How are heart rhythm disorders treated?

The decision of whether to treat a heart rhythm disorder depends on the severity and type of the arrhythmia as well as any existing health conditions. If you have mild arrhythmia and an otherwise healthy heart you probably won’t need treatment. Your doctor will most likely recommend a range of lifestyle changes which can help you manage the heartbeat abnormalities. These may include making steps to cut down on stress levels or reducing nicotine consumption.

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A number of drugs and medicines can control the symptoms of arrhythmia. These are sometimes called beta blockers, which correct the abnormal rhythms and aim to maintain a steady pace. Anticoagulant drugs also treat arrythmia, which thin the blood and reduce the risk of stroke and atrial fibrillation.

When conventional drugs are not effective in treating arrhythmia then a treatment known as electrical cardioversion is sometimes used. This involves a small electrical shock to the chest, which aims to return the heart to its normal rhythm.

For severe heart rhythm disorders such as ventricular tachycardia, doctors often suggest a device called an implantable cardioverter defibrillator (ICD). This surgically-implanted device monitors the heart rhythm and delivers an electric shock when it detects an abnormal pace. An implantable cardioverter defibrillator is able to swiftly and effectively counter the potentially deadly effects of ventricular fibrillation. A pacemaker works in a similar way, sending smaller, more frequent impulses to the heart to maintain a healthy rhythm.

Some types of arrhythmia require surgery. “Maze” surgery involves the resection of pathways in the upper chambers of the heart to ensure that the heart returns to its normal pace.

What is arrhythmia?

When your heartbeat deviates from its usual rhythm on a regular basis, it may be an indication that you have arrhythmia, otherwise know as heart rhythm disorder. During a normal heartbeat the electrical impulses which enable the heart to pump blood throughout the body occur at regular, steady intervals. Any abnormalities in the heartbeat can result in a number of problems, with the heart not able to effectively pump blood around the body. Heartbeat abnormalities may involve changes in speed, regularity, or sequence of beats, as well as changes in where the electrical impulses in the heart are produced.

The heart itself tends to beat anywhere between 60 and 100 times every minute during a normal, healthy rhythm cycle. This will slow during sleep or periods of deep relaxation, and speed up when you are under stress. Arrhythmia occurs in millions of people worldwide each year, and in most cases heartbeat irregularities are harmless. If there are significant changes to the heartbeat that cannot be otherwise explained and occur over a long period of time, however,  then a heart rhythm disorder could be the cause. Some heart rhythm disorders can have serious impacts on your health, and can be fatal if you already suffer from some form of heart disease.

Defects in the heart's electrical system can cause arrythmia. Heartbeat is generated by a system similar to than in a domestic electrical circuit, with two main areas of control sending impulses along a series of pathways to other areas of the heart. The sinoatrial node is the main source of every single heartbeat and also controls the pace with which it beats. These impulses from the sinoatrial node travel through the atrioventricular node, which directs them from the atria (upper chamber) into the ventricles. The atrioventricular node also allows the atria to contract before the ventricles, ensuring that the functions of the heartbeat are performed in correct timing.

The heart is divided into two separate chambers, and arrhythmia can occur in both chambers. Types of arrhythmia in the upper chamber include:

Atrial fibrillation occurs when the electrical impulses become chaotic and confused, causing the heart to beat at irregular intervals, sometimes up to five times its normal speed. Consequences of atrial fibrillation include severe fatigue and an increased risk of stroke. In some cases it may also lead to heart failure. Atrial fibrillation is the most common form of heart rhythm disorder, and is present in about 3% of the population across North America and Europe

In a similar way to atrial fibrillation, an atrial flutter also causes the heart to beat at a speed far beyond its normal rate, but the heartbeat remains steady rather than fluctuating.

Sinus tachycardia is a normal change in heartbeat caused by exercise, fever, excitement or stress. Sinus tachycardia only requires treatment when a pre-existing heart condition is identified.

Sick sinus syndrome. The sinus node helps to control the rhythm and pace of the heart. Sick sinus syndrome is a collection of symptoms which suggest the sinus node is not functioning correctly, with the heart rate either abnormally slow or fast.

Heart rhythm abnormalities found in the lower section of the heart could include:

Ventricular tachycardia. When the activity in electrical system of the ventricles is abnormal, it can lead to a potentially fatal condition known as ventricular tachycardia, which results in a dangerously-fast heartbeat. This requires urgent treatment.

Ventricular fibrillation. The rapid heartbeat during ventricular fibrillation causes convulsions and cramps in the ventricles and often results in total heart failure. Ventricular fibrillation occurs in around half of all cardiac arrests. Ventricular fibrillation is caused by electrical failures and is different from a heart attack ( a circulatory problem whereby the arteries become blocked and blood can no longer a circulate), but can happen as a result of one.

Other forms of heart rhythm disorder:

Atrial flutter. This occurs when electrical impulses are not able to travel from the atria to the ventricles, resulting in a dangerously slow heart beat.

Premature contractions. Often referred to as the heart ‘skipping’ a beat or an extra heartbeat, premature contractions can occur anywhere in the heart and produce irregular heartbeats.

Long QT syndrome. An abnormality in the heart’s electrical system, long QT syndrome can bring a higher chance of ventricular fibrillation.

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Risk factors/causes of heart rhythm disorders

There is no root cause that can be attributed to every case of arrhythmia. It is possible for people with perfectly healthy hearts and no previous history of any heart condition to encounter some form of heart rhythm disorder, but research suggests there are a number of contributing factors which increase the chance of arrhythmia developing.

Coronary artery disease is one of the greatest risk factors. When plaque and fatty deposits are allowed to build up in the arteries they can become blocked, reducing the amount of blood which is able to flow freely around the body. This can result in abnormal heart rhythms, alongside high blood pressure and potential heart failure.

A number of lifestyle factors can increase the likelihood of coronary artery disease, such as:

  • Nicotine consumption
  • Diabetes
  • High cholesterol
  • Obesity
  • Excessive stress
  • Family history of heart disease
  • Substance abuse

Heart rhythm disorders are not 100% preventable, but there are a number of changes in lifestyle which can drastically reduce the chances of a condition developing.

What are the symptoms of heart rhythm disorders?

In many cases, arrhythmia will present no noticeable symptoms. Many people have abnormal heart rhythms without knowing about them, or notice them but have no concerning side-effects. However, for some people it will be obvious that something is not quite right with their heart rhythm. The main symptoms of arrhythmia include:

  • Palpitations, or the feeling that the heart is missing a beat
  • Racing heartbeat
  • A thumping sensation in the chest

A number of more general signs may be the result of an abnormal heart rhythm, including:

  • Sustained fatigue and tiredness
  • Dizziness
  • Chest pain
  • Fainting or loss of consciousness

As many of these symptoms can have a whole range of potential causes, it is important to get a definitive diagnosis to rule out or confirm arrhythmia. There are many ways to diagnose abnormal heart rhythms.

The first thing you should do if you suspect you have a heart rhythm disorder is consult a doctor or, if possible, a cardiac specialist. Your doctor will ask you in-depth about your symptoms as well as your medical record and family medical history. A number of tests can determine the cause of your symptoms. An electrocardiogram, a quick and easy test carried out using small patches attached to your chest, helps to give a better picture of the electrical activity in the heart. A holter monitor is another diagnostic tool, which works in a similar way to an electrocardiogram but needs to remain attached for up to 2 days. Tests for high blood pressure, diabetes and heart disease can also see whether there is an underlying cause of the arrhythmia.

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