A healthy heart is imperative to your daily ability to function. Learn why cardiac arrhythmias can sometimes be problematic, and how they can be treated.
Most cardiac arrhythmias aren’t serious. But of course, there are some that require complicated interventions.
There are many types of cardiac arrhythmias – you have your slow heartbeats (bradycardias), your fast heartbeats (tachycardias) and your irregular heartbeats (flutters or fibrillations). Learn more about these tricky heart problems and how they’re treated.
What is an Arrhythmia?
At the appropriate time, the top chambers of your heart – called the atria – must contract so that blood can fill the lower chambers of your heart. A structure in between the upper and lower chambers – the AV node – has the sole responsibility of delaying the signal by about a seventh of a second so that your chambers aren’t “firing” at the same time, says Dr. Mark Hiser, cardio electrophysiologist at OSF Saint Anthony Medical Center in Rockford.
A typical heartbeat is usually somewhere between 60 to 100 beats per minute, but this can vary with age and fitness, Hiser adds. It’s not unusual for a regular heart rate to be as low as 40 bpm, or even 30 bpm for elite athletes. An arrhythmia occurs when your heart rate is outside an ordinary range, according to your age and fitness. Your heart either beats too quickly, too slowly or at an irregular rhythm.
“So, if a person who’s athletically fit comes in and their heart rate is 120 at rest, that’s an arrhythmia. If a person of any age comes in and their heart rate is 20, that’s an arrhythmia. If a person comes in and has a heart rate that’s obviously irregular, especially if they can feel it, that’s an arrhythmia,” Hiser explains.
Arrhythmias can be anywhere from completely benign – in fact, they’re universally present in everyone from time to time – all the way up lethal.
The majority of the arrhythmias Hiser discovers in his patients are simple palpitations, where the patient feels something moving in their chest that seems not quite right. Common causes of simple arrhythmias are stress, depression, poor sleep habits, caffeine, alcohol and decongestive medications, Hiser adds.
More-significant arrhythmias can be due to defects, which are sometimes genetic, though not always. Patients can acquire congenital defects due to mechanical damage to their heart – from poison, a virus or a coronary event where part of the muscle was killed due to lack of blood flow. Constant stress from high blood pressure, which strains the heart, can also lead to lethal arrhythmias.
Who Can Get Arrhythmias?
Arrhythmias can occur in anyone at any age. However, they happen more commonly in patients 60 and older who already have risk factors for cardiac disease, such as hypertension, sleep apnea and diabetes, says Dr. James Kolka, Chief Physician Executive for FHN, in Freeport. Smokers are also at a higher risk.
It’s not uncommon, though, for Kolka to discover an arrhythmia called atrial fibrillation – which is a quivering or irregular heartbeat – in teenage or 20-year-old patients.
“There are hereditary conditions that can cause atrial fibrillation,” Kolka explains. “For example, sometimes, people can have what’s called Wolff-Parkinson-White syndrome, where they have an extra pathway in their heart that’s present at birth that causes a rapid heartbeat. But it’s a fairly rare kind of thing. For the most part, we find arrhythmias in older populations.”
What Does an Arrhythmia Feel Like? How Are They Detected?
Sometimes, you may not feel an arrhythmia at all. But, if you find you can’t sleep at night, feel a fluttering in your heart, or feel your heart racing exceptionally fast, you may be experiencing an arrhythmia, Kolka says.
People with serious arrhythmias may even feel dizzy, like they’re about to lose consciousness, to the point where they actually do lose consciousness.
“When people come into the ER with these symptoms, we need to first figure out what kind of arrhythmia it is,” Kolka says. “This isn’t too difficult – we can figure that out with an EKG [electrocardiogram] pretty easily.”
An EKG is a simple, painless test that measures the heart’s electrical activity.
But with technology being as advanced as it is today, Hiser has actually detected arrhythmias using only his watch.
“I actually diagnosed a guy with a bad arrhythmia in a coffee shop last year,” he recalls. “Fitbit, Apple watches – they can interface with smartphones and take a 30-second snippet of your heart rate and tell you if you have an arrhythmia.”
However, some arrhythmias that occur infrequently may need more-advanced screening to detect. But fortunately, there are monitors that can track 48 hours of heart rhythm, two weeks of heart rhythm, 30 days, or even multiple years, Hiser says.
How Are Arrhythmias Treated?
Arrhythmias can be treated with simple medications, more-aggressive medications, and procedures to correct abnormal pathways in the heart. There are also medical devices that can be implanted if necessary.
Beta-blocker drugs such as Carvedilol, Metoprolol and Nadolol (anything ending in “lol”) are simple, safe drugs that interfere with the brain’s ability to aggravate the heart.
“They don’t really work on the heart at a basic level, they just stop outside influences from making things worse,” Hiser explains.
Calcium channel blockers, such as Diltiazem, can “tighten” your heart’s AV node so that your heart rhythm becomes regular.
“So, if somebody is in atrial fibrillation and their heart rate is 130, you can give them Diltiazem and that AV node won’t let as many beats go through, so it will slow your heart down,” Hiser explains. “Beta-blockers and calcium channel blockers – they’re safe. They have no serious long-term side-effects.”
The next step is to proscribe more “intense” drugs.
“The best antiarrhythmic drug of all time, bar none, is Amiodarone,” Hiser says. “In the 1960s, the French discovered that it would suppress almost every arrhythmia – top chamber, lower chamber, everything – and it was like, ‘Wow. We don’t even have to teach our med students to recognize arrhythmias because one drug cures it all. Just give them all Amiodarone.’”
However, there can be complications if a patient is on Amiodarone for too long.
“The biggest problem is it can crystallize in the lungs and cause a chemical pneumonia,” Hiser explains. “It’s not common, but it’s common enough that when we have somebody on it, we screen them all the time. And, if we see any little abnormality, we get a CT scan of their lungs.
“It’s safe and extremely effective in the short-term, but you have to be careful with it in the long-term.”
After medications, the next step in treating arrhythmias is to perform an ablation surgery, where catheters are used to either burn or freeze away pathways in the heart that shouldn’t be there, or modify normal pathways that are misbehaving.
If necessary, pacemaker devices can be inserted to help control abnormal heart rhythms.
What Are Some Novel Advancements in Pacemaker Devices?
Recently, hospitals in our region have been implanting “the world’s smallest pacemaker,” called the Micra. The device is about the size of a vitamin capsule, and unlike most pacemakers, which are placed in a patient’s chest with wires running to the heart, the Micra is implanted directly into a patient’s heart.
“The benefit of the Micra is that you really don’t risk infection,” says Dr. Jeffrey Smith, cardiac electrophysiologist at Mercyhealth, in Rockford. “It’s inserted into the heart through a vein in the leg, which is a lot less invasive than doing chest incisions. And also, you don’t have these wires running around your veins.”
Micra pacemakers work best in patients who have a combination of a slow heartbeat and atrial fibrillation, one of the most common arrhythmias, Smith says. It’s only intended for patients who need a single-chamber pacemaker.
After it’s inserted, the Micra helps to prevent dizziness and loss of consciousness in arrhythmia patients. The battery life averages about 12 years, and unlike most other pacemakers, there’s a retrieval feature to enable the reclamation of the device if needed.
“Usually, when a person gets a new pacemaker with the wires going into the heart, we’ll often give them limitations of how much they can exert themselves,” Smith says. “But, since you don’t have to worry about lead dislodgement, the Micra has fewer limitations.”
In general, people with pacemakers have to take special precautions around MRIs, but the Micra is approved to be used safely with MRI scanners, Smith says. In addition, patients can go through airport security, use household appliances such as microwave ovens, and resume regular exercise activities as long as they don’t exceed their fitness level.
What Happens if a Cardiac Arrhythmia Goes Untreated?
With simple arrhythmias, such as palpitations or extra beats, typically nothing bad happens, especially if there’s no significant heart disease.
But bad arrhythmias that cause patients to lose consciousness can result in falls, which can result in broken bones, especially in the elderly. These arrhythmias can also cause patients to develop congestive heart failure because the heart is incapable of sustaining abnormal rates for long periods of time.
If left untreated, atrial fibrillation in particular can lead to blood clots, stroke and heart failure.
“So, if you do feel like your heartbeat is irregular, don’t be afraid to go see a cardiologist or go to the emergency room to find out what’s going on,” Kolka says.