Cardiac arrhythmias: symptoms, treatment and causes

Cardiac arrhythmia symptoms include palpitations, skipped heartbeats, nausea, sweating and fatigue. But what exactly are cardiac arrhythmias and what types are there? The heart contracts due to an electrical stimulus that originates in the sinus node. This happens about 60 to 100 times per minute in a resting adult. During exercise this increases to about 150 to 180 times per minute. This happens in a regular rhythm. A cardiac arrhythmia is defined as a recurring disturbance of the heart rhythm, in which the heart beats too fast, too slow or too irregularly. It can occur at any age. Treatment is not necessary in all cases. However, annual check-ups by the GP are important, because cardiac arrhythmias worsen, gradually or quickly.

  • What is a cardiac arrhythmia?
  • Abnormality in the stimulus conduction system
  • Heart rhythm
  • An extra hit every now and then
  • Often innocent
  • Subdivision of cardiac arrhythmias
  • Too slow or too fast heart rate
  • Normal abnormalities of the heart rhythm
  • Types of cardiac arrhythmias
  • Atrial fibrillation (atrial fibrillation)
  • Atrial flutter
  • Chamber tachycardia
  • Chamber fibrillation (ventricular fibrillation)
  • Sick sinus syndrome
  • Wolff-Parkinson-White syndrome
  • Long QT syndrome
  • Catecholaminergic polymorphic ventricular tachycardia
  • Heartbeats
  • Symptoms of a heart rhythm disorder
  • Causes of a heart rhythm disorder
  • Causes outside the heart
  • Causes in the heart
  • Is a heart rhythm disorder dangerous?
  • Usually not dangerous
  • Blood thinners
  • Further investigation
  • Examination and diagnosis
  • Possible treatments for cardiac arrhythmias
  • Medicines
  • Other treatments
  • Prognosis
  • Prevention

 

What is a cardiac arrhythmia?

Abnormality in the stimulus conduction system

A heart rhythm disorder (arrhythmia) is an abnormality in the impulse conduction system, an electrical network that stimulates the heart to beat regularly. A cardiac arrhythmia is a recurring disturbance of the heart rhythm, in which the heart beats too fast, too slow or too irregularly. Cardiac arrhythmias usually arise in attacks, where they occur suddenly and disappear just as suddenly, sometimes after a few seconds, sometimes only after a few hours.

Too much coffee can accelerate sinus rhythm / Source: Istock.com/PuwanaiSomwan

Heart rhythm

Normally the heart has a regular rhythm. The heart rhythm is an autonomous event. A heartbeat is caused by the contraction of the muscular wall of the heart. This is preceded by an electrical stimulus that originates in the sinus node, a group of cells in the ceiling of the right atrium of the heart. This stimulus ultimately reaches all muscle fibers of the heart. Under normal circumstances, the sinus node sends approximately 60-100 stimuli per minute.¹ This happens in a regular rhythm. This rhythm is influenced by breathing. The sinus rhythm accelerates slightly during inhalation, especially in young people. In addition, there are also other factors that influence the sinus node, such as certain hormones (adrenaline) and nerve impulses. These can make the heart beat faster under the influence of effort, pain, anger, fear or stress or slower at rest. Excessive amounts of coffee and alcohol or too much smoking can also accelerate sinus rhythm. It is normal for the heart rhythm to show small fluctuations, which usually depend on changes in activity, your emotions, etc. It can also happen that a beat is skipped or an extra beat occurs.

An extra hit every now and then

Everyone sometimes suffers from an extra stroke, usually stimulated by alcohol, chocolate and caffeinated drinks or some medicines for asthma or colds, for example. If you are otherwise healthy, there is nothing to worry about. You also don’t have to worry about a skipping heart rate or pounding heart due to fright and fear.

 

Often innocent

Cardiac arrhythmias are often quite harmless and do not always cause complaints. However, it is important to go to the doctor for further examination if someone notices that their heart rate is frequently irregular or is accompanied by other complaints, such as shortness of breath.

Anatomy of the heart / Source: Okili77/Shutterstock.com

Subdivision of cardiac arrhythmias

Cardiac arrhythmias have different subdivisions. A clear classification is that which divides cardiac arrhythmias into:

  • a heart rate that is too slow (bradycardia), where the heart rate is below 50 beats per minute;
  • an excessively fast heart rate (tachycardia), where the heart rate is above 100 beats per minute; and
  • in skips (extrasystoles).²

 

Too slow or too fast heart rate

A heartbeat that is too slow or too fast can remain regular or become irregular. Bradycardia is only rarely dangerous. A heartbeat that is too fast can be normal or abnormal. If it is abnormal, it can be harmless or dangerous. Conditions in which the heart contracts in an uncoordinated manner (fibrillation or fluttering) are very serious in nature, which always indicates a serious underlying disorder. Atrial fibrillation is a cardiac arrhythmia in which the atria contract more normally after a discharge of the sinus node, but they contract much too quickly and irregularly. Atrial fibrillation is characterized by an irregular, usually too fast heartbeat. There is also a reduction in the pump function of approximately 20-30%, which makes you more likely to become short of breath.

Normal abnormalities of the heart rhythm

Some examples of normal deviations from the usual rhythm:

  • A fast heart rhythm occurs under normal circumstances when the heart is required to perform more, because the body needs more oxygen during exercise and therefore the heart must pump faster and pump more blood per heartbeat. This is called exercise tachycardia and is a normal physiological response to physical exertion. With considerable effort, the number of strokes can increase to 160 to 180 strokes per minute.
  • When there is anxiety and stress, the body produces a number of hormones, including adrenaline and norepinephrine, that stimulate the heart. This is called adrenaline tachycardia .
  • If you do a lot of sports, you can have a heart that is considerably enlarged. You then have such a strong and large heart that it has to beat much less often per minute to pump enough blood. About 40 heartbeats per minute is not unusual for a highly trained endurance athlete at rest. This phenomenon is called athlete bradycardia . After stopping top sports, the heart returns to normal dimensions.

 

Types of cardiac arrhythmias

There are different types of cardiac arrhythmias. The most common cardiac arrhythmias are the following.

Atrial fibrillation (atrial fibrillation)

In atrial fibrillation there is a very fast and irregular heart rhythm in both atria.

Atrial flutter

The atria contract very quickly, while the ventricles contract much more slowly but still too quickly and irregularly.

Chamber tachycardia

The heart chambers contract very quickly, regardless of the atrial rhythm.

Chamber fibrillation (ventricular fibrillation)

The heart beats much too fast, causing the ventricles to no longer really contract.

Sick sinus syndrome

Sick sinus syndrome is a malfunction of the sinus node, causing it to produce too few electrical impulses and your heart to beat too slowly.

Wolff-Parkinson-White syndrome

The Wolff-Parkinson-White syndrome (WPW) is a congenital (heart) defect in the electrical system of the heart in which the rhythm in the heart chambers is disrupted and the heart beats very quickly during an attack, often more than 200 beats per minute .

Long QT syndrome

Long QT syndrome is a serious congenital abnormality of the electrical function of the heart.

Catecholaminergic polymorphic ventricular tachycardia

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a hereditary heart disease in which ventricular fibrillation can develop during physical exertion, stress or intense emotions.

Heartbeats

In fact, heart failure is not a true arrhythmia; The extrasystoles can occur with a heart condition, but usually there is no clear cause, although you are more likely to suffer from them during (over) fatigue and there are also substances that can induce extrasystoles, such as alcohol, chocolate, coffee and cola and medicines for asthma or cold.³

Symptoms of a heart rhythm disorder

A heart rhythm disorder does not always cause complaints. Sometimes a heart rhythm disorder is discovered accidentally during a routine examination, for example. Some people do have noticeable complaints, which may include:

  • palpitations;
  • heart beats;
  • nausea;

Shortness of breath / Source: Wavebreakmedia/Shutterstock.com

  • perspiration;
  • tiredness, feeling weak;
  • chestpain;
  • shortness of breath;
  • shortness of breath;
  • a light-headed feeling;
  • dizziness;
  • fainting (syncope) or near fainting.

 

Causes of a heart rhythm disorder

There is not always an explanation for a heart rhythm disorder. The cause can be inside or outside the heart, respectively due to abnormalities of the heart itself and due to exogenous (outside the heart) causes.

Alcohol and cardiac arrhythmias / Source: Istock.com/karelnoppe

Causes outside the heart

Causes outside the heart include:

  • exercising a lot or excessively;
  • underactive thyroid function;
  • too fast thyroid function;
  • medication use;
  • high bloodpressure;
  • old age;
  • effort;
  • tension and stress;
  • fever;
  • anemia;
  • excessive coffee, alcohol and/or nicotine use;
  • drug use;
  • Electric shock;
  • diabetes mellitus.

 

Causes in the heart

Causes in the heart include:

  • coronary heart disease, such as acute myocardial infarction;
  • heart muscle disease (cardiomyopathy);
  • heart failure (signs of heart failure include shortness of breath at night and on exertion, swelling of the feet and ankles, nighttime urination: frequent urination at night);
  • surgery on the heart;
  • congenital heart defect.

Sometimes one cause can be identified, but it can also be a combination of factors.

Is a heart rhythm disorder dangerous?

Usually not dangerous

A heart rhythm disorder can be annoying, but is usually not dangerous. If someone suffers from shortness of breath in addition to palpitations or if an attack has not disappeared after a few hours or keeps coming back, it is important to contact the doctor immediately. If someone suddenly becomes short of breath or experiences chest pain, call the doctor or emergency number 112 immediately.

Blood thinners

Blood thinners are necessary for some heart rhythm disorders. This is due to the possibility that after some time clots will form in the atria of the heart because the atria do not empty themselves sufficiently. This remaining blood can form clots, which can enter the bloodstream. If there is a narrowing somewhere in the blood vessels, there is a possibility that a clot will completely block the blood vessel. In the brain this can lead to a cerebral infarction or stroke (CVA) and in the coronary arteries that supply the heart muscle with blood to a heart attack. The heart can also lose more and more pumping function under the influence of a longer-standing rhythm disorder. Both complications of cardiac arrhythmias are easy to treat.

Further investigation

Cardiac arrhythmias usually get worse over time and so do the risks. That is why it is important to go to the doctor for further examination if you notice that the heartbeat is irregular.

Examination and diagnosis

Your GP can refer you to a heart specialist. A heart rhythm disorder is usually diagnosed by means of an electrocardiogram (ECG). This is colloquially known as ‘ECG’. This is a recording of the electrical activity of the heart muscle. You may also need to wear a small portable ECG recording device for 24 hours or more. This is called a Holter monitor or ambulatory ECG monitoring. This involves recording your heart activity for 24 hours (sometimes 48 hours).
If your symptoms appear to be caused by exercise, an exercise ECG may be necessary. This measures the electrical activity of your heart during increasing exertion.
Other tests and investigations used in diagnosing arrhythmias include:

  • Wearing an Event Recorder, a device that is especially suitable for recording cardiac arrhythmias that do not occur daily, but do occur regularly.
  • Electrophysiological examination (EFO): it shows what type of arrhythmia it is and where the arrhythmia originates.
  • Echocardiogram (ultrasound): an ultrasound of your heart.

 

Prescribing medication for a heart rhythm disorder / Source: Istock.com/Wavebreakmedia

Possible treatments for cardiac arrhythmias

Treatment is not necessary in all cases. However, annual check-ups by the GP are important because cardiac arrhythmias worsen, gradually or quickly. If treatment is indicated, the following options are available:

Medicines

The following medications, among others, may be prescribed:

  • Antiarrhythmics, which lower the heart rate and ensure a regular heart rate.
  • Beta blockers, which lower heart rate, the heart’s oxygen requirement and blood pressure.
  • Calcium blockers or vasodilators.
  • Anticoagulants. These slow down the formation of blood clots. This reduces the chance of a blood vessel becoming blocked.

 

Other treatments

If medications do not work or have worn off and the situation requires intervention, you can proceed with:

  • Electrical cardioversion. The specialist uses a device that sends an electrical impulse through the heart muscle.
  • Ablation. During this medical procedure, the specialist uses a catheter to make small lesions in the heart tissue. During an ablation, scar tissue is created and this does not conduct stimuli, blocking the wrong route of the stimuli.
  • Pacemaker. A pacemaker can offer a solution for a heart that beats much too slowly.

 

Prognosis

The detection and treatment of cardiac arrhythmias is constantly being improved. It is now 2023. In recent years, an unprecedented explosion of information about cardiac arrhythmias has been observed. Early detection and adequate treatment of cardiac arrhythmias has improved the quality and quantity of life. However, patients must be adherent to medication, because not taking medications can seriously reduce the prognosis. Untreated, ignored, or undertreated serious arrhythmias can lead to syncope (fainting), stroke, heart failure, and sudden death.

Prevention

You can take several measures to reduce the risk of heart rhythm disorders, such as:

  • Healthy lifestyle: Improve nutrition, exercise regularly and lose weight if you are overweight, quit smoking and limit alcohol consumption.
  • Have your blood pressure and cholesterol levels checked regularly.
  • Reduce stress: Avoid stressful situations or reduce stress by practicing relaxation techniques and getting enough sleep.
  • Taking medications such as blood pressure and cholesterol lowering agents according to the instructions of the treating physician.
  • Checking for underlying conditions such as diabetes, which may require regular checks and treatment. (Type 1 diabetes increases the risk of a heart rhythm disorder, in which the atria of the heart contract much too quickly and irregularly.)

Notes:

  1. Heart rate varies between people, but at rest the normal range is somewhere between 60-90 beats per minute in adults, 90-110 beats per minute in children, and 110-140 beats per minute in babies.
  2. Hans Koch & Peter van Druenen: Diagnosis guide – 200 conditions – Symptoms, diagnosis and treatment. Terra Lannoo Publishers, Arnhem, 2009, p.88.
  3. www.hartenvaatgroep.nl

 

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