‘I wish I knew then what I know now’, is something we all feel when diagnosed with a medical condition that may otherwise have been avoidable had we been better informed. There is considerable awareness in the general population that chest discomfort or acute onset of breathlessness needs urgent visits to the emergency department, as these can be the first symptoms of an impending heart attack. However, the same cannot be said about diseases pertaining to the conduction system of the heart or heart rhythm abnormalities.
In a nutshell, the heart is a four-chambered structure. Synchronized movement of blood is facilitated by the sequential contraction of the top chambers (atria) followed by the contraction of the lower chambers of the heart (ventricles). Electrical impulses are generated from a particular area in the upper part of the right atrium (referred to as the sinus node). These electrical impulses are spread across to all parts of the heart via specialized networks of cells that constitute the conduction system of the heart. Once the cardiac impulse reaches the cardiac muscle, it stimulates muscle contraction. Cardiac impulse conduction and resultant muscle contraction can be recorded by placing electrodes on the chest wall in an investigation called electrocardiography, commonly referred to as ECG. Any disruption or malfunction in the conduction system of the heart can result in a loss of normal cardiac rhythm, often referred to as dysrhythmia or arrhythmia.
I often compare the heart to a house with both water (blood supply) and electric supply (conduction system). While any problems with the blood supply to the heart may result in a heart attack, problems with the conduction system in the heart cause cardiac dysrhythmias. Heart rhythm abnormalities exist as separate disease entities to heart attacks and must be diagnosed and treated promptly, to save lives.
How to avoid heart strokes?
For instance, one in five strokes is caused due to a dysrhythmia called atrial fibrillation. In this condition, the synchronicity between the top and bottom chambers of the heart is lost, resulting in an irregularly irregular and often fast pulse rate. The rapid and ineffective atrial contraction predisposes to stasis (stagnation) of blood in the atrial chamber and results in clot formation, which may eventually lead to stroke or other catastrophic consequences. If diagnosed in a timely fashion, these can be avoided by instituting medical therapy by giving blood thinning medications such as warfarin or other newer anticoagulant medicines and anti-arrhythmic medications (which help prevent episodes of atrial fibrillation).
Depending on a patient’s symptoms, other treatments for atrial fibrillation include delivering a small electric shock to the heart, a therapy called cardioversion, or an invasive procedure in which abnormal cells in the left upper chamber of the heart are destroyed by using radio-frequency waves, referred to as ablation therapy.
How to understand the symptoms of the heart not being in rhythm?
The symptoms of heart arrhythmias can vary depending on the type of arrhythmia. Common symptoms include:
Palpitations: Sensations feeling like your heart is fluttering, racing or beating too hard or too slow
Chest discomfort: You may feel discomfort, pain, or pressure in the chest area.
Shortness of breath: You might experience difficulty breathing or a sensation of being out of breath.
Dizziness or light-headedness: Some people with arrhythmias may feel dizzy or faint with fainting or near-fainting spells.
Fatigue: Feeling excessively tired or lacking energy.
Sweating: Unexplained sweating, especially during periods of rest or minimal exertion.
Anxiety
However, not all arrhythmias cause symptoms. Some arrhythmias can only be detected during a medical examination or through heart-monitoring tests like an electrocardiogram (ECG). That’s why regular check-ups with a healthcare provider are essential, particularly if you have risk factors or a history of heart disease.
How should an ordinary person know this? When should he run to the hospital, which rhythms are serious and which are not?
If you experience any of the symptoms listed above, especially if they are new, persistent, or worsening, you should contact your doctor. Many of the symptoms may be common with other diseases, and it is not advisable to ignore symptoms or self-medicate, and only a doctor can find the cause of the symptoms after proper examination and tests.
While some arrhythmias are relatively harmless, others can be serious and potentially life-threatening. For example, ventricular fibrillation (a type of arrhythmia) can cause cardiac arrest and is a medical emergency.
That said, it can be hard for a non-medical person to determine the seriousness of an arrhythmia just based on symptoms. If you’re experiencing severe chest pain, difficulty breathing, fainting, or severe dizziness, you should seek immediate medical attention, as these could be signs of a serious condition such as a heart attack or a severe arrhythmia. This is particularly true if you have other risk factors for heart disease, like high blood pressure, diabetes, smoking, a high cholesterol level, a family history of heart disease, or if you’re older.
How do we detect arrhythmias?
One way to protect yourself is to promptly report to your doctor if you experience awareness of a racing heart (symptom referred to as palpitations), shortness of breath, or episodes of near or total loss of consciousness. An ECG done during symptomatic periods or heart tracings from your smart watch can often help with diagnosis. Sometimes extended periods of heart rate monitoring, such as using bluetooth enabled wireless patches on the chest wall may be required to diagnose, when symptoms are infrequent and last only for a brief period. Other investigations, such as an ultrasound scan of the heart (referred to as an echocardiogram) to evaluate the cardiac muscle and the integrity of the heart valves or even an angiogram (a test done to evaluate the blood supply of the heart) may be performed. Routine blood tests to rule out low haemoglobin (anaemia), abnormal thyroid function and electrolyte disturbances in the blood may also be performed.
How to treat arrhythmias?
Not all cardiac rhythm disturbances are treated in a similar way. For a slow heart rate, pacemaker therapy may be recommended. In the event of fast heart rates, treatment with the medications or an electrophysiology study to evaluate the conduction abnormalities of the heart, followed by radiofrequency ablation therapy may be recommended. In some cases, we address the underlying causative problems such as smoking, excessive alcohol or caffeine consumption, optimizing blood pressure control, diabetes, weight management, and issues with anxiety or stress.
Even if an arrhythmia isn’t immediately life-threatening, it can still increase the risk of other heart conditions, like stroke or heart failure. So, it’s always a good idea to get any potential heart-related symptoms checked out by a doctor.
https://indianexpress.com/article/health-wellness/heart-rhythm-heart-stroke-prevention-8636420/
