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Arrhythmia PDF Print E-mail

An arrhythmia is a change in the rhythm of your heartbeat. When the heart beats too fast, it's called tachycardia. When it beats too slow, it's called bradycardia. An arrhythmia can also mean that your heart beats irregularly (skips a beat or has an extra beat).

Tachycardia

Tachycardia is an abnormally rapid beating of the heart, defined as a resting heart rate of over 100 beats per minute.

There are three types of tachycardia, each with its own specific symptoms/causes.

Sinus tachycardia

Sinus Tachycardia is due to rapid firing of a the sinoatrial (sinus) node, which is the natural pacemaker of the heart. A person with Sinus Tachycardia will see his or her heart rate increases rapidly with minimal exertion; the rapid heart rate may be accompanied by symptoms of palpitations, fatigue, and exercise intolerance. Sinus Tachycardia is not associated with an abnormal electrical pattern on the electrocardiogram. Anyone can suffer from Sinus Tachycardia, but it is most often seen in young women in their late 20s or early 30s. In addition to the most prominent symptoms of palpitations, fatigue and exercise intolerance, Sinus Tachycardia can also be associated a drop in blood pressure upon standing, blurred vision, dizziness, tingling, shortness of breath, and sweating.

Paroxysmal atrial tachycardia

Like Sinus Tachycardia, Paroxysmal Atrial Tachycardia is symptomized by bouts of rapid, regular heart beating, but in the case of Paroxysmal Atrial Tachycardia (sometimes called PAT), the rapid heart beating originates elsewhere in the atrium, or upper chamber of the heart, rather than in the sinoatrial (sinus) node. Paroxysmal Atrial Tachycardia occurs and ends suddenly. The heart rate is usually between 160 and 200 beats per minute. It can occur without any heart disease being present. It is usually more annoying than dangerous and is caused by a premature atrial beat that sends an impulse along an abnormal electrical path to the ventricles. Other causes stem from anxiety, stimulants, overactive thyroid, and in some women, the onset of menstruation. Other symptoms include lightheadedness, chest pain, palpitations, anxiety, sweating, and shortness of breath.

Ventricular tachycardia

Ventricular tachycardia is an abnormal heart rhythm that is rapid, regular and originates from an area of the ventricle, the lower chamber of the heart. Ventricular tachycardias are most commonly associated with heart attacks or scarring of the heart muscle from previous heart attacks and are life threatening. It can occur in the absence of apparent heart disease, but often develops as an early or a late complication of a heart attack, during the course of a general weakening of the heard (called cardiomyopathy), heart disease affecting the heart valves, an inflammation of the heart muscle, and following heart surgery. Ventricular tachycardia can also result from anti-arrhythmic medications (an undesired effect) or from altered blood chemistries (such as a low potassium level), pH (acid-base) changes, or insufficient oxygenation.

Dangers of tachycardia

Tachycardia is harmful for two reasons. First, when the heart beats too rapidly, it performs inefficiently (since there is not enough time for the ventricles to fill completely), causing blood flow and blood pressure to diminish. Second, it increases the work of the heart, causing it to require more oxygen while also reducing the blood flow to the cardiac muscle tissue, increasing the risk of ischemia and resultant infarction.

Diagnosis

Proper diagnosis is very important, however, since the severity of tachycardia ranges greatly. A careful description of the episode will aid the doctor.

Symptoms include:

  • Sensation of feeling the heart beat (palpitations)
  • Light-headedness or dizziness, Fainting, Shortness of breath
  • Chest discomfort (angina)

Note: Symptoms may start and stop suddenly. In some cases, there are no symptoms.

Diagnosis is not always easy, because the event is usually over by the time the patient sees a doctor.

In addition to the above symptoms, Tachycardia resulting in loss of consciousness may occur. Ventricular tachycardia is a potentially lethal arrhythmia and may result in an absent pulse. If the rapid heart rate is still occurring, an electrocardiograph will show the condition. If the event is over, physicians often recommend a period of ambulatory electrocardiographic monitoring (called Holter monitoring) to confirm the diagnosis. An intracardiac electrophysiology study or blood chemistries and other tests may also be performed.

Treatment

Treatment varies with the symptoms, the situation, and the underlying cardiac disorder. No treatment may be required in cases of non-life threatening tachycardia.

Ventricular tachycardia may become an emergency situation and may be require CPR, electrical defibrillation or cardioversion (electric shock), or intravenous anti-arrhythmic medications.

Non-emergency treatment can take several paths. An electrophysiologist may recommend one of three options:

  • Medications Sometimes, the cardiologist or electrophysiologist may prescribe the use of oral anti-arrhythmic medications. Such medications, however, can have side effects, and their use is currently decreasing in favor of other treatments. A physician may still prescribe these medications to be used in addition to other procedures.
  • Implantable Cardioverter Defibrillators (ICDs) An Implantable Cardioverter Defibrillator is a small device about the size of a pager that is implanted under the skin in the chest. It monitors the heart and if it detects abnormal beating it delivers a small shock that restores the normal rhythm by aborting or interrupting the rapid heart beat.
  • Catheter Ablation Following tests, an electrophysiologist may be able to determine if a certain part of the heart is the cause of the tachycardia. If so, the electrophysiologist may decide that the best option is to use heat or cold to destroy the small areas of heart muscle that cause the abnormal electrical signals that cause rapid or irregular heart rhythms. The heat or cold is delivered through catheters that are snaked through the veins or arteries to the heart. Ablation can eliminate or decrease the frequency of abnormal heart rhythms.
 


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Testimonials

He took time to explain and answer all my questions...

I was born with an extra electrical pathway in my heart that causes frequent episodes of rapid heartbeat, which was diagnosed as supra-ventricular tachycardia. A cardiologist treated me with a medication called a beta-blocker, which reduced the frequency but did not eliminate the condition.

Recently, a severe episode forced me to go into the emergency room at Crittenton Hospital. While there, I went into an almost lethal rhythm and was fortunately shocked out of it. I thank God this occurred while I was in the hospital.

Dr. Goel was consulted to give an opinion on my condition. He diagnosed me as having been born with WPW Syndrome, which causes a rapid heartbeat due to a short-circuit in the electrical system of my heart. He offered the options of radio frequency ablation to correct the condition or continued medication with unpredictable risk of recurrence. After extensive discussion with Dr. Goel, I decided to go with the ablation procedure and was subsequently transferred to Beaumont Hospital.

Dr. Goel performed an electrophysiological study that localized the pathway to the left side of my heart. After making a pathway puncture to the wall between the upper heart chambers, he successfully cauterized (ablated) the pathway. The procedure went very smoothly and I was up the next day and discharged to go home.

I feel better than ever and have not had a single incident of palpitation for three months since my procedure.

I have totally discontinued the medication that I had been taking for 25 years for this condition. Further, I am relieved of the psychological burden of an unexpected attack and the risk of it being fatal.

I am very pleased with my experience with Dr. Goel. He took time to explain and answer all my questions, which greatly contributed to my confidence in proceeding with the ablation procedure. He is indeed an excellent and very experienced Cardiologist and Electrophysiologist.

-- Ronald G.


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