Cardiac Arrhythmia

What Is Cardiac Arrhythmia?

Cardiac arrhythmias are deviations from the normal heartbeat. These can be harmless or have a pathological value. A distinction is made between bradycardia, when the heart beats too slowly, tachycardia when the heart beats too fast, and extrasystole when the heart beats irregularly. Not all variants of cardiac arrhythmia are relevant for treatment. For example, every healthy person repeatedly has sporadic extrasystoles.

What Is Considered a Normal Heartbeat?

The human heart beats rhythmically at a rate between 60 and 100 beats per minute. The heartbeat is created by electrically exciting heart muscle cells and transmitting this excitation to each cell of the heart. The excitation begins at a small area in the heart's right atrium, the so-called sinus node. It generates a rhythm on its own and transmits it to the rest of the heart via specific conduction paths. This frequency can be influenced by various parameters (e.g., the sympathetic nervous system, parasympathetic nervous system, or excitement/stress/sports versus relaxation/digestion).

If the heart comes out of this rhythm, it is called cardiac dysrhythmia or arrhythmia (from Greek: unrhythmic). Depending on their severity and type, arrhythmias can be divided into different groups. If the heart beats too slowly (under 60 beats per minute), this is called bradycardia. A heartbeat that is too fast, on the other hand, is called tachycardia (more than 100 beats per minute at rest). Furthermore, there are extra beats (extrasystoles) or blockages in the heart's transmission of excitation.

Different Types of Cardiac Arrhythmia

The most frequent cardiac arrhythmias are:

• Atrial fibrillation
• Tachycardia (rapid heartbeat)
• Atrioventricular-block
• WPW syndrome
• Sick-sinus-syndrome

The Causes of Cardiac Arrhythmia

Cardiac arrhythmias can have many different causes. However, there are also cardiac dysrhythmia cases in which no reason can be found even after an intensive search. The following heart diseases can influence the heart rhythm:

• Congenital heart defects: these can be congenital, like some types of heart defects, electrical conduction path disorders, or defective ion channels.
• Acquired myocardial insufficiency: inflammation of the heart (myocarditis), a heart attack, or heart valve diseases can cause disturbances in heart rhythm.
• Besides, disturbances outside the heart can also lead to cardiac arrhythmia. Since the heart's electrical conduction is carried between the cell and the outside of the cell by changes in ions (such as potassium and magnesium), electrolyte disorders, thyroid disorders, and medication can also lead to cardiac arrhythmia.
• Stress, lack of oxygen, or alcohol consumption can also lead to disorders. For example, alcohol consumption can trigger atrial fibrillation in some people, known as holiday heart syndrome, as it is more common when excessive alcohol consumption occurs during vacations or weekends.

Signs and Symptoms of Cardiac Arrhythmia

Depending on the type of cardiac arrhythmia, the effects vary. Common signs are:

• Extrasystole: The heart's extra beats lead to a compensatory suspension of the next beat, which can be felt like a heart stumbling.
• Tachycardia: palpitations are so-called irregular or intense or strenuous heart actions. If the heart becomes too fast, whether regular or irregular, this can be felt as sometimes unpleasant or frightening palpitations. Sometimes you can even feel this down to the throat.
• Heart pain: heart pain can also occur (angina pectoris); this should always be checked by an internist or cardiologist because there is a risk of a heart attack.
• Dizziness and fainting: As a cardiac dysrhythmia can lead to a massive restriction of the heart function in some instances, there is a risk of insufficient blood circulation in the brain.
• Shortness of breath and edema

How Is Cardiac Arrhythmias Clarified?

Usually, the symptoms lead the patient to a general practitioner or internist who, after taking the medical history and carrying out a physical examination (including pulse and blood pressure measurement, auscultation of heart and lungs), will arrange an ECG examination in the next step.

Up to 12 electrodes are attached to the body during the ECG. Then, the heart's current flow can be calculated, whether it is delayed or too fast, and initial signs to the cause can also be found. Since a single ECG does not have any particular significance (if it looks normal), an ECG can also occur under stress (usually on a bicycle), which may reveal rhythm disturbances that do not occur at rest.

A long-term ECG can also be carried out. In this case, the patient usually wears the ECG electrodes and a small measuring and storage device on the body for 24 hours. A cardiologist evaluates the ECG after 24 hours.

Since electrolyte disorders, hyperthyroidism, or hypothyroidism can also lead to cardiac arrhythmia, a blood sample should be taken to check the specific values depending on the patient's medical history.

Another examination method is echocardiography, a type of ultrasound that allows us to measure and observe the heart walls and valves' structure and movement, and the blood flow in the heart. The echocardiography can be carried out at rest and during movement (stress echo). In addition to the external ultrasound examination, there is also an echocardiography examination through the esophagus (TEE transesophageal echocardiography), which offers different views of the heart due to its proximity to the heart.

Furthermore, there is an invasive method of electrophysiological examination, a particular type of heart catheter examination. It offers the possibility to identify the electrical leads and the origin of cardiac arrhythmias using small wires, which are placed into the heart via veins or arteries.

What to Do in Case of Cardiac Arrhythmia

All cardiac arrhythmias should be clarified at least once by a cardiologist or internist. Some types of cardiac dysrhythmia can be harmless and do not require therapy. However, other types can be extremely dangerous and even fatal. Today, treatment is only given when it is absolutely necessary.

When is Heart Rhythm Treatment Necessary?

The following indications make treating cardiac arrhythmias necessary:

• Risk of sudden cardiac death.
• The danger of a stroke is imminent.
• Physical performance is limited.
• High stress for the affected person due to dizziness, palpitations, or pronounced discomfort

Which Therapeutic Methods Can Be Used?

If an underlying disease can be held responsible for the cardiac arrhythmia, it has to be treated initially. In the case of thyroid disorders, poisoning, and electrolyte disorders, appropriate therapy leads to rapid subsidence of heart complaints.

If the rhythm disturbances occur due to stress, alcohol consumption, or psychological problems, the lifestyle should be changed. Important factors are abstention from alcohol and cigarettes, sufficient sleep, and no meals that exceed the feeling of satiety. Relaxation and sufficient exercise are also important for a healthy heart.

For arrhythmias, which can be traced back to the heart, the following therapeutic procedures are available, depending on the type of cardiac arrhythmia.

Medications for Cardiac Arrhythmia

So-called rhythm medication or antiarrhythmic drugs are used for drug treatment. These are drugs that regulate the heart rate differently (depending on the mode of action). They can ensure that rhythm disturbances occur less frequently and are easier to tolerate. Unfortunately, it is never foreseeable how the individual patient will react to a particular medication. Therefore, different drugs and dosages often have to be tested until a satisfactory result can be achieved, taking months.

The first administration of rhythm medication should always be under medical supervision. Either in the cardiological practice or during a hospital stay in a heart clinic. Patients should never change the dosage on their own or stop taking the medication without consulting a cardiologist. Regular check-ups by the attending physician are important even in well-adjusted patients. Ideally, these should take place every three months.

Rhythm Surgery - Surgical Procedures for Cardiac Arrhythmia

Some causes of arrhythmias require surgery by a heart surgeon, for example, for valvular heart disease or bypass surgery for coronary heart disease. Drugs do not help to prevent sudden cardiac death either. The following important surgical procedures can be used for cardiac arrhythmias. Detailed information on the individual procedures can be obtained by clicking on the link.

• Pacemaker for bradycardia
• Defibrillator implantation for the danger of sudden cardiac death
• Atrial fibrillation ablation

What Are the Prognoses and Life Expectancy for Cardiac Arrhythmia?

Many types of cardiac dysrhythmia can be fatal and should, therefore, not be taken lightly. The absolute necessity for action is valid. If a targeted therapy is carried out after the cause has been identified, the chances of leading a normal life again are good.

Of course, every therapy also has its risks, both the medication and the surgeries. However, your attending cardiologist or internist will discuss all possibilities and disadvantages with you in detail before starting therapy. If you have any questions, do not hesitate to ask. It is your life and your illness. The better you know about it, the better you can handle it.

The therapy offers the possibility to live more carefree again, without the danger of fainting, sudden clouding of consciousness, and loss of consciousness due to cardiac arrhythmia. By the way, driving a motor vehicle is also prohibited from these symptoms.

Which Doctors and Clinics Are Specialized in Cardiac Arrhythmia?

Every patient suffering from cardiac dysrhythmia wants the best medical diagnosis and treatment. Therefore, the patient is wondering where to find the best clinic for cardiac arrhythmias or the best cardiac clinics in Germany, Austria, and Switzerland. As this question cannot be answered objectively, and a reliable doctor would never claim to be the best one, we can only rely on a doctor's experience.

The diagnosis of arrhythmias is primarily the responsibility of the general practitioner and resident cardiologists. Depending on the cause, a cardiologist can carry out treatment or a cardiac surgeon in a heart clinic. Several heart centers offer rhythmology and rhythm surgery in a separate department with heart specialists who deal exclusively with cardiac arrhythmias. The more patients are treated or operated on, the more experienced the doctor becomes.

Sources:

http://www.herzstiftung.de/Herzrhythmusstoerungen-Sonderband.html

http://www.herzstiftung.de/pressemeldungen_artikel.php?articles_ID=651

Herold, Gerd: Innere Medizin. Köln, Eigenverlag 2012.

Arasteh, K. ; Baenkler, H.-W. ; Bieber, C. ; et al.: Innere Medizin. Stuttgart, Georg Thieme Verlag KG 2009.