1. What is an Irregular Heartbeat or Arrhythmia?
Have you ever felt your beat faster or harder when you’re excited or have just completed a long run? Fortunately, the heart rhythm comes back to normal fairly quickly and if it doesn’t, it could be a symptom of a disorder. Arrhythmia, or irregular heartbeat, is a heart disorder that occurs when the heart is beating too quickly or too slowly or is beating at an irregular rhythm. When the heart beats faster than its natural rhythm of 60 to 100 beats per minute, it is called Tachycardia. When the heart beats too slowly, compared to the average rate, it is called bradycardia.
Although Arrhythmia doesn't generally exhibit any symptoms, some people experience chest pains, fluttering chest, giddiness, skipping beats, shortness of breath and excessive sweating. These are considered indicators of heart rhythm problems during a diagnosis. An irregular heartbeat often occurs due to congenital diseases, smoking and consumption of alcohol. The treatment options for this condition can include medication or surgery to implant a pacemaker.
Not all irregular heartbeats indicate a problem in the heart. Sometimes, after intense workouts, the heart tends to beat very fast and pump a lot of blood. There are also times when the heart beats at a relatively slow pace during rapid eye movement (REM) sleep.
The sinuses, also known as the heart's pacemaker, send impulses to the atrium and ventricles in the heart. When these impulses are sent from the atria to the ventricles in a specified manner, without any transmission loss, the heart pumps blood normally.
In a normal heartbeat, the sinus nodes send signals to the right atria, which are then transmitted down to the ventricles through a network of complex fibres, called the His-Purkinje system.
Arrhythmia occurs when this progression of impulses causes the atrium and ventricles to pump blood at the same time, the atrium and ventricles to pump blood rapidly, slow it down significantly or pump blood without any order in the atrium and ventricles.
2. Symptoms of Arrhythmia
Often, Arrhythmia remains undetected while at other times, without irregular heartbeat symptoms present themselves in various forms. Since Arrhythmia can range from being completely harmless to fatal, it is important to consult a cardiologist if you observe any of the following:
- Skipped beats (also known as palpitations)
- A fluttering or thumping sensation in the chest
- Feeling constantly tired
- Passing out constantly
- Shortness of breath and chest pains
- Racing heart.
3. What Causes Irregular Heartbeat
Arrhythmia can occur due to various reasons. It can be a result of a genetic condition, a side-effect of a previous condition, eating and drinking habits of an individual, and the consumption of tobacco, alcohol or drugs, including amphetamines and cocaine. Irregular heartbeat can also occur due to stress, herbal treatments, health supplements, structural changes to the heart or as a side-effect of medicines.
Here’s a look at what else can cause irregular heartbeat:
- Stress and anxiety
- Excessive exercise
- Caffeine
- Nicotine
- Hormonal changes
- An ongoing heart attack
- Scarring of the heart due to a previous heart attack
- Blocked blood vessels in the aortic region
- High blood pressure and an imbalance in the body’s blood sugar and salt levels
- Hyperthyroidism and hypothyroidism
- Excessive consumption of alcohol
- As a hereditary condition
- From over-the-counter (OTC) medications for colds, allergies and other supplements.
Most Arrhythmias are not fatal. However, there are a few conditions that when left undiagnosed and untreated can become life-threatening. These conditions include:
- Coronary heart disease: Previous heart surgeries due to a heart attack or narrowed walls can lead to Arrhythmias, which can subsequently cause irregular heartbeats.
- High blood pressure: High blood pressure can lead to stiffening of the walls in the ventricles, which can cause Arrhythmia. It can also increase the risk of developing coronary artery disease, such as narrowing of the arteries due to deposits of cholesterol-containing plaque.
- Congenital conditions: Certain conditions or deformities in the heart can result in irregularities in the way the heart pumps blood, in turn leading to an irregular heartbeat.
- Hormonal imbalance: The thyroid glands are the hormone centres of the body and over- or under-secretion by these glands can cause irregular heartbeats.
- Imbalance in electrolytes: Imbalance in the amount of sodium, potassium, calcium and magnesium electrolytes in the body can be a major driving force for irregular heartbeats. These electrolytes help trigger electrical impulses through the sinusoidal artery, and an electrolyte imbalance can hamper the way the signals are sent to the atrium and ventricles in the heart, causing them to pump blood irregularly.
4. Types of Irregular Heartbeats
On a broader spectrum, Arrhythmia can be classified into different types depending on the irregularity presented in the electrocardiogram.
Tachycardia
Tachycardia is a form of Arrhythmia that occurs when the heart is beating too fast, without the patient participating in any excessive physical activities at that moment. For an average adult, anything above 100 beats per minute can be considered Tachycardia.
Symptoms of Tachycardia include:
- Breathlessness
- Syncope (a sensation of fainting)
- Chest pain
- Lightheadedness
- Dizziness and sudden weakness
Bradycardia
Bradycardia occurs when the heartbeats are too slow, below 60 beats per minute.
Symptoms of Bradycardia include:
- Trouble concentrating
- Angina
- Confusion
- Feeling of constant exhaustion
- Excessive sweating or diaphoresis
- Lightheadedness and syncope
Atrial Fibrillation
Atrial fibrillation occurs when the sinus nodes send irregular impulses to the atrium and the upper valves pump blood irregularly or without any orientation to each other or to the ventricles. This causes the atrium to flutter and twitch. This is called fibrillation. This causes the heart to beat irregularly and often too fast, thus leading to Arrhythmia.
Atrial Flutter
Atrial flutter occurs when an electrical imbalance causes the atrium to beat too fast, at a pace that ranges between 250 and 400 beats per second. This irregular heartbeat causes the heart to pump too quickly. When this happens, vital organs like the brain and heart muscles might not get enough blood, resulting in heart failure or stroke.
Symptoms of atrial flutter include:
- Syncopy
- Lightheadedness
- Shortness of breath
- Anxiety
- Severe chest pain
Ventricular Fibrillation
Ventricular fibrillation occurs when the ventricles quiver but do not pump any blood. In this condition, just like in atrial fibrillation, you can observe irregular heartbeat symptoms, but the effects of ventricular fibrillation can be fatal. In this condition, the heart stops pumping blood, which means the heart and brain do not have access to oxygen-rich blood. This can cause a stroke or heart failure. Unlike atrial fibrillation, the ventricles will only quiver but pump no blood, thereby cutting the supply of oxygen-rich blood to the body and rendering the patient unconscious almost immediately.
Symptoms of ventricular fibrillation include:
- Tachycardia
- Nausea and dizziness
- Syncope (feeling of fainting)
- Shortness of breath
Long QT Syndrome (LQTS)
Here, the heart beats erratically for prolonged durations and causes the patient to experience seizures, unconsciousness or even death. Since LQTS is a genetic disorder, the risk of this disease exists from birth. However, most people experience their first episode of LQTS after entering their 40s.
Symptoms to detect the presence of LQTS are:
- Giddiness
- Syncope
- Seizures
- Sudden death
5. Complications That May Arise
Arrhythmias are common in people who have undergone heart surgery or a coronary stent procedure. Irregular heartbeat is also common among those with genetic structural defects in the heart. In most cases, these Arrhythmias are non-life-threatening, but there are instances when they can be fatal, such as:
- Aneurysms: An aortic aneurysm occurs when the wall of the arteries in the heart weakens and causes an uneven bulge. Arrhythmia can be a major reason for an aortic aneurysm.
- Autoimmune diseases: Lupus and rheumatoid arthritis can be triggered due to irregular heartbeats.
- Cardiomyopathy: Heart rhythm problems cause the heart muscles to thicken, enlarge and, sometimes, become stiff. Cardiomyopathy causes strokes, which leads to fluid buildup in the lungs, heart, knees and brain.
- Heart Inflammation: Inflammation is the body’s way of handling injuries or infections. Arrhythmia, in its various forms, holds the potential to cause inflammation due to the stiffening or enlargement of heart muscles. Heart inflammation can show up as chest pain, shortness of breath, weakness, and rapid heartbeat.
- Heart failure: Heart failure can be caused by ventricular fibrillation or, sometimes, atrial fibrillation.
- COPD: Chronic Obstructive Pulmonary Disease (COPD) is caused by inhaling cigarette smoke directly or through second-hand channels. It also occurs due to prolonged exposure to chemical effluents and factory smoke. Patients diagnosed with COPD exhibit a high occurrence of ventricular fibrillation, which could result in a stroke and prove fatal.
- Narrowed arteries and heart valves: Tachycardia or Bradycardia leads to decreased blood supply, which causes the heart to pump more blood to meet the body's demand for oxygen-rich blood. Also, when the heart valves and arteries around the aortic region are narrowed, the same effect takes place. The result is reduced blood supply to the heart muscles and brain.
6. Prevention
Heart rhythm disorders can be prevented by ensuring a healthy and active lifestyle. Making conscious decisions to eat a cholesterol-free diet, staying away from smoking or second-hand smoke and exercising regularly to maintain a healthy weight, devoid of excess fat in the body are the first steps towards prevention.
An extra layer of preventive measures to keep irregular heartbeat at bay include:
- Avoiding caffeine, alcohol and drugs.
- Avoiding unnecessary stress and avoiding situations that could trigger fear, anger and stress.
- Controlling blood sugar and salt levels in the body to prevent diabetes.
7. Diagnosing Heart Rhythm Disorders
Heart rhythm problems can be diagnosed through a series of physical tests and ECGs in controlled simulations. The doctor might look for abnormal activities in the thyroid glands or test the heart rate under different conditions. You may also be subjected to different heart monitoring tests, which can include:
ECG
An electrocardiogram (ECG) is a device attached to your chest to measure electrical activity in the heart. It measures and times the duration of every electrical phase. This helps diagnose any irregularity in the heartbeat and the presence of Arrhythmia.
Holter Monitor
A Holter monitor is a portable version of an ECG. It can be worn all day to measure and monitor the activity of the heart for longer durations. The readings from a Holter monitor provide information on the way impulses are transmitted through different parts of a person’s body.
Event Recorder
An event recorder is a portable ECG machine that lets you record the functioning of your heart during Arrhythmia by pressing a button. This gives the doctor a data stream to read the performance of the heart in specific conditions, thus making it easier for them to make a diagnosis.
Echocardiogram
An Echocardiogram is a non-invasive test that uses sound waves to measure the size, structure and motion of the heart. It is a hand-held portable device, generally placed on the chest and uses sound waves to assess the functioning of the heart. An Echocardiogram can detect an irregular heartbeat and help the consulting cardiologist recommend treatment or prevention options, depending on the type of arrhythmia.
Implantable loop recorder
An implantable loop recorder is a device used to track occurrences of inconsistent arrhythmias. Here, the doctor plants a recorder under your skin, which consistently records the electrical activity of the heart and any anomalies.
Doctors use the above tests to identify the occurrence of Arrhythmias. However, in a few scenarios, when these tests do not work, a targeted approach is taken to trigger Arrhythmias in the form of:
- Stress set
Stress can be used to trigger or worsen Arrhythmias. A stress test is conducted in a controlled environment, where the patient is made to run on a treadmill or cycle till stress builds and Arrhythmia appears. If the patient has difficulty exercising, the doctor will induce stress through a drug that simulates the sensation one experiences while exercising to induce Arrhythmia.
- Tilt table test
This test is recommended if the patient is experiencing syncope or fainting conditions. In a tilt table test, the patient is exposed to inclines and declines at various angles and their reactions to those conditions are monitored. In most cases, Arrhythmia is triggered, enabling the doctors to monitor it while it occurs and find the cause of the irregular heartbeat.
- Electrophysiological testing and mapping
Here, the doctor connects multiple electrode-tipped catheters to various regions of the heart to see what is triggering and halting Arrhythmia and which portions of the heart it originates in. This test helps doctors diagnose the nature of the irregular heartbeat, understand its triggers and foresee situations that can trigger this condition.
8. Treatment
When patients take medications exactly as prescribed by their consulting physician, the results can be remarkable. These medications can correct irregular heartbeats, prevent strokes, and reduce or delay the risk of coronary heart disease. However, it is crucial not to interrupt or deviate from the prescribed course without first consulting the doctor.
The most effective and sought-after treatment options for heart rhythm problems are:
Antiarrhythmic drugs
Antiarrhythmic drugs are either given intravenously in emergencies or taken orally in the form of tablets to suppress irregular heartbeats caused by the misfiring of a pacemaker or suppress the transmission of impulses that can cause the rapid firing of the atrium or ventricles.
Patients suffering from atrial fibrillation are generally advised to use anticoagulants or blood thinners to battle the underlying causes on a long-term basis.
However, antiarrhythmic drugs are known for their long medication period and the chances of proarrhythmic conditions. In this, the patient is on medication for life, and, as a side-effect, it can increase the occurrence of Arrhythmia or cause new Arrhythmias to occur, which can be worse than the previous ones.
Calcium channel blockers
Calcium channel blockers work by limiting the flow of calcium into the heart. Calcium is an electrolyte that the Sinusoidal Artery uses to fire electric charge into the atrium and ventricles. Excessive calcium content can cause misfiring of impulses. Calcium channel blockers are also used to treat angina, blood pressure and other forms of irregular heartbeat.
Beta-blockers
Beta-blockers are the most common form of medication prescribed for patients suffering from atrial fibrillation. Here, the patient is prescribed atenolol, bisoprolol and metoprolol to reduce the adrenalin content in the blood. Consuming beta-blockers can make the patient drowsy and lethargic in the early stages, although this changes as the body gets accustomed to the medication.
Anticoagulants
Anticoagulants are blood thinners prescribed to patients at risk of developing new blood clots, either due to atrial fibrillation or the narrowing of blood vessels. This medication keeps the blood from clotting and is not designed to break/dissolve existing clots. Anticoagulants can be an effective cure for irregular heartbeats caused in the atrium.
Inserting a pacemaker
A pacemaker is a device that is implanted in the body near the collarbone. A wire, tipped with a cathode, is extended and anchored near the heart permanently. If the pacemaker detects any anomalies in the way the heart functions, it sends electrical impulses to correct the course of the heart and resume normal function.
Maze procedure
This is a treatment option that involves surgery. Therefore, it is reserved for people who do not respond to other forms of treatment. In this procedure, the surgeon makes a series of incisions on the heart to trigger the formation of scar tissue. Scar tissues do not conduct electricity and hence obstruct any stray impulses that could lead to irregular heartbeats.
9. Road to Recovery
Undergoing surgery or taking medication to treat irregular heartbeat is the first step towards recovery. Complete recovery from this condition can be achieved by making a few lifestyle changes to minimise the chances of another Arrhythmia. These lifestyle changes include:
- Eat healthy food: Avoid eating junk food or mass-produced food from fast-food chains or roadside eateries. Eat home-cooked food that is rich in proteins, carbohydrates and fats. Also, drink as much water as possible.
- Exercise regularly: If you don’t exercise regularly, try to work out for at least 30 minutes 3-5 times a week and slowly increase the intensity and duration of the workout over time. But consult a physician before increasing the intensity or duration of the workout.
- Quit smoking: Nicotine and tobacco smoke are major contributors to heart rhythm disorders.
- Check your weight: Being overweight increases the chances of developing coronary heart disease or Arrhythmia and other complications related to the heart. It is also advisable to keep blood pressure and cholesterol in check as these factors can affect the functioning of the arteries and the heart.
- Alcohol consumption in moderation: Check with your doctor if consuming alcohol will affect the underlying condition. However, in most cases, if the patient is below 65 years of age, they are advised not to have more than 2 drinks a day. This number goes down to 1 drink a day if the patient is over 65.
- Maintain follow-up care: Following the doctor’s instructions diligently can minimise the risk of new Arrhythmias and heart diseases. Ensure that all your medications are consumed without any breaches.
- Keep a track of new symptoms, if any: If there are any new symptoms, make a note of them and share them with your doctor. That way, the doctor can track your progress even between scheduled visits.
- Practice alternative methods: Yoga, meditation and other relaxation techniques can work wonders in keeping new Arrhythmias from developing. These methods improve the functioning of the heart and lungs and reduce the risk of developing coronary artery disease.
10. Arrhythmia FAQs: All your concerns addressed.
Q. What is arrhythmia?
Arrhythmia is a change in the normal sequence of electrical impulses of the heart. The electrical impulses may happen too fast, too slowly, or erratically. When the heart doesn’t beat properly, it can't pump blood effectively. When the heart doesn't pump enough blood, the lungs, brain and other organs cannot function properly and may shut down or be damaged.
Q. What is the normal heart rate?
Our heart beats 60-100 times per minute, generating a normal heart rate ranging from 60 to 100 beats per minute.
Q. What causes arrhythmia?
Arrhythmia is caused by:
- Coronary artery diseases
- Changes in the hurt muscles
- Heart attack-related injuries
- Recovery process after heart surgery
- Imbalance of electrolytes in the blood
Irregular heart rhythms can also take place in healthy hearts.
Q. What are the consequences of arrhythmias?
Certain arrhythmias increase the risk of heart attack, heart failure, cardiac arrest and stroke.
Q. What substances can contribute to arrhythmia?
Substances that can contribute to an abnormal/irregular heartbeat include:
- Caffeine
- Tobacco
- Alcohol
- Cold and cough medications
- Appetite suppressants
- Psychotropic drugs (used to treat certain mental illnesses)
- Antiarrhythmics (paradoxically, the same drugs used to treat arrhythmia can also cause arrhythmia. Your healthcare team will monitor you carefully if you're taking antiarrhythmic medication.)
- Beta-blockers for high blood pressure
- Street drugs, such as cocaine, marijuana and ‘speed’ or methamphetamines.
Q. What happens if arrhythmia is left untreated?
If Arrhythmia is left untreated, the heart will not pump sufficient blood to the body. This will damage the heart, brain, and other vital organs. It’s important to check with your doctor because the risk of arrhythmia depends on the environment, age, lifestyle, medical conditions, gender, ethnicity, and history of surgery.
Q. How do you check if you have arrhythmia at home?
Place your index and middle fingers firmly on your wrist and move them around till you locate the pulse. Count your heartbeat for thirty seconds and then multiply it by two to get your exact heart rate. If your heart is beating irregularly, you can count for one minute and not multiply.
Q. Can you get a stroke from heart arrhythmia?
If you have heart arrhythmia, the risk of a stroke rises. This is especially true for people over the age of 65 and for patients who have existing heart conditions. One of the major causes of heart arrhythmias is blood clots. If a clot occurs or breaks loose, it can travel to your brain from the heart. This is where it may block the blood flow, leading to a stroke.
Q. What can trigger an arrhythmia?
The heart’s electrical system can trigger an arrhythmia. Note that irregular heart rhythms can happen in healthy hearts as well. Certain substances, such as caffeine, nicotine, alcohol, cocaine, inhaling aerosols, diet pills, and cough and cold medicines can trigger arrhythmias.
Q. What are the symptoms of arrhythmia?
Arrhythmia can be silent and not have any symptoms. In such cases, the doctor will notice that you have an irregular heartbeat during a medical test/examination. They will observe your pulse, listen to your heart, or perform a series of diagnostic tests. If the symptoms of irregular heartbeat are observable, they will include:
- Heart palpitations
- Pounding feelings in the chest
- Feeling lightheaded or dizzy
- Shallow breathing
- Feeling discomfort in the chest
- Fatigue or weakness
Q. What are the various types of Ventricular Arrhythmias?
This arrhythmia starts in the heart’s vessels, and it includes:
- Premature ventricular contractions: This condition occurs when the heartbeats are early and extra. They start in the ventricles and don’t show any symptoms in the beginning. It’s a common type of arrhythmia and is related to excess stress, caffeine intake, nicotine, or exercise.
- Ventricular tachycardia: This occurs as a series of rapid heartbeats that start in the ventricles of the heart. The quick rhythm keeps the heart from filling up with adequate levels of blood. As a result, less blood is pumped through the body. It can be quite serious in people who have existing heart conditions.
- Ventricular fibrillation: This is a disorganised and erratic firing of impulses that starts from the ventricles. When the ventricles start to quiver and don’t generate effective contractions, it results in a lack of blood supply to the rest of the body.
Q. Can Arrhythmia be life-threatening?
Arrhythmias can sometimes be harmless but when left untreated, they can lead to major health complications, including strokes, heart valve diseases and death.
Q. Can Arrhythmias be cured?
Yes, most forms of Arrhythmia can be cured. Extensive medical surveys show that 80% of patients diagnosed with arrhythmias report being cured after following the medication regime.
Q. Is it safe to indulge in physical exercises if I have arrhythmia?
It is best to consult your doctor to evaluate your condition and determine whether your body can safely withstand the effects of physical workouts.
Q. Can I smoke or drink if I am diagnosed with an irregular heartbeat?
It is advisable to stay away from all tobacco and tobacco-based products because active and passive smoking has adverse effects on the heart.
It is advised to consult a medical practitioner regarding alcohol consumption.
Q. Will I be allowed to drive if I have an irregular heartbeat?
It depends on the type of arrhythmia and the severity of the condition. If the condition does not affect your driving and does not put you or others in harm's way, you can drive.
Q. What measures can be taken to prevent arrhythmia?
- Keep blood pressure under control.
- Control cholesterol levels.
- Lose excess weight.
- Eat a heart-healthy diet.
- Avoid smoking.
- Ensure regular physical activity.
Q. What treatment is given for arrhythmia?
The treatment modalities for arrhythmias are:
- Medicines
- Radiofrequency ablation
- Devices, such as pacemakers and AICD
The treatment option depends upon the type of arrhythmia.
Q. How many heartbeats per minute indicate a heart attack?
The normal heart rate is between 60 and 100 heartbeats per minute. Sometimes, due to cardiac arrest, your heart stops beating immediately. On the other hand, some cardiac muscles might start to fail due to a heart attack. Irregular heartbeat (slower or faster than normal heartbeats) can lead to failed cardiac muscles. The symptoms and heartbeats are dependent on the type of heart attack.
Q. What are the common symptoms of Arrhythmias?
If you are experiencing any of the below-mentioned symptoms, it could indicate Arrhythmia:
- Breathlessness
- Pain in the chest
- Bradycardia (slow heartbeats)
- Tachycardia (fast heartbeats)
- Fatigue
- Anxiety
- Sweating
- Dizziness
- Fainting
Q. What are the determinants of heart palpitations?
The causes of heart palpitations Include:
- Stress and anxiety
- Exercise
- Caffeine
- Nicotine
- Hormone changes
- Fever
- Certain medicines
- Low blood sugar
- Overactive thyroid gland
- Heart rhythm issues
- Premature ventricular contractions
- Alcohol
- Drugs
If you are experiencing one or more of the above, talk to your physician to understand the diagnosis and treatment.
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