INTRODUCTION

An arrhythmia is an irregular heartbeat. If you have an arrhythmia, your heart may beat faster or slower than
others without arrhythmia. There are several different conditions might cause your heart to beat abnormally, and
treatment depends on the cause. Talk to your healthcare provider if you feel like your heart is racing, if you feel
dizzy or lightheaded, or you have chest pain.

DEFINITION
A heart arrhythmia (uh-RITH-me-uh) is an irregular heartbeat. Heart rhythm problems (heart arrhythmias)
occur when the electrical signals that coordinate the heart's beats don't work properly. The faulty signaling
causes the heart to beat too fast (tachycardia), too slow (bradycardia) or irregularly.

TYPES

In general, heart arrhythmias are grouped by the speed of the heart rate. For example:

 Tachycardia (tak-ih-KAHR-dee-uh) is a fast heart. The resting heart rate is greater than 100 beats a
minute.

 Bradycardia (brad-e-KAHR-dee-uh) is a slow heartbeat. The resting heart rate is less than 60 beats a
minute.
Fast heartbeat (tachycardia)

Types of tachycardias include:

 Atrial fibrillation (A-fib). Chaotic heart signaling causes a rapid, uncoordinated heart rate. The condition
may be temporary, but some A-fib episodes may not stop unless treated. A-fib is associated with serious
complications such as stroke.

 Atrial flutter. Atrial flutter is similar to A-fib, but heartbeats are more organized. Atrial flutter is also
linked to stroke.

 Supraventricular tachycardia. Supraventricular tachycardia is a broad term that includes arrhythmias

that start above the lower heart chambers (ventricles). Supraventricular tachycardia causes episodes of a
pounding heartbeat (palpitations) that begin and end abruptly.

 Ventricular fibrillation. This type of arrhythmia occurs when rapid, chaotic electrical signals cause the
lower heart chambers (ventricles) to quiver instead of contacting in a coordinated way that pumps blood
to the rest of the body. This serious problem can lead to death if a normal heart rhythm isn't restored
within minutes. Most people who have ventricular fibrillation have an underlying heart disease or have
experienced serious trauma.

 Ventricular tachycardia. This rapid, regular heart rate starts with faulty electrical signals in the lower
heart chambers (ventricles). The rapid heart rate doesn't allow the ventricles to properly fill with blood. As
 a result, the heart can't pump enough blood to the body. Ventricular tachycardia may not cause serious
problems in people with an otherwise healthy heart. In those with heart disease, ventricular tachycardia
can be a medical emergency that requires immediate medical treatment.
Slow heartbeat (bradycardia)

Although a heart rate below 60 beats a minute while at rest is considered bradycardia, a low resting heart rate
doesn't always signal a problem. If you're physically fit, your heart may still be able to pump enough blood to
the body with fewer than 60 beats a minute at rest.

If you have a slow heart rate and your heart isn't pumping enough blood, you may have a type of bradycardia.
Types of bradycardias include:

 Sick sinus syndrome. The sinus node is responsible for setting the pace of the heart. If it doesn't work
properly, the heart rate may alternate between too slow (bradycardia) and too fast (tachycardia). Sick
sinus syndrome can be caused by scarring near the sinus node that's slowing, disrupting or blocking the
travel of impulses. Sick sinus syndrome is most common among older adults.

 Conduction block. A block of the heart's electrical pathways can cause the signals that trigger the
heartbeats to slow down or stop. Some blocks may cause no signs or symptoms, and others may cause
skipped beats or bradycardia.
Premature heartbeats

Premature heartbeats are extra beats that occur one at a time, sometimes in patterns that alternate with the
normal heart beat. The extra beats may come from the top chamber of the heart (premature atrial contractions)
or the bottom chamber (premature ventricular contractions).

A premature heartbeat may feel like your heart skipped a beat. These extra beats are generally not concerning,
and they seldom mean you have a more serious condition. Still, a premature beat can trigger a longer-lasting
arrhythmia, especially in people with heart disease. Occasionally, very frequent premature beats that last for
several years may lead to a weak heart.

Premature heartbeats may occur when resting. Sometimes premature heartbeats are caused by stress, strenuous
exercise or stimulants, such as caffeine or nicotine.

CAUSES

To understand the cause of heart arrhythmias, it may be helpful to know how the heart typically works.

How does the heart beat?

The heart is made of four chambers — two upper chambers (atria) and two lower chambers (ventricles).

The heart's rhythm is normally controlled by a natural pacemaker (the sinus node) in the right upper chamber
(atrium). The sinus node sends electrical signals that normally start each heartbeat. These electrical signals
move across the atria, causing the heart muscles to squeeze (contract) and pump blood into the ventricles.

Next, the signals arrive at a cluster of cells called the AV node, where they slow down. This slight delay allows
the ventricles to fill with blood. When the electrical signals reach the ventricles, the chambers contract and
pump blood to the lungs or to the rest of the body.

In a healthy heart, this heart signaling process usually goes smoothly, resulting in a normal resting heart rate of
60 to 100 beats a minute.

Things that can cause an irregular heartbeat (arrhythmia) include:

 Current heart attack or scarring from a previous heart attack

 Blocked arteries in the heart (coronary artery disease)

 Changes to the heart's structure, such as from cardiomyopathy

 Diabetes

 High blood pressure

 Infection with COVID-19

 Overactive thyroid gland (hyperthyroidism)

 Sleep apnea

 Underactive thyroid gland (hypothyroidism)

 Certain medications, including cold and allergy drugs bought without a prescription

 Drinking too much alcohol or caffeine

 Drug abuse

 Genetics

 Smoking

 Stress or anxiety
RISK FACTORS

Things that may increase the risk of heart arrhythmias include:

 Coronary artery disease, other heart problems and previous heart surgery. Narrowed heart arteries, a
heart attack, abnormal heart valves, prior heart surgery, heart failure, cardiomyopathy and other heart
damage are risk factors for almost any kind of arrhythmia.

 High blood pressure. This condition increases the risk of developing coronary artery disease. It may also
cause the walls of the left lower heart chamber (left ventricle) to become stiff and thick, which can change
how electrical signals travel through the heart.

 Congenital heart disease. Being born with a heart condition may affect the heart's rhythm.

 Thyroid disease. Having an overactive or underactive thyroid gland can raise the risk of irregular
heartbeats.

 Obstructive sleep apnea. This condition causes pauses in breathing during sleep. It can lead to a slow
heartbeat (bradycardia) and irregular heartbeats, including atrial fibrillation.

 Electrolyte imbalance. Substances in the blood called electrolytes — such as potassium, sodium, calcium
and magnesium — help trigger and send electrical impulses in the heart. An imbalance in electrolytes —
for example, if they are too low or too high — can interfere with heart signaling and lead to irregular
heartbeats.

 Certain drugs and supplements. Some prescription drugs and certain cough and cold medications
bought without a prescription can cause arrhythmias.

 Excessive alcohol. Drinking too much alcohol can affect the electrical impulses in your heart and can
increase the chance of developing atrial fibrillation.

 Caffeine, nicotine or illegal drug use. Caffeine, nicotine and other stimulants can cause your heart to
beat faster and may lead to the development of more-serious arrhythmias. Illegal drugs, such as
amphetamines and cocaine, may greatly affect the heart and cause many types of arrhythmias or sudden
death due to ventricular fibrillation.

SYMPTOMS

Heart arrhythmias may not cause any signs or symptoms. A doctor may notice the irregular heartbeat when
examining you for another health reason.

In general, signs and symptoms of arrhythmias may include:

 A fluttering in the chest

 A racing heartbeat (tachycardia)

  A slow heartbeat (bradycardia)

 Chest pain

 Shortness of breath

Other symptoms may include:

 Anxiety

 Fatigue

 Lightheadedness or dizziness

 Sweating

 Fainting (syncope) or near fainting

PREVENTION

Lifestyle changes to reduce the risk of heart disease may help prevent heart arrhythmias. A heart-healthy
lifestyle includes:

 Eating a heart-healthy diet

 Staying physically active

 Maintaining a healthy weight

 Not smoking

 Limiting or avoiding caffeine and alcohol

 Reducing stress, as intense stress and anger can cause heart rhythm problems

 Using medications as directed and telling your doctor about all the medicines you take, including those
bought without a prescription

DIAGNOSIS

To diagnose a heart arrhythmia, the doctor will usually do a physical exam and ask questions about your
medical history and symptoms. Tests may be done to confirm an irregular heartbeat and look for conditions that
can cause arrhythmias, such as heart disease or thyroid disease.

Tests to diagnose heart arrhythmias may include:

  Electrocardiogram (ECG or EKG). During an ECG, sensors (electrodes) that can detect the electrical
activity of the heart are attached to the chest and sometimes to the arms or legs. An ECG measures the
timing and duration of each electrical phase in the heartbeat.

 Holter monitor. This portable ECG device can be worn for a day or more to record your heart's activity
as you go about your routine.

 Event recorder. This wearable ECG device is used to detect sporadic arrhythmias. You press a button
when symptoms occur. An event recorder may be worn for a longer period of time (up to 30 days or until
you have an arrhythmia or typical symptoms).

 Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on the chest uses sound
waves to produce images of the heart's size, structure and motion.

 Implantable loop recorder. If symptoms are very infrequent, an event recorder may be implanted under
the skin in the chest area to continually record the heart's electrical activity and detect irregular heart
rhythms.

 Stress test. Some arrhythmias are triggered or worsened by exercise. During a stress test, the heart's
activity is monitored while you ride on a stationary bicycle or walk on a treadmill. If you have difficulty
exercising, a drug may be given to stimulate the heart in a way that's similar to exercise.

 Tilt table test. A doctor may recommend this test if you've had fainting spells. Your heart rate and
blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up.
The doctor observes how your heart and the nervous system that controls it respond to the change in
angle.

TREATMENT

Treatment for heart arrhythmias depends on whether you have a fast heartbeat (tachycardia) or slow heartbeat
(bradycardia). Some heart arrhythmias do not need treatment. Your doctor may recommend regular checkups to
monitor your condition.

Heart arrhythmia treatment is usually only needed if the irregular heartbeat is causing significant symptoms, or
if the condition is putting you at risk of more-serious heart problems. Treatment for heart arrhythmias may
include medications, therapies such as vagal maneuvers, cardioversion, catheter procedures or heart surgery.

Medications

Medications used to treat heart arrhythmias depend on the type of arrhythmia and potential complications.

For example, drugs to control the heart rate and restore a normal heart rhythm are often prescribed for most
people with tachycardia.
If you have atrial fibrillation, blood thinners may be prescribed to prevent blood clots. It's very important to take
the medications exactly as directed by your doctor in order to reduce the risk of complications.

Therapies

Therapies to treat heart arrhythmias include vagal maneuvers and cardioversion to stop the irregular heartbeat.

 Vagal maneuvers. If you have a very fast heartbeat due to supraventricular tachycardia, your doctor may
recommend this therapy. Vagal maneuvers affect the nervous system that controls your heartbeat (vagus
nerves), often causing your heart rate to slow. For example, you may be able to stop an arrhythmia by
holding your breath and straining, dunking your face in ice water, or coughing. Vagal maneuvers don't
work for all types of arrhythmias.

 Cardioversion. This method to reset the heart rhythm may be done with medications or as a procedure.
Your doctor may recommend this treatment if you have a certain type of arrhythmia, such as atrial
fibrillation.

During the cardioversion procedure, a shock is delivered to your heart through paddles or patches on your
chest. The current affects the electrical impulses in your heart and can restore a normal rhythm.

Treatment for heart arrhythmias may also involve catheter procedures or surgery to implant a heart (cardiac)
device. Certain arrhythmias may require open-heart surgery.

Types of procedures and surgeries used to treat heart arrhythmias include:

 Catheter ablation. In this procedure, the doctor threads one or more catheters through the blood vessels
to the heart. Electrodes at the catheter tips use heat or cold energy to create tiny scars in your heart to
block abnormal electrical signals and restore a normal heartbeat.

 Pacemaker. If slow heartbeats (bradycardias) don't have a cause that can be corrected, doctors often treat
them with a pacemaker because there aren't any medications that can reliably speed up the heart.

A pacemaker is a small device that's usually implanted near the collarbone. One or more electrode-tipped
wires run from the pacemaker through the blood vessels to the inner heart. If the heart rate is too slow or
if it stops, the pacemaker sends out electrical impulses that stimulate the heart to beat at a steady rate.

 Implantable cardioverter-defibrillator (ICD).  Doctor may recommend this device if you're at high risk
of developing a dangerously fast or irregular heartbeat in the lower heart chambers (ventricular
tachycardia or ventricular fibrillation). If sudden cardiac arrest or have certain heart conditions that
increase your risk of sudden cardiac arrest, doctor may also recommend an ICD.
BIBLIOGRAPHY

1. Arrhythmia. National Heart, Lung, and Blood Institute.

https://www.nhlbi.nih.gov/health-topics/arrhythmia. Accessed Aug. 4, 2021.
2. How the heart works. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-
topics/how-heart-works. Accessed Aug. 4, 2021.
3. Panchal AR, et al. 2018 American Heart Association focused update on advanced cardiovascular life
support use of antiarrhythmic drugs during and immediately after cardiac arrest. Circulation. 2018;
doi:10.1161/CIR.0000000000000613.
4. Overview of arrhythmias. Merck Manual Professional Version.
https://www.merckmanuals.com/professional/cardiovascular-disorders/arrhythmias-and-conduction-
disorders/overview-of-arrhythmias. Accessed Aug. 4, 2021.
5. Zipes DP, et al. Assessment of the patient with a cardiac arrhythmia. In: Cardiac Electrophysiology:
From Cell to Bedside. 7th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed
Aug. 4, 2021.
 CLASS TEACHING
ON
ARRHTTHMIAS

SUBMITTED TO SUNMITTED BY
DIMPAL SAHU
M.SC (N) 2ND YEAR