ARRHYTHMIA

• Arrhythmia is a term for any of a large and heterogeneous group of conditions in which there is abnormal electrical activity in the heart. • The heart beat may be too fast or too slow, and may be regular or irregular.• can occur with a normal heart rate, or with heart rates that are slow and also rapid heart rates

CAUSES OF ARRHYTHMIA1. Coronary artery disease - produces scar tissue in the heart that disrupts the transmission

of signals which control the heart rhythm

2. Changes in heart muscle - abnormal enlargement, thickening and stiffening of heart

muscles

3. Healing process after heart surgery - may take some changes in order to for heart to function

normally.

4. Congenital - born with the condition

TYPES OF ARRHYTHMIAS

1. Premature atrial contractions - Due to premature discharge of an electrical

impulse in the atrium - These are early extra beats that originate in

the atria

2. Premature ventricular contractions - cause by stress, heart disease or too much

exercise

3. Atrial fibrillation - common irregular heart rhythm that causes the

atria, the upper chambers of the heart to contract abnormally

4. Paroxysmal supraventricular tachycardia - there are 2 types: a) AV nodal reentrant tachycardia - due to more than one pathway through the AV node - can cause heart palpitations, fainting or heart failure

b) Accessory pathway tachycardias - due to an extra abnormal pathway between the atria and the ventricles.

5. Atrial flutter - caused by one or more rapid circuits in the atrium - occurs most often in people with heart disease in the first week after heart surgery. - often converts to atrial fibrillation

6. Ventricular tachycardia - originating from the lower chambers (or ventricles) - rapid rate prevents the heart from filling adequately with blood cause less blood is able to pump through the body

7. Ventricular fibrillation - disorganized firing of impulses from the

ventricles - The ventricles quiver and are unable to contract

or pump blood

8. Sinus node dysfunction - due to an abnormal SA (sinus) node 9. Heart block - A delay or complete block of the electrical impulse as it travels from the sinus node to the ventricles - heart may beat irregularly and, often, more slowly

SYMPTOMS OF ARRHYTHMIAS

Most common symptoms:• palpitations or rapid thumping in your

chest• feeling tired or light-headed• loosing consciousness• shortness of breath • chest pain.

Symptoms that lead to fast heart rate:• heartbeat might feel like a strong pulse in

neck• a fluttering, racing beat in chest• feelings of discomfort• Weakness• shortness breath• faint• sweaty• dizzy

Symptoms that lead to slow heart rate:• feeling tired• short of breath• dizziness

How are arrhythmias diagnosed?

1. Electrocardiogram

- Small patches called electrodes are placed on our chest, arms and legs, and are connected by wires to the ECG machine.

- Our heart's electrical impulses are translated into a wavy line on a strip of moving paper

- enabling doctors to determine the pattern of electrical current flow

2. Holter monitor - a small, portable machine that we wear for 24 hours - enables continuous recording of our ECG

3. Tilt Table Test - used to diagnose fainting or black-out spells (vasovagal syncope) by trying to reproduce

the black-out episodes - You will be tilted upright to about 60 degrees on a special table for a period of time

4. Electrophysiology study (EPS) - Special catheters are threaded through veins into the heart. - electrical impulse generated by the heart shows up on a computer screen. - Electrical impulses are utilized to evaluate for arrhythmias

5. Stress Test - enables physicians to record our heart's electrical activity which may not occur at rest.

6. Magnetic Source Imaging - used as an overlay to magnetic resonance imaging - The device senses weak magnetic fields generated by heart muscle tissue - localizes the arrhythmia non-invasively to save time during the invasive study.

7. Event Recorder - small portable transtelephonic monitor that may be worn for several weeks. - The monitor "loops" a two-minute recording into its memory that is continually overwritten

TREATMENT OF ARRHYTHMIAS

1. Lifestyle Changes - avoid activity that lead to irregular heart rhythm - stop smoking - stop drink alcohol - Limit or stop using caffeine - Stay away from stimulants used in cough and cold medications

2. Medications - Antiarrhythmic drugs (control heart-rate) - Anticoagulant or antiplatelet therapy (reduce the risk of blood blood clots)

3. Surgical Procedures a) electrical cardioversion - After administration of a short-acting anesthesia, an electrical shock is delivered to our chest wall that synchronizes the heart and allows the normal rhythm to restart.

b) pacemaker - a device that sends small electrical impulses to the heart muscle to maintain a suitable heart rate - primarily prevent the heart from beating too slowly. - has a pulse generator (which houses the battery and a tiny computer) and leads (wires) that send impulses from the pulse generator to the heart muscle.

4. implantable cardioverter-defibrillator (ICD) - to treat ventricular tachycardia and ventricular fibrillation, two life-threatening heart rhythms - When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle to cause the heart to beat in a normal rhythm again

5. catheter ablation - high-frequency electrical energy is delivered through a catheter to a small area of tissue inside the heart that causes the abnormal heart rhythm - This energy "disconnects" the pathway of the abnormal rhythm.

6. heart surgery - needed to correct heart disease that may be causing the arrhythmia - During this procedure, a series (or "maze") of incisions are made in the right and left atria to confine the electrical impulses to defined pathways