on its own and you experience symptoms such as fainting, see a doctor immediately.

Most importantly: If you think you are having symptoms of a `Heart Attack` (e.g. severe pain in the middle of the chest, difficulty breathing, vomiting, excessive sweating), call 1990 immediately and call an ambulance!

What are the important questions to ask the doctor?

If your doctor tells you that you have ``Idioventricular Rhythm'', it's a good idea to ask these questions:

• "Doctor, can you tell me exactly what is causing my `Idioventricular Rhythm`?"
• "If I need treatment for this, what is the best treatment for me?"

Although `Idioventricular Rhythm` is usually not a big problem, other abnormal heart rhythms can be dangerous. Therefore, if you feel a strange heartbeat, if you experience things like dizziness, see a doctor without delay. If your doctor tells you to start or stop taking any medication, follow those instructions exactly. Also, it is very important to go for `follow-up` tests on the scheduled dates.

Take-Home Message

Okay, so let's briefly remind you of some important points from what we've talked about:

• Idioventricular Rhythm is a heart rhythm that begins in the lower chambers (cells) of the heart and is usually slow.
• Most of the time, this is not a dangerous condition, and many people do not even show symptoms.
• However, if this condition persists with symptoms such as nausea , you should definitely seek medical advice.
• Treatment often addresses the underlying condition that caused it, and can sometimes be managed with medication.
• Always follow your doctor's instructions and attend scheduled checkups.

It is very important to take care of your heart. I hope this information is helpful to you!

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