Finding out that you have a heart condition can be a frightening experience. It immediately conjures images of heart attacks and blocked arteries, open-heart surgery and other gruesome conditions. However, those problems are related to the heart’s “plumbing” system… the coronary arteries. Sometimes people develop problems with the electrical system of the heart, which controls the heart rhythm. Abnormal heart rhythms, broadly referred to as “arrhythmias,” are sometimes more difficult to understand than coronary artery disease (most people can easily imagine a clogged pipe). Arrhythmias are quite common, however, and it’s best to understand the nature of this problem and how it affects your body.
Everyone knows that the heart is a pump. It beats our whole life (even before we are born), and most of the time we don’t even know it’s there. The heart beats at different rates, according to our body’s needs. Nearly everyone has experienced an elevated heart rate due to simple things like running to catch a bus or during normal exercise. The human heart can beat at a wide range of rates and still be functioning normally. A normal resting heart rate for adults is anywhere from 60 to 80 beats per minute (bpm), depending on age, level of fitness, and genetics. During normal “activities of daily living” (washing, dressing, eating, walking around) the normal heart rate can even approach 100 bpm. The term arrhythmia, which is the combination of the Greek prefix a- (no) and Greek word rhythmos (rhythm), is used to describe an abnormal heart rhythm. Arrhythmia can refer to a large number of different electrical problems that can affect the heart rate and cause it to be high – greater than 100 beats per minute, or low – less than 60 beats per minute. Some arrhythmias cause the heart to beat irregularly. Some cause severe symptoms and some are not even noticeable.
Arrhythmias can be challenging to diagnose, particularly in patients who experience symptoms sporadically, rather than on a frequent or continual basis. Sometimes it’s best to see a specialist to correctly diagnose and treat arrhythmias. Heart specialists are called cardiologists, but there are specially trained cardiologists who concentrate primarily on diagnosing and treating arrhythmias. These sub-specialists are known as cardiac electrophysiologists.
What Are the Symptoms of Arrhythmia?
The feeling that your heart is beating funny is referred to as having “palpitations.” Palpitations can include the sensation of a fluttering heart, skipping, pausing, jumping, thumping, and even racing. Obviously, if you are exercising or stressed out over something, you may feel your heart race, but that would likely be normal. Racing of the heart when you are not exerting yourself is more of a cause for concern. Patients who are diagnosed with arrhythmia also report other symptoms such as shortness of breath, fatigue, lightheadedness or feeling faint. While these very same symptoms may accompany a heart attack or stroke, it is important to remember that arrhythmia symptoms are usually related to the rhythm disturbance reducing the heart’s ability to pump properly. Once the arrhythmia stops, the heart usually goes right back to pumping normally, generally with no lasting effects or damage.
The heart rate may be increased because of exercise or stress, which causes the release of a substance called adrenaline from the nerve endings and the adrenal gland (which sits on top of the kidneys). In that case, resting quietly, performing deep breathing exercises and thinking about something else can help heart rates return to a normal range. Under those circumstances, we are generally dealing with a normal rhythm that is just sped up by the effects of the adrenaline. Some patients with a very rapid arrhythmia may require immediate medical therapy, especially if there is a history of heart disease or serious symptoms associated with the abnormal heartbeat.
How Are Heart Arrhythmias Diagnosed?
An appointment with your primary care doctor may be the first step in diagnosis. They will ask you about the nature of the symptoms, the frequency and duration of the heartbeat disturbance, and what may be triggering it. They should review your history and medications and then should perform a physical examination, including a measurement of blood pressure and a complete cardiovascular examination. You should discuss your personal activity to see if there are habits or activities that may be contributing to an abnormal heartbeat. Some over-the-counter and prescription drugs can elevate heart rates, as can smoking, caffeine or physical deconditioning (i.e. when you are “out of shape”). A family history of heart disease will also be considered.
If an arrhythmia is suspected or diagnosed, your doctor may refer you to a cardiac specialist who will likely perform a more comprehensive physical exam. The cardiologist may order specific cardiac testing such as an electrocardiogram (ECG or EKG), which is a painless diagnostic study to record the electrical activity of the heart. Blood tests, x-rays and an echocardiogram (getting a picture of the beating heart using sound waves) may also help determine if factors beyond environmental ones are contributing to an abnormal heartbeat. A stress test may be used to evaluate the coronary arteries, especially if your symptoms are related to exercise.
How Are Arrhythmias Treated?
There are many different kinds of arrhythmias, and the treatment has to do with the cause of the rhythm disturbance and the severity of the symptoms. Many patients who are diagnosed with heart arrhythmias have mild or tolerable symptoms and no long-term side effects or consequences, and are often advised to monitor their heart rates from home and to limit or avoid certain activities. If an arrhythmia is found to be “benign” or harmless, then the patient may be able to resume all normal activities, even strenuous exercise, provided the heart is otherwise healthy.
Patients who have more complex electrical problems are better off seeing a cardiac electrophysiologist for consultation. In certain cases, more severe types of arrhythmia requires therapy, especially in the setting of significant cardiovascular disease. Further testing may be needed, such as long-term monitoring using a portable, wearable device that records heart activity for extended periods of time (up to a couple of weeks). For monitoring that can go on for months or even years, a small implantable cardiac monitor “chip” may be very helpful. These monitors are so small they are often undetectable, and they are inserted using a local anesthetic in a 5-minute procedure. In more serious cases a minimally invasive procedure called an Electrophysiology (EP) Study can be recommended to further determine the cause of an abnormal heart rhythm. Serious arrhythmias may have to be treated with medications known as “anti-arrhythmic drugs.” Also, many arrhythmias can be cured with a procedure known as Catheter Ablation, which would be done at the time of an EP Study.
Once the cause of the arrhythmia has been established, your doctors can prescribe a course of treatment that is appropriate for your particular circumstances and health history.
Can Heart Arrhythmias Be Cured?
Remember, the medical definition of arrhythmia is an abnormal heartbeat. In some cases arrhythmia can be triggered by environmental factors such as stress, alcohol, smoking, extreme physical exertion, or medications. Lifestyle changes may help reduce or eliminate symptoms of arrhythmia.
Most of the time, however, arrhythmias are due to electrical problems like a short circuit in your heart’s rhythm system. if your heart rate is abnormal enough that it causes you to consult a physician, it could be indicative of a serious cardiac problem. You should seek medical attention for symptoms suggestive of arrhythmia, as that can be the first step in treating cardiovascular disease. If you are concerned about your heart rate, or think that you may be at risk for heart disease, contact your doctor or medical practitioner immediately.
If properly diagnosed by a specialist, your heart rhythm problem is definitely treatable, and could potentially be cured, most often with some sort of ablation procedure. Minor arrhythmias often respond to lifestyle measures and do not need to be treated with anything more than reassurance.