Arrhythmia - Meaning, Types, Causes, Symptoms & Treatment

An arrhythmia, commonly known as an irregular heartbeat, occurs when the natural rhythm of the heart is disrupted. The heart might beat too fast, too slow, or with an erratic pattern, affecting how efficiently it pumps blood throughout the body.

While it's normal for the heart rate to change with physical activity or rest, frequent irregularities could indicate that the heart isn't supplying enough blood to vital organs, which can cause symptoms like dizziness, fainting, or fatigue.

Under normal circumstances, the rhythm of the heart is controlled by a precise electrical pathway that starts in the sinoatrial (SA) node, often referred to as a pacemaker. The signal then travels through the atrioventricular (AV) node, slowing down slightly before continuing, which spreads the impulse to the ventricles.

Any disruption in this pathway can lead to an arrhythmia, causing the heart to beat abnormally.

Arrhythmias can be categorised in several ways, but the most common classification is based on heart rate. The condition can also occur in the upper chambers of the heart, known as the atria, or in the lower chambers, called the ventricles.

When the heart beats slower than 60 beats per minute, it is referred to as bradyarrhythmia, while a heart rate exceeding 100 beats per minute is termed tachyarrhythmia.

The different types of arrhythmias are given below:

Based on Heartbeats

As the name suggests, it is based on the number of heartbeats and their rhythm. The types are:

• Sinus Tachycardia: Often triggered by factors like stress, exercise, fever, or stimulant substances such as caffeine. It has a rapid heart rate above 100 beats per minute.
• Sinus Bradycardia: Can involve long pauses between heartbeats. It has a slow heart rate below 60 beats per minute.
• Respiratory Sinus Arrhythmia: The heart rate fluctuates with breathing patterns and the heartbeat speeds up during inhalation and slows down during exhalation. It is common in children and young adults due to the intermittent activation of the vagus nerve.

Supraventricular Arrhythmias

These arrhythmias start in the upper chambers, the atria of the heart. The types include:

• Atrial Fibrillation (AFib) is the most common, affecting millions of people and causing the heart to beat rapidly, sometimes over 400 beats per minute. This rapid beating disrupts the coordination between the upper and lower chambers, leading to insufficient blood flow to the lungs and body.
• Atrial Flutter is another type, where the atria may beat 250 to 350 times per minute, often due to blocked electrical signals caused by scar tissue.
• Paroxysmal Supraventricular Tachycardia (PSVT) causes sudden bursts of extra heartbeats due to misfiring electrical signals. PSVT often occurs during physical activity and is usually not dangerous, though it can be unsettling.

Ventricular Arrhythmias

These originate in the ventricles, the lower chambers of the heart and are generally more severe. Below are the types:

• Ventricular Tachycardia is characterised by a fast, regular beating of the ventricles, which might last only a few seconds or much longer. Short episodes may not be harmful, but prolonged instances can lead to more dangerous conditions like ventricular fibrillation (v-fib).
• V-fib is a life-threatening condition where the ventricles quiver instead of pumping blood effectively, leading to cardiac arrest and, if not treated immediately, death within minutes.

Arrhythmias can sometimes go unnoticed, but when symptoms do appear, they can vary widely in intensity and impact. In some cases, a stroke may be the first sign of atrial fibrillation.

Recognising these signs can help in seeking timely medical attention. The common arrhythmia symptoms are:

• Heart Palpitations: You may feel your heart skipping a beat, fluttering, or beating too fast or hard, which can be unsettling and is often the first noticeable sign of an arrhythmia.

• Chest Pain or Discomfort: This can occur due to reduced blood flow to the heart, which may signal a more serious underlying condition related to the arrhythmia.

• Dizziness or Fainting: Inadequate blood flow to the brain caused by an irregular heartbeat can lead to lightheadedness or even fainting spells.

• Shortness of Breath: Difficulty breathing or gasping during sleep can result from the heart's inability to pump blood efficiently, leading to reduced oxygen supply to the body.

• Fatigue or Weakness: An irregular heartbeat can make your heart work harder, leading to feelings of extreme tiredness or general weakness.

• Anxiety: The irregular beating of your heart may trigger feelings of anxiety or unease as your body reacts to the abnormal rhythm.

• Confusion: A significant drop in blood flow to the brain due to an arrhythmia can cause confusion or a lack of mental clarity.

Arrhythmias often arise from issues with the electrical signals of the heart, which control its rhythm and rate. This can happen if the nerve cells responsible for generating electrical impulses malfunction, or if these signals don't travel correctly through the heart.

Additionally, other areas of the heart might begin producing errant electrical signals, further disturbing the normal rhythm.

The causes of arrhythmia can include:

1. Coronary Artery Disease: Narrowed or blocked arteries can impair blood flow to the heart, disrupting its rhythm.

2. Cardiomyopathy: Diseases of the heart muscle can affect its ability to contract and maintain a regular rhythm.

3. Valve Disorders: Problems with the heart valves can cause irregular blood flow, triggering arrhythmias.

4. Myocardial Infarction: A heart attack can alter the electrical signals of the heart, resulting in arrhythmias.

5. Hypothyroidism: An underactive thyroid gland can influence heart rate and rhythm.

6. Post-cardiac Surgery: Due to changes in heart structure or function, arrhythmia may occur as a complication following heart surgery.

Sometimes, specific factors may also trigger the irregularities, though the exact cause may not always be clear.

Triggers for arrhythmias can include:

• Extremely low or high blood sugar levels

• Stimulants such as caffeine, illicit drugs, or certain medications that boost alertness or energy

• Dehydration

• Imbalances in electrolytes like potassium, magnesium, or calcium

• Intense physical activity

• Emotional stress, including anxiety, anger, pain, or sudden shocks

• Vomiting or persistent coughing

Heart disease, kidney issues, lung diseases, sleep apnea, thyroid imbalances, and viral infections can all contribute to the development of arrhythmias. Identifying the risks of getting arrhythmia helps take proactive steps to reduce the likelihood of developing irregular heartbeats

The key risk factors include:

1. Lifestyle Habits: Poor habits such as smoking, drug use, and excessive alcohol consumption can elevate arrhythmia risk.
2. Obesity: Excess weight can strain the heart and disrupt its normal rhythm, increasing the risk of arrhythmias.
3. Medicines: Some medications, including those for high blood pressure and mental health conditions, can affect heart rhythm. Always consult your doctor about the side effects of prescribed medications.
4. Hypertension (High Blood Pressure): Chronic high blood pressure can cause changes in the heart that may lead to arrhythmias.
5. Hypercholesterolemia: High cholesterol levels can lead to artery damage and heart disease, increasing the risk of arrhythmias.
6. Age: As we age, the heart undergoes changes that can increase the risk of arrhythmias, compounded by other chronic conditions like high blood pressure and diabetes.
7. Family History of Heart Disease: A genetic predisposition to heart conditions can increase the likelihood of arrhythmia if close relatives have experienced similar issues.
8. Congenital Heart Disease: Heart defects present from birth can lead to arrhythmias, especially in younger individuals.

By adopting healthy lifestyle habits and managing risk factors, you can significantly reduce your chances of developing irregular heartbeats. Avoid the triggers if you already have a family history of the condition.

Routine medical check-ups can help detect potential issues early therefore, visit your doctor from time to time.

Below are some effective ways to prevent arrhythmia:

• Manage Hypertension: High blood pressure can damage your heart and its electrical system.

• Maintain a Healthy Weight: Being overweight can increase the strain on your heart and elevate the risk.

• Limit Alcohol Consumption: Excessive liquor intake can disrupt heart rhythms.

• Avoid Tobacco: Smoking can harm the heart and blood vessels, resulting in arrhythmias.

• Exercise Regularly: Daily physical activity strengthens the heart and improves its efficiency.

• Reduce Stress: High levels of stress and anxiety can trigger heart conditions. Practising self-care techniques, such as meditation or deep breathing exercises, can help keep your heart rhythm steady.

• Monitor Caffeine Intake: Too much caffeine can overstimulate the heart. Keeping its consumption in check can help prevent irregular heartbeats.

A patient came to me with an erratic heart rhythm that was initially thought to be a panic attack. He described episodes of rapid, irregular heartbeats that left him breathless and fearful. However, after thorough examination and testing, we discovered that he was actually suffering from atrial fibrillation. 

The diagnosis brought relief as we could now address the root of his symptoms. Through a combination of medication and lifestyle changes, we worked together to restore the rhythm of his heart and manage his condition, allowing him to regain control over his life.

- Dr. Saurabh Chopra

Cardiologist

Diagnosing dysrhythmias involves a series of tests designed to know irregularities of the electrical signals and overall function of the heart. Identifying the specific type of arrhythmia is paramount for choosing the proper treatment and ensuring effective management.

Below are the recommended series of diagnostical tests the cardiologist may recommend:

1. Electrocardiogram (EKG or ECG): The gold standard for diagnosing an arrhythmia, an EKG records the electrical activity of the heart, revealing any irregular rhythms. This test can be performed during a stress test to monitor how your heart responds to physical exertion.
2. Blood Tests: It measures the levels of key substances like potassium, electrolytes, and thyroid hormones, which can influence heart rhythms. Abnormal levels of these substances might contribute to arrhythmias.
3. Electrophysiology Study (EPS): This involves threading a wire through a blood vessel to your heart to stimulate it and trigger arrhythmias. It pinpoints the electrical disturbances and assess whether treatments like medication could be effective.
4. Holter Monitors and Implantable Loop Recorders: These devices track your heart rhythm over extended periods while you go about your daily activities. Holter monitors are worn externally for short-term monitoring, whereas implantable loop recorders, placed under the skin, offer long-term data transmission to your doctor. These tools help diagnose intermittent arrhythmias that may not be detected in a brief examination.
5. Tilt Table Testing: This test is useful for diagnosing the cause of fainting spells. You lie on a table that shifts from horizontal to vertical, and your heart rate, EKG readings, and blood pressure are monitored as you potentially experience fainting.
6. Heart Imaging Tests: Computed tomography (CT) scans or magnetic resonance imaging (MRI) provide detailed images of the structure and function of the heart. These tests can reveal issues like scar tissue, structural abnormalities, or problems with heart arteries that might be causing arrhythmias.

How to prepare for a cardiologist consultation?

By being well-prepared, you help your cardiologist understand your condition better and get the right treatment plan in place. You can ask the following questions on the day of the visit:

1. What is the cause of my symptoms?
2. Are there other possible causes of this condition?
3. What diagnostic tests do I need?
4. What treatment approach do you recommend?
5. How do I manage my other health conditions with arrhythmia?

Depending on the type and severity of the arrhythmia, treatment can range from lifestyle changes to advanced medical procedures.

Non-Surgical Approaches

Adopting healthier habits can significantly impact arrhythmia management. The cardiologist will advise you to improve your overall lifestyle, such as maintaining a healthy weight, engaging in regular physical activity, and managing stress.

These changes help your heart function more efficiently and reduce the frequency of abnormal rhythms. With these, the doctor will recommend the following treatment modalities:

1. Medications: These are often the first line of treatment for arrhythmias. Antiarrhythmic drugs help regulate the rhythm of the heart by controlling the electrical signals. You might need one or more medications. Often, these medicines are used in combination with other treatments for better results.
2. Blood Thinners: For certain types of arrhythmias, especially atrial fibrillation, anticoagulants are prescribed to prevent clot formation. This helps reduce the risk of stroke, which is a serious complication of arrhythmias.
3. Cardioversion: This procedure uses electrical shocks to restore a normal heart rhythm. It is often used for arrhythmias like atrial fibrillation when medications alone are not effective. Cardioversion can quickly return the heart to its normal rhythm.

Surgical Approaches

If medications aren't sufficient to manage your arrhythmia, you might require one of the following procedures or devices. These can be minimally invasive or invasive.

1. Catheter Ablation: It is a procedure where a thin, flexible tube is inserted into a blood vessel and guided to the heart. Radiofrequency energy is then used to destroy the small areas of heart tissue causing the abnormal rhythms. This can be highly effective in treating arrhythmias that do not respond to medication.
2. Implantable Cardioverter-Defibrillator (ICD): An ICD is a device implanted under the skin that continuously monitors the heart’s rhythm. If a dangerous arrhythmia is detected, it delivers electrical shocks to restore a normal heartbeat. This is particularly useful for patients at high risk of sudden cardiac arrest.
3. Pacemaker: It is a small device implanted under the skin that helps regulate the rhythm of the heart. It sends electrical impulses to prompt the heart to beat at a normal rate. Pacemakers are often used for bradyarrhythmias, where the heart beats too slowly.
4. Surgical Maze Procedure: This surgery involves creating a series of scars in the heart tissue to disrupt abnormal electrical pathways. It is typically used for severe cases of atrial fibrillation when other treatments have failed. This procedure helps restore a normal heart rhythm by preventing erratic electrical signals.
5. Open Heart Surgery: In some cases, arrhythmias may be treated through open-heart surgery, especially if there are structural heart issues that contribute to the abnormal rhythms. This approach is used when other treatment options are not sufficient.

Diet of Arrhythmia

Maintaining a healthy diet helps in managing arrhythmias. The foods you choose can influence heart health and help regulate your heartbeat. A balanced diet not only supports overall cardiovascular wellness but also reduces the risk of arrhythmias.

Below are dietary tips to help manage the condition:

• Emphasise Heart-Healthy Foods: Incorporate plenty of fruits, vegetables, whole grains, and lean proteins into your diet. These are rich in nutrients that support heart health and can help prevent arrhythmias.
• Reduce Sodium Intake: Excess sodium can lead to high blood pressure, which may trigger arrhythmias. Opt for fresh, unprocessed foods and use herbs and spices to flavour your meals instead of salt.
• Include Omega-3 Fatty Acids: Foods high in omega-3s, such as fatty fish like salmon and flaxseeds, can help reduce inflammation and support heart rhythm stability.
• Limit Caffeine and Alcohol: Both caffeine and alcohol can affect your heart rate and rhythm. Reducing or eliminating these from your diet may help manage arrhythmia symptoms.
• Monitor Electrolyte Levels: Ensure adequate intake of electrolytes like potassium, magnesium, and calcium, which are essential for maintaining normal heart function. Foods such as bananas, spinach, and nuts are good sources.
• Avoid Excessive Sugar and Processed Foods: High sugar intake and processed foods can contribute to weight gain and cardiovascular problems, which can exacerbate arrhythmias. Focus on whole, unprocessed foods for better heart health.

  
  

Cost of Arrhythmia Treatment

The total cost for treating arrhythmias can vary between ₹1,75,000 and ₹5,00,000. Several factors influence this cost, including but not limited to:

• The type of treatment, whether surgical or non-surgical

• Doctor's consultation fees

• Insurance coverage

• Hospital expenses if surgery is required

For a detailed estimate of your specific costs, consult HexaHealth.

Without treatment, arrhythmia can cause problems such as:

1. Heart failure
2. Cardiac arrest
3. Stroke
4. Sudden death
5. Alzheimer’s disease or dementia (these cognitive disorders occur because the brain doesn’t get enough blood over time)

When to see a cardiologist?

If the heart beats too slow, too fast, or skips a beat, you should call your healthcare professional. Other symptoms that require medical attention include:

1. Dizziness
2. Shortness of breath
3. Lightheadedness
4. Weakness
5. Chest pain
6. Discomfort
7. Fainting or near fainting

Arrhythmias can be managed effectively with medication to regulate irregular heart rhythms. Without proper treatment, arrhythmias can lead to serious complications such as damage to the heart, brain, or other organs, potentially resulting in life-threatening conditions like stroke, heart failure, or cardiac arrest. 

While preventing arrhythmias entirely may not always be possible, adopting a healthy lifestyle can significantly reduce your risk of developing heart-related issues.

HexaHealth is here to support you with expert guidance and comprehensive resources. Consult us to find the right hospital, doctor, and cost of the procedure or get a second opinion. Our team is dedicated to providing personalised, high-quality care to meet your needs.