An overview of arrhythmias
Arrhythmia is manifested as having an irregular or regular pulse which is different from the normal pulse due to some multiple causes. To first understand how arrhythmia occurs and why, you should first understand the anatomy of the heart health and its electrical circuit generation and conduction that helps to pump blood out from the heart to the systemic circulation.
The heart is separated by 4 chambers namely 2 atriums and 2 ventricles separated by a thick septum. The sinoatrial node which is located at the junction of the right atrium is responsible to produce and generate an electrical impulse which is then spread to the atrium walls to contract. The electrical impulse is then sent to the atrioventricular node which is located at the septum separating the both ventricles.
From there, the impulse is then sent to ventricular walls through some multiple fine fibres called bundle of His and Purkinje fibres. This will eventually cause the heart to pump out blood to the cells, tissues and organs and produce a heartbeat or a regular normal pulse.
In arrhythmias, there is a problem with the generation and conduction of electrical impulses causing the heart to beat slower or faster than usual. Generally, arrhythmias can be divided into tachyarrhythmias and bradyarrhythmias which are having fast and slow irregular heart beats respectively. Among these arrhythmias, atrial fibrillation, atrial flutter and heart blocks are the common arrhythmias experienced by most patients. Some other severe examples of arrhythmias are ventricular fibrillation and ventricular tachycardia which requires immediate attention from doctors.
What are the symptoms of arrhythmias?
Not all patients will experience similar signs and symptoms of arrhythmias, some will experience mild to moderate symptoms while some will experience severe to life threatening symptoms which will require emergency treatment. Below are some examples of common signs and symptoms of arrhythmias.
- Palpitations
- Heart racing sensation
- Lightheadedness
- Chest discomfort
- Shortness of breath
- Dizziness
If you have any of these symptoms that persist for quite a time and annoys you a bit more often, you shall immediately see a doctor to get your evaluation as soon as possible to start treatment. Some arrhythmias can be asymptomatic and are usually detected incidentally by using an ECG.
What is the treatment for arrhythmias?
Treatment of arrhythmias is depending on the clinical condition and ECG finding of the patient at that particular time. The treatment can be short term which is an acute treatment or long term treatments.
For tachyarrhythmias patients who are clinically unstable such as having altered mental status, chest pain and shortness of breath, synchronized cardioversion is the treatment of choice where this method is used to revert back to the normal rhythm of heart. Different energy levels are used based on the type of arrhythmias in patients and it is calculated in Joule forms.
For stable patients on the other hand, antiarrhythmic drugs are used. Some examples of antiarrhythmic drugs are like amiodarone, procainamide, and sotalol. Specifically for supraventricular tachycardia, non pharmacological methods such as the valsalva maneuver and carotid artery massage are used. For atrial fibrillation, additional anticoagulant medication is also practiced to prevent formation of blood clots from the disease which can cause severe complications like stroke and peripheral vascular diseases.
Apart from that, bradyarrhythmias are treated differently. Unstable patients are initially treated with atropine sulphate or transcutaneous pacing. On the other hand, stable patients are usually observed in the medical wards and several blood and imaging investigations are taken to find out the cause of bradyarrhythmias. Some surgical approaches are also used at times for only suitable patients to revert back the abnormal pulse to a normal one.
