Why do some hearts go off beat?
Though most cardiac arrhythmias are relatively minor medical events, some basic knowledge about what causes the condition, and how it can be prevented, can keep your heart beating just right year after year.
In novels and movies, fluttering heartbeats and palpitating chests are popular symptoms for love-at-first-sight and budding romances. In real life though, an irregular heartbeat is a medical condition known as cardiac arrhythmia that ranks as one of the most prevalent heart disorders in Thailand and worldwide.
While most arrhythmias are treatable and pose little threat to a patient’s future health, more serious cases are potentially fatal and require urgent medical attention. To understand more about the condition and how to prevent it, Better Health called on Dr. Kriengkrai Jirasirirojanakorn, a Bumrungrad cardiologist specializing in cardiac electrophysiology who has many years of experience treating patients with irregular heartbeats.
What is arrhythmia?
Cardiac arrhythmia is an “equal opportunity” health threat.The condition strikes people from all walks of life and every age group. Many sufferers were in excellent physical condition and had no prior history of heart problems before their diagnosis.
Arrhythmia describes the heart’s beating rhythm becoming abnormal or irregular – too fast, too slow, or beating erratically. “The rhythm of the heartbeat is regulated by electrical signals that move from the heart’s upper right chamber over to the upper left chamber, then down to the lower chambers,” Dr. Kriengkrai explains. “The signals tell the heart when it’s time to contract and when it’s time to pump blood out into the body’s circulatory system. The electrical system makes subtle adjustments to the heartbeat pattern in response to external events, such as when a person’s activity level changes.”
A healthy heart beats 50 to 100 times every minute while resting. When a patient suffers a cardiac arrhythmia, the heart may speed up, slow down, or feel like it’s skipping some beats. “Irregular heartbeats can be triggered by faults in the heart’s electrical signaling process,” notes Dr. Kriengkrai.
“In other cases, the source of the problem may turn out to be an abnormality in the electrical pathways. The abnormal beating rhythm can quickly impair the healthy functioning of the body’s circulatory system.”
Upper and lower
Arrhythmias may originate from either the upper or the lower chambers of the heart. Serious cases, such as those involving patients with ventricular tachycardia arrhythmias originating from the heart’s lower chambers, can be deadly, especially if a victim fails to get medical help quickly.
The most common arrhythmia – atrial fibrillation – originates from the heart’s upper chambers. While generally not life-threatening, the condition does require medical attention to prevent serious complications such as heart failure or stroke.
Causes and symptoms
Despite the potentially serious nature of their condition, most arrhythmia patients don’t realize they have it until it is diagnosed “accidentally”, i.e. during routine health check-ups or while being treated for an unrelated condition.
When arrhythmias are detected early, treatments are more successful and less traumatic. Dr. Kriengkrai reminds patients about the benefits of early disease detection while encouraging them to remain vigilant about spotting warning signs and symptoms. “During an arrhythmia, the most common
symptoms are dizziness and light-headedness, chest pain, a pounding sensation in the chest, shortness of breath and/or fainting,” says Dr. Kriengkrai. “The situation can quickly deteriorate if patients don’t seek medical help right away.”
One way to prevent an arrhythmia is to steer clear of external sources that may over-stimulate the heart. “An irregularity in the heartbeat can be triggered by external factors,” Dr. Kriengkrai says. “The most common are excessive coffee drinking, heavy alcohol consumption, stress, and the use of certain drugs. The arrhythmias caused by these external triggers don’t usually turn out to be serious,
and they’re unlikely to occur if the triggers are avoided.”
Internal factors such as underlying medical conditions can also trigger an irregular heartbeat. “In many cases, we can trace the problem to an abnormality in the patient’s heart structure,” says Dr. Kriengkrai. “The most common causes include congenital heart disease, valvular heart disease,
coronary artery disease, hypertrophic cardiomyopathy, and myocardial infarction.”
Diagnosis and detection
Diagnosing cardiac arrhythmias requires expertise and flexibility. The electrocardiogram (EKG) is a widely used tool for arrhythmia detection, but the unique nature of arrhythmias sometimes requires the use of other testing methods. The EKG may be unable to spot the problem if the symptoms don’t recur while the test is being administered.
“An initial result that shows no abnormality doesn’t mean there isn’t a problem,” Dr. Kriengkrai explains. “Several types of diagnostic tests are capable of detecting the source of the heartbeat problem even if it’s not picked up during the EKG.”
Widely used tests include: exercise stress testing; Holter testing which conducts continuous monitoringof electrical activity in the cardiovascular system over a period of 24 to 48 hours; Cardiac electrophysiology testing involves a tiny catheter that is inserted into a blood vessel and is guided to its correct position near the heart’s upper and lower chambers. The catheter records information on electrical conduction that allows the doctor to pinpoint the location of the arrhythmia source.
Some arrhythmias resolve themselves without any medical treatment. In cases where treatment is deemed necessary, determining the best course of treatment requires a thorough review of the patient’s overall health, the nature and severity of symptoms, checking for the presence of other medical problems which may be affecting the heartbeat, and completing a suitability assessment for each treatment option to confirm their suitability for the individual patient.
The most common treatments for arrhythmias include:
Medication. Many cardiac arrhythmia patients can be successfully treated by medication alone. While medication doesn’t produce a permanent cure, arrhythmia medications have excellent histories of safely and effectively reducing the frequency of arrhythmia events, and for limiting the severity of symptoms;
Cardioversion. This treatment involves the use of an external device that transmits electrical signals to the heart which prompt it to convert the irregular heartbeat back to a normal rhythm;
Ablation therapy. During this electrical conduction treatment, a cardiac electrophysiologist implants a tiny catheter into a blood vessel and guides it to the problem area. High-frequency radio waves transmitted through the catheter dissolve the abnormal tissues that were impairing the heart’s normal beating. This treatment has been shown to permanently cure certain types of arrhythmias;
Pacemaker. A tiny pacemaker device is implanted under the skin near the clavicle bone. It monitors heartbeat rhythm and emits electrical impulses when the heart needs stimulation to maintain a healthy beat;
Implantable cardioverter defibrillator. This treatment uses a pacemaker-like device in patients diagnosed with life-threatening ventricular fibrillation. When the heart-beat is too slow, the device sends a signal instructing the heart to pick up the pace. If the heartbeat becomes too fast, a signal from the device converts the rapid heart-beat back to its healthy, slower rate.
Take charge and prevent
While there’s no guaranteed method for total arrhythmia prevention, you can significantly lower your own arrhythmia risk by following a three-pronged preventive approach:
- Avoid known triggers such as excessive caffeine consumption, heavy alcohol consumption, smoking and stress;
- Adopt healthier nutrition and exercise habits;
- Follow your doctor’s recommendation for periodic check-ups and preventive screenings.
Your heart will repay your efforts with healthy heartbeats for years to come.