Why people get an Arrhythmia?

1. There may be one or sometimes several factors causing Arrhythmia
2. Types of arrhythmias are:
1. Tachycardia: Fast heart rate of more than 100 beats a minute.
2. Bradycardia: Slow heart rate of less than 60 beats a minute.
3. People get arrhythmias with either problems with the upper or lower chamber of heart.

Risks/Causes of an Arrhythmia?

1. Several cardiovascular and non-cardiovascular health conditions may cause a sudden (rapid) development or deterioration of heart failure leading to hospitalization.
2. The possible causes includes:
1. Acute Heart Attack
2. Acute Heart Failure
3. Scar of heart muscle due to previous heart attack.
4. Damage to the heart muscle (Cardiomyopathy)
5. Coronary Artery Disease (Blocked or narrowed arteries in your heart)
6. Faulty heart valves
7. Damage to the heart muscle (Cardiomyopathy)
8. Myocarditis
9. Congenital heart defect
10. Poorly controlled High blood pressure
11. Overactive thyroid gland (hyperthyroidism)
12. Underactive thyroid gland (hypothyroidism)
13. Excessive alcohol intake
14. Excessive caffeine drinks (strong tea, strong coffee)
15. Drinking too much alcohol or caffeine
16. Recreational Drugs

How to diagnosis an Arrhythmia?

The diagnosis is made by symptoms and ECG test.

The symptoms of arrhythmias are:

1. Arrhythmias may not cause any symptoms and in some cases are find during a routine examination.
2. The possible symptoms includes:
1. A fluttering in your chest
2. Palpitations -A racing heartbeat (tachycardia)
3. A slow heartbeat (bradycardia)
4. Chest pain
5. Shortness of breath
6. Lightheadedness or dizziness
7. Fainting (syncope) or near fainting

Tests to diagnose arrhythmias:

1. ECG: A tracing of heart is obtained, which may confirm diagnosis.
2. 24 Hour Holter: In some patients, ECG may be normal, therefore, a 24-hoour monitoring of the tracing of heart may be needed
3. Echocardiogram: This is to look for any new or old heart attacks. The strength of the pumping action of heart can be checked.
4. Implantable loop recorder: This device detects abnormal heart rhythms and is implanted under the skin in the chest area. Can monitor heart for upto 3 years.

Types of Arrhythmias:

There are two main types of arrhythmias, depends on the speed of heart (fast or slow)

1. Tachyarrhythmias ( fast heart beats): These includes:
1. Atrial fibrillation
2. Atrial flutter
3. Supraventricular tachycardia
4. Wolff-Parkinson-White syndrome
5. Ventricular tachycardia
6. Ventricular fibrillation
7. Long QT syndrome
2. Bradyarrythmias (slow heart beats). These includes:
1. Sick sinus syndrome.
2. AV Conduction block.

Treatment of Arrhythmias:

Treatment of arrhythmias depends on how fast they develop and how fast needs treatment. The two types of management includes acute arrhythmias treatment and chronic arrhythmias treatment.

1. Treatment of acute arrhythmias
2. Treatment of Chronic arrhythmias

Treatment of Acute arrhythmia (Emergency)

The steps to follow are:

1. Step 1: Call for ambulance or Go to the nearest Hospital
   if you have the following symptoms, which starts suddenly:
1. Moderate to severe palpitations, Shortness of breath, Dizziness.
2. Chest pain or chest discomfort may be mild or severe. ( if due to Heart attack) usually on the left side of upper chest/left arm or neck/jaw)
3. Some people may have their heart stop immediately (sudden cardiac arrest)
2. Step 2: Doctor in hospital will do:
1. The doctor will take a detailed history of your symptoms and do physical examination.
2. Do and Urgent ECG/EKG
3. Additional tests may be required ( Bloods, Chest X-ray, Urgent scan- Echocardiogram)
3. Step 3: Doctor Will Make diagnosis and decide for treatment
4. Once the doctor confirms the acute arrhythmia, the aim is to:
   
   “Quickly restore the blood flow to the heart muscle (if heart attack) and remove the excessive fluids from lungs (pulmonary oedema), in order to save the heart muscle from damage”.
   
   The steps are as follows:
1. You will be attached to heart monitor/ Blood pressure monitor and ECG/EKG.
2. Oxygen may be given via Mask OR pressurized machine.
3. An IV line will be inserted for the use of medications and fluids.
4. Pain relievers with morphine or other medications.
5. Special medication like Amiodarone, digoxin or Beta-blocker may be needed to reduce the heart rate.
6. If patient unstable, may need small electric shock to the heart to restore normal rhythm.
7. Blood-thinning medications called heparin may given.
1. Heparin make your blood less "sticky" and stops clots formation.
2. Heparin is given intravenously or by an injection under your skin
8. Clot-preventing drugs. (Anti-platelet medications)--- IF heart attack
9. Furosemide: medications to remove water from the lungs.
10. Nitrates: Given to remove water from lungs. Given via IV line
11. Inotropes. These are live saving medications given in severe heart failure in order to improve heart pumping function and maintain blood pressure
12. Heart support devices; if patient is unwell, may need additional heart devices including; Intra-Aortic Balloon Pump, ECMO, Impella mechanical support.
13. If doctor confirms a heart attack then the doctor will follow the treatment.

Treatment of chronic Arrhythmias

Treatment and use of medications depends on the type of arrhythmias.

1. Treating of Bradyarrythmias (slow heart beats). includes:
1. Atropine medication via IV line
2. Pacemaker
2. Treatment of Tachyarrhythmias (fast heart beats) includes:
1. Vagal manoeuvres.
2. Medications. This depends on the type of arrhythmia and underlying medical conditions. The medications used are Amiodarone, digoxin, Beta-blocker, flecanide, sotalol and calcium channel blocker.
3. Cardioversion
1. This is usually needed, in emergency when patient is unstable.
2. May be used in atrial fibrillation, if your doctor wants to treat and control heart rhythm.
4. Catheter ablation
1. If medications are not affective, then in this procedure, your doctor threads one or more catheters through your blood vessels to your heart. They use radiofrequency energy to treat the condition.
5. Implantable cardioverter-defibrillator (ICD)

How to live with arrhythmia

Diet and Life style changes

If you had an arrhythmia, you must work on your lifestyle changes: these changes include:

1. Stop smoking and avoid exposure to passive smoking.
2. Eat a healthy diet with limited amounts of saturated fat; eat whole grains, and many fruits and vegetables and Restrict sodium in your diet
3. Treat diseases or conditions that can increase your risk of arrhythmia, such as diabetes, high blood pressure and high blood cholesterol and stress.
4. Limit alcohol consumption to one to two drinks or fewer a day.
5. Maintain a healthy weight and maintain weight monitoring diary

Cardiac rehabilitation

1. If you have a heart attack as a cause of arrhythmia, it is very important program run by doctors and medical team to help you recover from your heart failure.
2. Cardiac rehabilitation programs generally focus on four main areas — medications, lifestyle changes, emotional issues and a gradual return to your normal activities.
3. The above changes will be tailored according to your individual needs and the amount.

Arrhythmia and Driving

1. This usually depends on the type of arrhythmia (slow or fast heart rates), similarly depends on the treatment you received.
2. You can drive after 4 weeks following arrhythmia and fully recovery
3. You must inform your licensing authority and get advice if you drive large goods vehicles (LGV) or passenger-carrying vehicles (PCV).
4. For individual type of arrhythmias, please discuss with your doctor
1. Ventricular Tachycardia: you can drive after 6 months, if you had no symptoms after your last episode and on regular medicine.

Arrhythmia and Working

1. After about 4-6 weeks you can usually go back to your work.
2. If your job involves heavy lifting or manual laborer, discuss with your employer.
3. For individual type of arrhythmias, please discuss with your doctor

Arrhythmia and Sexual Life

1. Most people can safely return to sexual activity after recovery but usually depends on your physical comfort, psychological readiness and previous sexual activity.
2. Some heart medications can affect sexual function. Your doctor can then prescribe alternative medications particularly beta blockers

Arrhythmia and support services

1. Having an Arrhythmia is one of the scariest experiences of your life.
2. People may experience Fear, anger, guilt and depression after a an Arrhythmia
3. Discussing them with your doctor, a family member or a friend might help. Or consider talking to a mental health provider or joining a support group.

Please refer to online support groups such as:

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