A guide to managing arrhythmias
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Almost everyone has at some time experienced an odd heartbeat — feeling your heart race, pound, flutter, pause or skip a beat. These episodes of an unusual heart rhythm, or arrhythmia, caused by abnormal electrical impulses in the heart, are often minor and harmless. Sustained or more serious irregular rhythms, however, can pose a danger and lead to cardiac arrest.
Some people don’t notice any symptoms. Others feel palpitations or a galloping or sluggish heartbeat, shortness of breath, chest pain or discomfort, fatigue or weakness, dizziness or unexplained falls or fainting. If you experience any of these symptoms suddenly or frequently, seek urgent care.
WHAT’S GOING ON?
A normal heart rate is between 60 and 100 beats a minute and fluctuates during the day and in response to anxiety, excitement or some medications. Heart rate speeds up during exercise and slows during sleep.
“Physicians classify the many types of arrhythmias by where they originate and the type of heart rate they cause. A rate faster than 100 beats a minute is called tachycardia and slower than 60 beats a minute is called bradycardia,” said Apoor Patel, M.D., board-certified electrophysiologist at Houston Methodist DeBakey Cardiology Associates at Sugar Land.
For example, in atrial fibrillation, abnormal impulses in one of the heart’s upper chamber, or atria, cause the heart to beat too fast. Atrial fibrillation (AFib), the most common arrhythmia, affecting millions of Americans, refers to very fast and chaotic contracting of the heart’s atrial chambers. The uncoordinated impulses cause the atria to beat so fast — 300 to 400 beats a minute — they quiver. Supraventricular tachycardia, or SVT, is another example of a fast heartbeat from the upper chamber due to a short circuit in the heart that can present with a rapid and sustained heartbeat. When patients get rapid heartbeats from the bottom chamber of the heart, or the ventricles, they have ventricular tachycardia which can often be dangerous.
Slow heart rates, or bradycardia, can be due to degeneration of the conduction system of the heart. “Sinus node dysfunction occurs in the area of the heart that serves as a natural pacemaker and causes the heart to beat slowly. In some instances, when the heart’s normal electrical pathways shut down or allow only intermittent signals, heart block (also called conduction block) occurs, which can slow down the heart rate at varying degrees of severity,” Patel explained.
TREATING YOUR ARRHYTHMIA
Not all arrhythmias require treatment, but patients need to manage arrhythmias that cause significant symptoms, increase risk for a more serious condition or impair the heart’s efficiency and circulation. Treatment depends on the type and degree of the arrhythmia, and may include:
• Lifestyle measures. Because many arrhythmias arise from underlying heart disease, doctors may recommend more exercise, an improved diet, better stress management, not smoking and limiting caffeine and alcohol as ways to reduce episodes.
• Vagal maneuvers. Some types of tachycardia, especially SVT, can be treated by stimulating your vagal nerves — the part of the nervous system that regulates your heart rate — which respond by slowing your heart rate. These “maneuvers” include holding your breath and straining, coughing and dunking your face in ice water.
• Medications. Beta-blockers, calcium channel blockers, sodium and potassium channel blockers, and digitalis may slow or suppress tachycardia. However, these medications may produce unwanted side effects, cause an arrhythmia to occur more frequently, or produce a new arrhythmia.
• Implantable devices. Surgery to implant an artificial pacemaker is a common treatment for bradycardia. This device, implanted under the skin and attached to the heart, sends an electrical impulse whenever the heart rhythm slows or becomes erratic. Another device, the implantable cardioverter defibrillator, can be placed in the chest to correct an abnormally fast heartbeat usually in patients with a weak heart.
• Cardioversion. This treatment uses drugs or an electrical shock to reset the heart to its regular rhythm.
• Catheter ablation. “Catheters are threaded through blood vessels to the heart and deliver radiofrequency energy to carefully destroy (ablate) the abnormal portions of the heart causing the arrhythmia. This method is highly successful in treating many arrhythmias,” Patel said.
THE BOTTOM LINE
It’s important to tell your doctor about any symptoms of arrhythmia you experience. Even if symptoms pass quickly, your heart’s ability to work may be compromised. Over time, a seemingly harmless arrhythmia could lead to a more serious condition.
To schedule an appointment with Apoor Patel, M.D., at Houston Methodist DeBakey Cardiology Associates at Sugar Land, call 346.901.2070.
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