2014: Issue 29

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Better Health 2014 > Better Heart Care > Cardiac arrhythmia

Cardiac Arrhythmia

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Cardiac arrhythmia:

Essential knowledge for healthy hearts 

Symptoms like dizziness, palpitations, fatigue and light-headedness usually aren’t a cause for concern. But they can also be symptoms of cardiac arrhythmia, one of the most prevalent heart disorders. Most arrhythmias are minor and highly treatable, but those left untreated may end up posing a much more serious threat to health.

     What is an arrhythmia? What causes the condition? What are its symptoms? And how is it treated? Better Healt consulted Dr. Chotikorn Khunnawat, a US-board certified cardiologist and electrophysiologist at Bumrungrad with many years of experience treating patients with cardiac arrhythmia, to learn what everyone should know about arrhythmias and the ways to reduce your personal risk of a future problem.

Too slow, too fast

      A healthy heart beats 60 to 100 times per minute in a steady, even rhythm. The upper and lower chambers of the heart beat together in a synchronized rhythm. Cardiac arrhythmia describes an irregular rhythm – the heart beats too fast, too slow, unevenly, or feels as if it’s skipping some beats.

      Cardiac arrhythmia strikes people from all walks of life and every age group. According to Dr. Chotikorn, there are many causes of arrhythmias, including:

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  • Congenital heart condition which means a person was born with an abnormality such as a thickening of the heart walls
  • Disorders that damage the heart or its valves, including diabetes, high blood pressure, hyperlipidemia, coronary heart disease, and other ailments normally associated with aging
  • Certain substances such as caffeine, alcohol and chocolate
  • Certain medications including those containing stimulants and some asthma treatment medications
  • Conditions affecting the thyroid gland, such as hyperthyroidism, electrolyte abnormalities such as low magnesium and potassium
  • Emotional stress and anxiety

     These factors can trigger an arrhythmia by disrupting the electrical impulses that follow a precise pathway through the heart. A rapid heartbeat in the upper chamber can produce a blood clot that, should it travel to the brain, can cause a paralyzing stroke. If the lower chamber’s rhythm is too fast, the heart may not send enough blood to the brain and can be deadly.

    Dr. Chotikorn emphasizes that a heartbeat that’s too fast or too slow doesn’t necessarily pose a serious threat. “If the heart is beating irregularly, a physician will determine the specific nature of the arrhythmia,” he explains. “If it is because of extra beats from the upper or lower chamber of the heart and no sign of blockage of coronary artery and the heart pumping function is normal, the situation isn’t likely to be harmful. But for patients with atrial fibrillation, which usually occurs in older patients, there is more potential for harm – especially for older patients diagnosed with underlying diseases such as diabetes or high blood pressure.” ”

Diagnosing arrhythmias

      Some arrhythmias are diagnosed after the patient experiences symptoms like palpitations, dizziness, lightheadedness or fainting and decides to see a doctor. It’s quite common though, especially among patients in good health, for an arrhythmia to produce only minor symptoms – or none at all.

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      Diagnosis begins with a review of the patient’s medical history. “When an arrhythmia is suspected,” Dr. Chotikorn explains, “the doctor conducts a physical examination to see whether the rhythm of the heart, the heart sound and the size of the heart are normal or not, followed by conducting laboratory blood screenings including thyroid function, and diagnostic tests such as EKG.”

      Dr. Chotikorn continues: “If these tests don’t reveal the arrhythmia, the doctor may carry out other tests to capture the arrhythmia. The doctor may have the patient wear a 24-hour Holter monitor to record the heart’s activity during a patient’s normal daily activity. If the arrhythmias are intermittent, the patient can be given the event monitor which can record the arrhythmia during symptoms by a simple trigger placed on the chest area to record the rhythm.” Your doctor may recommend other diagnostic tests to determine the severity of the arrhythmia and pinpoint the likely cause. These include ultrasound echocardiogram testing to examine the heart’s structures, heart pumping function and function of the valves; and an exercise stress test, which may include a treadmill test, to assess how well the heart performs during exertion and to exclude cardiac ischemic causing arrhythmia. The diagnostic process provides critical information the doctor uses to identify the type of arrhythmia, the cause of arrhythmia and the best possible treatment options for each patient’s individual situation.

arrhythmia treatment doctor Thailand "A healthy heart beats 60 to 100 times per minute in a steady, even rhythm. The upper and lower chambers of the heart beat together in a synchronized rhythm."

Dr. Chotikorn Khunnawat


Arrhythmia treatments

      Several arrhythmia treatment options are available depending on the nature of the arrhythmia and the patient’s individual health situation. Patients taking medication for other conditions that cause arrhythmia may be required to temporarily stop the medication. For arrhythmias caused by thyroid disorders, your doctor may recommend treating the thyroid condition first. When advanced coronary artery disease is present, your doctor may recommend revascularization such as balloon angiography or coronary artery bypasses surgery treatment.

    “The initial treatment normally starts with medication. If the medication fails to control the arrhythmia or causes side effects, or the patient does not want to take medication, the doctor may recommend radiofrequency catheter ablation treatment. During this procedure, one or more catheters are inserted into the patient’s blood vessels to reach the heart. Electrodes at the catheter tips can generate the heat with radiofrequency energy. The heating process causes the abnormal area of the heart muscle to injure and become a scar and ends up curing the arrhythmia, and patients are able to discontinue their medication.”

    If the precise cause of the slow heartbeat can’t be determined — such as when thyroid hormone disorders and drug side effects have been ruled out — doctors may opt for treatment involving a pacemaker. And if it isn’t possible to speed up the heart using medication, your doctor may recommend insertion of an automatic defibrillator, a device that monitors your heart rhythm and, when it detects this becoming too slow, jolts the heart back into a healthy rhythm similar to how a pacemaker works.

    Patients with bradycardias (slow heartbeat) and pulmonary edema (fluid build-up in the lungs), which can cause irregular heartbeats, may be candidates for cardiac resynchronization therapy, in which a device implanted in the chest can detect an arrhythmia and instantly send an electric pulse to restore heartbeat back to normal.

Keeping a healthy rhythm

      Many heart arrhythmias are preventable. The best way to reduce your arrhythmia risk is to follow your doctor’s advice for healthier lifestyle habits and get regular check-ups. But in the event you experience arrhythmia-like symptoms – heart palpitations, shortness of breath, chest pains, or feeling faint – seek urgent medical attention.

      Paying attention to your heart and making healthier choices will help your body’s hardest working muscle maintain a healthy rhythm for many years to come.

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