Information on cardiac arrhythmias
What are cardiac arrhythmias?
Cardiac arrhythmias are deviations from the normal heartbeat. These can be harmless or indicate a disease. A distinction is made between bradycardia, when the heart beats too slowly, tachycardia, when the heart beats too quickly, and extrasystoles, when the heart beats irregularly. Not all types of cardiac arrhythmias require treatment. For example, every healthy person has occasional extrasystoles.
What is a normal heartbeat?
The human heart beats rhythmically at a frequency between 60 and 100 beats per minute. The heartbeat is created when heart muscle cells are electrically excited and this excitation is passed on to every cell in the heart. The excitation begins in a small area in the right atrium of the heart, the so-called sinus node. It generates a rhythm independently and transmits it to the rest of the heart via certain conduction pathways. This frequency can be influenced by various parameters (e.g. sympathetic, parasympathetic or excitement/stress/sport versus relaxation/digestion).
If the heart gets out of this rhythm, it is called a cardiac arrhythmia or arrhythmia (from the Greek: unrhythmic). Cardiac arrhythmias can be divided into different groups depending on their severity and type. If the heart beats too slowly (under 60 beats per minute), it is called bradycardia. A heartbeat that is too fast, on the other hand, is called tachycardia (over 100 beats per minute at rest). There are also extra beats (extrasystoles) or blockages in the transmission of excitation in the heart.
What cardiac arrhythmias are there?
The most common cardiac arrhythmias are:
- Atrial fibrillation
- Raps in the heartbeat (tachycardia)
- AV block
- WPW syndrome
- Sick sinus syndrome
What are the causes of cardiac arrhythmias?
Cardiac arrhythmias can have a variety of causes. However, there are also cases of cardiac arrhythmias where no cause can be found even after intensive research.
The following heart diseases can affect the heart rhythm:
Congenital heart defects: These can be congenital, such as some types of heart defects, disorders of the electrical conduction pathways or defective ion channels.
Acquired heart muscle damage: Heart rhythm disorders can occur due to inflammation of the heart (myocarditis), a heart attack or heart valve disease.
In addition, disorders outside the heart can also lead to cardiac arrhythmias. Since the electrical conduction in the heart is carried by changes in ions (such as potassium and magnesium) between the cell and the outside of the cell, electrolyte disorders, thyroid disorders and medication can also lead to cardiac arrhythmias.
Stress, oxygen deficiency or alcohol can also lead to disorders. For example, alcohol can trigger atrial fibrillation in some people, which is also known as holiday heart syndrome because it occurs more frequently when excessive alcohol is consumed on holiday or at the weekend.
Signs and symptoms of cardiac arrhythmia
Depending on the type of cardiac arrhythmia, these manifest themselves in different ways. Common signs are:
Heart palpitations: Extra heartbeats lead to a compensatory pause in the next beat, which is noticeable as heart palpitations.
Racing heart: Palpitations are so-called irregular or strong or strenuous heart actions. If the heart beats too fast, whether regularly or irregularly, this can sometimes be noticeable as an unpleasant or frightening palpitation. Sometimes you can even feel this in your throat.
Heart pain: Heart pain can also occur (angina pectoris), this should always be checked by an internist or cardiologist because there is a risk of a heart attack.
Dizziness and fainting: Since a cardiac arrhythmia can lead to a massive restriction of heart function in certain cases, there is a risk of insufficient blood flow to the brain.
Shortness of breath and edema
How are cardiac arrhythmias diagnosed?
The symptoms usually lead the patient to a general practitioner or internist who, after a medical history interview and a physical examination (including measuring the pulse and blood pressure, listening to the heart and lungs), will then order an ECG examination.
During an ECG, up to 12 electrodes are attached to the body. It is then possible to calculate how the current flow in the heart is, whether it is delayed or too fast, and initial clues to the cause can also be found. Since a one-off ECG measurement is not particularly meaningful (if the ECG looks normal), an ECG can also be taken under stress (usually on a bicycle). This may reveal rhythm disturbances that do not occur at rest.
A long-term ECG can also be done. The patient usually wears the ECG electrodes and a small measuring and storage device on their body for 24 hours. After 24 hours, the ECG is then evaluated by the cardiologist.
Since electrolyte imbalances or hyperthyroidism or hypothyroidism can also lead to cardiac arrhythmias, a blood sample should be taken to check the specific values, depending on the medical history.
Another examination method is the cardiac echo. This is a type of ultrasound in which the structure and movement of the heart walls and valves, as well as the blood flow in the heart, can be measured and observed. The cardiac echo can be done both at rest and during movement (stress echo). In addition to the ultrasound examination from the outside, there is also a cardiac echo examination through the esophagus (TEE - Trans Esophageal Echo), which offers different views of the heart due to its proximity to the heart.
Another invasive method is the electrophysiological examination. This is a special type of cardiac catheter examination. It offers the possibility of identifying the electrical currents and the origin of cardiac arrhythmias using small wires that are pushed into the heart via a vein or artery and, if necessary, treating them using electrical impulses (depending on the cause).
What to do if you have a heart rhythm disorder?
Basically, all heart rhythm disorders should be checked out by a cardiologist or internist at least once. Some types of heart rhythm disorders can be harmless and do not require treatment. However, there are other types that can be extremely dangerous and even fatal. Today, treatment is only given when it is absolutely necessary.
When is heart rhythm treatment necessary?
The following indications make treatment of heart rhythm disorders necessary:
- Risk of sudden cardiac death
- Risk of stroke
- Restricted physical performance
- High stress for the affected person due to dizziness, palpitations or severe malaise
What treatment methods can be used?
If there is an underlying disease that can be held responsible for the heart rhythm disorders, these must be treated first. In the case of thyroid disorders, poisoning and electrolyte disorders, appropriate treatment leads to a rapid reduction in heart problems.
If the rhythm disorders occur as a result of stress, alcohol consumption or psychological problems, lifestyle changes should be made. Important factors include avoiding alcohol and cigarettes, getting enough sleep and not eating more than you feel full. Relaxation and sufficient exercise are also important for a healthy heart.
For arrhythmias that are caused by the heart itself, the following treatment methods are available, depending on the type of cardiac arrhythmia.
Medications for cardiac arrhythmias
So-called rhythm medications or antiarrhythmics are used for medicinal treatment. These are medications that regulate the heart rate in different ways (depending on their mode of action). They can ensure that the rhythm disturbances occur less frequently and are easier to bear. Unfortunately, it is never possible to predict in advance how the individual patient will react to a particular medication. This is why different medications and dosages often have to be tested until a satisfactory result can be achieved. This can take months.
The first dose of a rhythm medication should always be given under medical supervision. Either in a cardiology practice or during a hospital stay in a heart clinic. Patients should never change the dosage on their own or stop taking the medication without consulting a cardiologist. Regular check-ups by the treating doctor are important, even for well-controlled patients. Ideally, these should take place every three months.
Rhythm surgery - surgical procedures for cardiac arrhythmias
Some causes of arrhythmias require surgery by a cardiac surgeon, for example in the case of heart valve defects or a bypass operation for coronary heart disease. Medications also do not help prevent sudden cardiac death. The following important surgical procedures can be used for cardiac arrhythmias. You can find detailed information on the individual procedures by clicking on the link.
Pacemaker for bradycardia
Defibrillator implantation if there is a risk of sudden cardiac death
Atrial fibrillation ablation
What are the prognosis and life expectancy for cardiac arrhythmias?
Many types of cardiac arrhythmias can be fatal and should therefore not be taken lightly. Action is absolutely essential here. If targeted therapy is carried out after the cause has been investigated, there is a good chance of being able to lead a normal life again.
Of course, every therapy has its risks, both medication and surgery. However, your treating cardiologist or internist will discuss all the options with their advantages and disadvantages with you in detail before starting treatment. If you have any questions, don't be afraid to ask. It's your life and your illness. The more you know about it, the better you can deal with it.
The therapy offers the opportunity to live a carefree life again, without the risk of fainting, sudden clouding of consciousness and loss of consciousness due to cardiac arrhythmias - if you have these symptoms, driving a motor vehicle is also prohibited.
Which specialists and clinics are specialists in cardiac arrhythmias?
If you suffer from cardiac arrhythmias, you want the best medical diagnosis and treatment for yourself. That's why the patient asks himself where can I find the best clinic for cardiac arrhythmias or the best heart clinics in Germany. University Hospital Bonn is one of the best hospitals in Germany.
