Cardiac Arrhythmia: what is it, symptoms, treatment, is it curable?

What is arrhythmia?

Any change in your normal heart rate is called an arrhythmia. The condition occurs when the electrical impulses of the heart do not work properly, causing fast (tachycardia), slow (bradycardia) or even irregular beats.

To be considered normal, the heart rate must be around 60 to 100 beats per minute.

Commonly, arrhythmias do not generate symptoms, being considered benign and harmless to health. However, the most severe cases cause sensations, such as fainting and chest pain, in addition to the risk of death. In these situations, treatment may include antiarrhythmic drugs, medical procedures and even surgery.

How does the heartbeat happen?

To better understand the disease, it is important to understand how the heart’s electrical system works . Through it it is possible to control the rate and rhythm of the heartbeat. Such a process allows the pumping of blood to all parts of the body, ensuring oxygen and nutrition for an organism in perfect harmony.

The heartbeat involves a complex series of events, in which the chambers of the heart (atria and ventricles) relax and contract. This cycle also involves the opening and closing of the valves in and out of the lower chambers of the heart.

In healthy hearts, each beat begins and is controlled by the sinus node (SA), a natural pacemaker that produces electrical impulses. Then, these impulses travel through the atria and, later, to the ventricles, thus guaranteeing the blood pumping system.

Normal heart rate: what does it mean?

The heart rate or pulse is given by the number of signals that the sinus node produces per minute, determining the rhythm of the heartbeat. When this value ranges from 60 to 100, we say that the individual’s heart is working perfectly.

In more physically conditioned individuals, as in the case of athletes, this frequency may be slower and still be considered normal. In addition, values ​​may vary in situations of rest or physical exertion.

Types

Basically, arrhythmias can be classified between: supraventricular, ventricular, premature (extra) and bradyarrhythmia (bradycardia).

Supraventricular arrhythmias

These changes affect the upper part of the heart (atria) and are considered tachycardias, that is, accelerated heart rates. They can also start at the atrioventricular node, a group of cells located between the atria and ventricles.

Atrial fibrillation

Quite frequently, atrial fibrillation is the most common type of severe arrhythmia . It commonly affects the elderly and is characterized by an irregular beat in the atrial chambers. In such cases, the contractions are rapid and can generate a frequency of more than 300 beats per minute.

Unlike healthy hearts, in atrial fibrillation, electrical signals do not start at the sinus node, but in other parts of the nearby atria or pulmonary veins.

This type of alteration is considered serious because it favors the appearance of blood clots, which can progress to a stroke.

Flutter atrial

Similar to atrial fibrillation, the flutter also produces electrical signals in the atria at an accelerated rate. In this case, however, the process occurs irregularly. Although less common, it can also be considered a serious condition.

Taquicardia supraventricular (TSV)

TSV is characterized by a regular and fast heart rate. In such cases, the patient will notice rapid beats that start and end suddenly, and can last for seconds or hours. It is common for the frequency to be between 160 and 200 beats per minute.

Other supraventricular arrhythmias include:

• Atrial tachycardia;
• Extra-sístole atrial;
• Wolff-Parkinson-White syndrome.

Ventricular arrhythmias

Ventricular arrhythmias are those that begin in the lower part of the heart (ventricles). These changes tend to be more dangerous and are commonly related to heart problems.

Ventricular fibrillation

Ventricular fibrillation causes an irregular rhythm, with rapid and uncoordinated contractions. Such a condition prevents the ventricles from pumping blood properly. Therefore, the change is considered a severe arrhythmia , which can result in sudden cardiac arrest and death of the patient.

There are some types of ventricular fibrillation, including Torsade de Pointes, a rare condition detectable by electrocardiogram .

Ventricular tachycardia

Characterized by the rapid and regular beat of the ventricles, ventricular tachycardia can have varying durations. In situations that last longer, it is possible that the change will develop into a more severe arrhythmia, such as ventricular fibrillation.

Premature arrhythmias (extra-systoles)

This type of arrhythmia is the most common , being caused by premature beats, which are harmless and do not usually generate symptoms. However, when signs occur, the patient may experience only palpitations. Thus, in the vast majority of cases, treatment is unnecessary.

These arrhythmias are so called because they generate extra beats, outside the normal rhythm. They usually occur naturally, but their cause may be related to heart disease, stress and excess caffeine / alcohol.

They can be differentiated between premature atrial contractions (PAC) and premature ventricular contractions (CVP).

Brady arrhythmia (Bradycardia)

Bradycardia occurs when a heartbeat is slow and records less than 60 beats per minute. However, it is common for people with high physical fitness to have lower rates. Therefore, these arrhythmias only represent a problem when the heart has a defect and does not pump enough blood to the body.

Sinus arrhythmia

Originating in the sinus node, this type of arrhythmia is quite common in children , but it can also affect adults. It is characterized by the change in heart rate during breathing, that is, it is the acceleration of beats when inhaling and decreases when exhaling.

Sinus arrhythmia is involuntary and does not usually show symptoms or require treatment.

Arrhythmia in children

A newborn’s heart tends to beat between 95 to 160 times a minute. As the child grows, these rates decrease.

As in adults, the causes of pediatric arrhythmias may be related to defects in the heart, which arise from birth. In other cases, the condition can arise throughout childhood.

Benign or malignant arrhythmia?

In most cases, the arrhythmia is benign. For it to be considered a more serious condition, the disease is usually related to patients who suffer from some change in the heart, such as heart failure.

Causes

Basically, the arrhythmia is caused by the interruption or malfunction of the electrical impulses that control the heartbeat. Its causes can be related to heart problems and other conditions.

Heart problems

• Cardiac insufficiency;
• Heart attack (infarction);
• Cardiac tissue healing after a heart attack;
• Blocked arteries in the heart (coronary artery disease);
• Changes in the structure of the heart, such as cardiomyopathy.

Non-cardiac

• Hyperthyroidism;
• Hypertension;
• Abuse of alcohol or caffeine;
• Anemia;
• Stress;
• Diabetes;
• Panic Syndrome;
• Anxiety;
• Sleep apnea;
• Smoking;
• Genetics;
• Chagas disease;
• Some medications.

It is worth mentioning that, in some cases, the causes are unknown.

Risk factors

The chances of developing an arrhythmia are greater in cases of:

• Cardiac problems: narrow arteries, heart attack, abnormally functioning heart valves, previous cardiac surgery, heart failure, cardiomyopathy and other damages can cause arrhythmias;
• Elderly people: old age contributes to the onset of heart disease;
• Hypertension: high blood pressure increases the risk of developing coronary artery disease, as well as other heart problems;
• Diabetes: in uncontrolled cases, there is a greater chance of coronary artery disease;
• Sleep apnea: Breathing interrupted during sleep can cause the heart to not receive enough oxygen;
• Thyroid dysfunction: hyperthyroidism increases the chances of arrhythmia;
• Alcoholism: alcohol abuse on a regular basis can affect electrical impulses in the heart;
• Electrolyte imbalance: the high or low presence of electrolytes in the blood can affect the functioning of the heart;
• Use of some medications: include some cough and cold remedies, such as bronchodilators, as well as certain prescription drugs;
• Excess of caffeine and / or nicotine: stimulants can increase the heart rate and favor the onset of severe arrhythmias;
• Congenital heart disease: defects present since birth that affect the functioning of the heart;
• Obesity: increases the risk of high blood pressure and, consequently, arrhythmia;
• Illegal drugs: amphetamines and cocaine can cause ventricular fibrillation and other arrhythmias.

Symptoms

In many cases the patient will not experience any symptoms of the disease. That’s because abnormal heartbeats can come and go quickly. However, in situations where the arrhythmia is more severe and lasts long enough to affect the functioning of the heart, the following signs may appear:

• Palpitation;
• Fatigue;
• Dizziness;
• Fainting or feeling faint;
• Pallor;
• Lack of air;
• Beats too fast or too slow;
• Sweating;
• Chest pain;
• Excessive sweat;
• Blurred vision.

When should I see a doctor?

It is important to seek medical help whenever you notice changes in your heart rate or experience any of the symptoms described above, especially in situations of mental confusion, fainting and chest pain. This is true in cases of patients with suspected arrhythmia or already undergoing treatment.

In an arrhythmia called ventricular fibrillation, the patient may collapse in a few seconds, due to lack of blood circulation. In such cases it is important to call the emergency immediately and, if possible, perform cardiopulmonary resuscitation (CPR).

Diagnosis

The diagnosis of arrhythmia can be made by a cardiologist or general practitioner . Initially, the doctor should talk to the patient about symptoms, health problems, lifestyle and family history. In addition, you can perform a physical exam that includes listening to the heartbeat frequency, measuring the pulse and checking for swelling in the legs or feet.

Some complementary tests can also be ordered by the doctor. Are they:

Electrocardiogram (ECG)

Small electrodes are placed on the chest, arms and legs in order to detect the electrical activity of the patient’s heart. Fast and painless, this is the most common test in the diagnosis of arrhythmia. The test is able to measure the time and duration of each electrical phase of the heartbeat. However, the ECG is unable to detect arrhythmias that occur outside the test period.

Read more: What is the Electrocardiogram for?

24 hour Holter

The 24-hour Holter is a portable ECG device, which must be used by the patient for 1 or 2 days. By recording the electrical signals from the heart for longer than the electrocardiogram, it allows the diagnosis of sporadic arrhythmia.

Electrocardiographic event monitor

Like the 24-hour Holter, the electrocardiographic event monitor or Loop Event Recorder records the electrical signals from the heart during daily activities. However, the registration only occurs at certain times, since the patient must activate the device only when he feels the symptoms. Thus, it will be possible to check the functioning of the heart during such episodes.

The event monitor is portable and can be maintained for days, weeks or until symptoms appear. Their results are usually captured by means of a computerized system and can be evaluated remotely, without the need for the patient to go to the hospital or clinic.

Echocardiogram

A noninvasive method, the echocardiogram assesses the heart and heart valves by means of sound waves (ultrasound). The test is able to provide information about the size and shape of the organ, as well as its functioning. In this type of examination, a portable device is placed on the patient’s chest.

Cardiac catheterization (coronary angiography)

Invasive examination, with local anesthesia, cardiac catheterization inserts thin, flexible tubes (catheters) into the blood vessels of the patient’s arms, groin or neck. With the aid of X-ray equipment , these tubes will be guided to the heart, in order to analyze the interior of the coronary arteries or evaluate the functioning of the valves and heart muscle.

During the procedure, the doctor will inject iodinated contrast into the catheters to facilitate the capture of images of the arteries, chambers and heart valves. This will help the professional to find obstructions that can cause a heart attack.

In the case of the examination in children, general anesthesia will be used in order to avoid agitation.

Blood and urine test

Laboratory tests may be ordered to check the level of some specific substances in the blood, such as potassium and thyroid hormone. The detection of abnormal levels can favor the appearance of arrhythmias and be the cause of the disease.

Electrophysiological study

This invasive procedure is used to assess severe cases of arrhythmia. It is also commonly used when other methods have not been able to diagnose the disease. In it, catheters with electrode tips that go to the heart are inserted into the patient’s groin veins or arms. From that moment, the doctor will be able to map the propagation of electrical impulses.

In addition, it is possible that during the examination, the professional will stimulate a cardiac arrhythmia and administer medications in order to verify its effectiveness in the treatment.

Tilt test

In cases of patients suffering from dizziness and fainting, the tilt test is usually indicated. The test monitors heart rate and blood pressure when the patient is in different positions.

The procedure is performed on a motorized tilting stretcher, known as a tilting table. After a period of rest, the patient will be subjected to changes in position by means of progressive inclinations of the equipment. The doctor will then observe how the body responds to each change in angle. Then, it is possible for the professional to administer medications to check the patient’s reactions.

Stress tests

Changes in heart rate can be triggered by exercise. For this reason, stress tests are used to analyze the heart’s ability to exert and beat faster.

There are several types of stress tests, the most common of which involves exercising on a bicycle or treadmill, while heart rate and blood pressure are monitored. In cases where the patient is unable to exercise, the doctor may administer a medication to stimulate the heart.

Looper implantável

Ordered in cases where the symptoms happen infrequently and have no clear origin, the implantable looper is used to detect abnormal heart rhythms, in periods that can include up to 3 years.

In this procedure, a subcutaneous implant is performed on the patient through simple surgery, without the need for hospitalization. The device is usually placed in the anterior thoracic region using local anesthesia.

Is cardiac arrhythmia curable? What is the treatment?

Arrhythmia is a problem that can be cured and may or may not require treatment. It is only in cases that generate more severe symptoms or if there is a risk of complications that the doctor will request some procedures. The measures may include the use of drugs, medical procedures, implantable devices and even surgery.

Arrhythmia medications

The drugs commonly used in the treatment of arrhythmias are known as antiarrhythmic drugs , and have the function of controlling the heartbeat, decreasing its speed and normalizing an abnormal rhythm. Drugs capable of accelerating a slow heart rate, as in the case of bradycardia, are not yet considered reliable.

Such medications include calcium channel blockers (relax blood vessels) and beta blockers (slow heart rate and lower blood pressure):

• Digoxin ;
• Diltiazem;
• Verapamil;
• Metoprolol;
• Atenolol;
• Amiodarone ;
• Sotalol;
• Flecainida;
• Propafenona;
• Dofetilida;
• Ibutilida;
• Quinidina;
• Procainamida;
• Disopyramide.

In addition, some arrhythmias, especially atrial fibrillation, can be treated by using blood -thinning drugs ( anticoagulants ) in order to decrease the risk of blood clots and strokes. Among them are:

• Coumadin;
• Aspirin;
• Eliquis ;
• Pradaxa;
• Xarelto.

It is possible to have side effects, which can even worsen an arrhythmia or develop a new alteration. For this reason, it is extremely important that medical follow-up is carried out throughout the treatment .

Attention!

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

Medical procedures

Catheter ablation

Ablation is used to eliminate diseased areas of the myocardium, by inserting catheters that are sent to the heart. It can be performed with cryoablation (cold) or radiofrequency (heat) energies, which destroy the small damaged portions of the cardiac tissue, responsible for arrhythmia.

This minimally invasive technique has a high rate of effectiveness. Before being performed, it is possible that the doctor requests a transesophageal echocardiogram, in order to exclude the possibility of the existence of a blood clot in the atria.

Electrical cardioversion

If the drugs do not work to control a persistent irregular heart rhythm, it is possible that the doctor will perform a cardioversion. The procedure consists of applying a shock to the sedated patient’s chest, capable of affecting electrical impulses and restoring the normal rhythm of the heart.

Implantable devices

Cardiac pacemaker

The small devices placed in a surgical procedure under the skin of the patient’s chest or abdomen are called pacemakers. These devices help to control abnormal heart rhythms, as they have sensors capable of detecting the electrical activity of the heart. As soon as they notice an abnormal rhythm, they send electrical impulses to induce normal beats.

Implantable cardioverter defibrillator (ICD)

In the most severe (life-threatening) arrhythmias, such as ventricular fibrillation and tachycardia, implantation of the ICD, a device similar to a pacemaker capable of continuously monitoring the heartbeat and, if necessary, sending electric shocks to the heart, may be requested. correct the pulse in an instantaneous way.

Surgery

Surgery will be recommended only in extreme cases, when there has been no improvement through clinical treatment. It can also be used in situations where the patient is already doing it to correct other problems.

Usually, preference is given to minimally invasive methods, with shorter recovery times. The most used are:

• Maze procedure: incisions are made in the cardiac tissue in order to stop the spread of disorganized electrical impulses. This surgery is usually indicated in cases of atrial fibrillation.
• Coronary bypass surgery: indicated in patients who also have severe coronary artery disease, in order to improve blood flow to the heart muscle.

Home treatment

Some measures can be adopted at home by the patient himself, in order to avoid arrhythmia. Are they:

• Stop doing activities when you notice that they trigger an arrhythmia more often;
• Stop smoking;
• Limit the use of alcohol, not exceeding one dose per day;
• Limit or stop using caffeine;
• Do not use cough and cold remedies that contain stimulants, always check with the doctor or pharmacist;
• Monitor your heart rate by measuring your pulse.

Vagal maneuvers

In some types of arrhythmia, it is also possible for the patient to perform the so-called “vagal maneuvers”. This type of treatment can be used to decrease the accelerated beats (tachycardia).

Through exercises that will affect the vagus nerves (structures that help to regulate the heartbeat), the electrical impulses are slowed down, causing the heart rate to return to normal in a few minutes.

Maneuvers can include actions ranging from coughing to putting an ice pack on your face. It is important that before starting any measures like these, the patient talks to the doctor responsible for the treatment.

Living together

Some measures may favor the treatment of arrhythmias and facilitate the patient’s coexistence with the disease. Care includes:

Tips for using medications

• Create a routine to take the medications, always respecting the medical prescription;
• Most cardiac medications should be taken over the long term, even if symptoms improve. Therefore, never stop taking a medication without medical consent.
• It is possible to experience side effects that include dizziness. In these cases, sit or lie down for a few minutes. Then, lift slowly. If symptoms persist, tell your doctor.
• Do not modify the medication in order to save. Always talk to your healthcare professional before taking any action.
• Tell your doctor if you are taking or plan to take a new medication, including herbs and vitamins, some substances may interfere with treatment.
• Anticipate the prescriptions in order to prevent the medication from running out and you don’t have a new prescription on hand.

Care of implantable devices

In treatments in which the patient uses implantable devices, such as a pacemaker, the patient must be aware of some events that may interfere with its functioning:

• Portable external defibrillators can cause temporary, permanent dysfunction or interruption of stimulation;
• Exposure to cumulative radiation doses can damage the battery or modify the main function of the device;
• Pacemaker interference may occur when the cell phone is placed directly on the generator.

How to monitor the pulse?

Follow the step by step to correctly identify your heartbeat:

1. Place your index and middle fingers on your wrist, just below the thumb line. Leave the hand of the arm being used to measure facing upwards.
2. Feel the pulse and then count the number of beats for 1 full minute.
3. Write down the value, along with the day, time and symptoms you felt at the time of measurement.

Common questions

Is palpitation always a sign of arrhythmia?

Although it is the most common symptom, palpitation does not guarantee the diagnosis of arrhythmia. Often, the sensation of a heart failing or an altered heart rhythm, reported by the patient, is only a sign of anxiety .

Can cardiac arrhythmia kill?

In severe cases, arrhythmia can result in the death of the patient. The risk is because the change in heart rate may cause the heart to be unable to pump enough blood to the body.

Who has arrhythmia can do physical exercises?

Regular practice of low-intensity physical activity can benefit a troubled heart. Therefore, it is common for patients with arrhythmia to exercise, although the recommendation and guidance of a cardiologist before starting any activity is essential .

Can physical exertion during sex cause arrhythmia?

Like exercises of light or moderate intensity, the sexual act is not capable of provoking an arrhythmia. However, it is possible that it aggravates cases in which the disease has not been adequately treated.

Are people suffering from anxiety more likely to have arrhythmia?

Anxious people or people with other types of disorders usually report palpitations, which are usually nothing more than sensations triggered by the psychological condition, without having any relationship with arrhythmia.

Complications

In a few cases the arrhythmia will be considered a cause for concern. However, especially in more severe conditions, such as fibrillations, there is a risk that the alteration will cause greater damage. Understand:

Stroke

Arrhythmia pictures can cause blood clots that, when ruptured, can reach the brain and block blood flow, depriving it of receiving oxygen. Stroke can cause irreversible damage to patients, as dead brain cells cannot be replaced.

Cardiac insufficiency

Especially in cases of atrial fibrillation, ineffective pumping of the heart for a long period can cause heart failure. This condition impairs the proper functioning of the organism, interfering with the patient’s quality of life.

Heart attack

Heart attack or myocardial infarction is the death of cardiac muscle tissue, caused by the lack of blood circulation, without necessarily resulting in the death of the patient.

Sudden death

Instant and sudden, sudden death occurs due to the impairment of the patient’s cardiac function. In the vast majority of cases, it happens outside the hospital environment, in people who have heart problems or have already suffered cardiac arrests.

If there is adequate care, sudden death can be reversed. This is possible by applying an electric shock to the patient’s chest (defibrillation). However, this resuscitation should occur quickly, as the brain begins to suffer damage after 3 minutes.

Prevention

Preventive measures against arrhythmia are the same as those used to prevent the onset of heart problems. It is also important to control risk factors and to have a regular check-up with a cardiologist. Tips include:

• Maintain a balanced diet, with low intake of salt and fats;
• Do not ingest or exceed the consumption of alcohol and caffeine;
• Practice physical activities regularly;
• Do not smoke;
• Control blood pressure;
• Control cholesterol levels;
• Avoid or overweight.

Arrhythmias are most often not a sign of concern. However, severe cases can cause the patient’s sudden death. Share the information in this text so that everyone can know the condition that affects thousands of Brazilians every year!