Arrhythmias: Symptoms, Causes, and Treatment

Heart rhythm disorders is the disruption of your heart’s normal beating pattern and is called arrhythmias in medicine. Under normal conditions, your heart beats regularly 60-100 times per minute, but in arrhythmias, this pattern changes. Your heart may beat too fast, too slow, or irregularly.

Most people experience at least one heart rhythm change during their lifetime. Sometimes this condition is completely normal and harmless. For example, your heart rate increases during exercise and slows down during rest. Stress, caffeine consumption, or fatigue can also cause temporary rhythm changes.

However, some arrhythmias may indicate serious health problems. If you experience sudden onset severe palpitations, chest pain, shortness of breath, or fainting, these conditions should be evaluated. Especially if symptoms recur frequently or affect your daily life, medical control is necessary.

What is arrhythmias?

Arrhythmias are changes that occur in your heart’s electrical conduction system. The sinus node, which is your heart’s natural pacemaker, normally produces regular electrical signals. These signals spread to the heart muscle, providing coordinated contraction and pumping blood to the body. Arrhythmias can disrupt the blood pumping mechanism.

Normal heart rate is between 60-100 beats per minute at rest. Bradycardia is when heart rate drops below 60, while tachycardia is when it rises above 100. In arrhythmias, not only speed but also the beating pattern can be disrupted. The heart may beat irregularly, skipping, or intermittently.

The electrical conduction system extends from the sinus node to the AV node, His bundle, and Purkinje fibers. When problems occur in any part of this system, arrhythmias develop. Sometimes extra electrical pathways form or abnormal electrical foci emerge.

Arrhythmias can originate from the upper chambers (atrial) or lower chambers (ventricular) of the heart. Additionally, blockages in the conduction system also lead to rhythm problems. Each type has its own specific symptoms and treatment approaches.

What are the types of arrhythmias?

Arrhythmias are generally classified according to the region they originate from and changes in heart rate.

• Slow heart rhythms are called bradyarrhythmias. Sinus bradycardia is the slow functioning of the sinus node, which is the heart’s natural pacemaker. AV block is the slowing or complete stopping of electrical conduction between the upper and lower chambers of the heart. In these types of arrhythmias, you may experience weakness, fainting, or dizziness.
• Fast heart rhythms are called tachyarrhythmias. Supraventricular tachycardias originate from the upper chambers of the heart. Types such as AVNRT, AVRT, and atrial flutter may manifest as sudden palpitation attacks.
• Atrial fibrillation (AFib) is the most common arrhythmia. The upper chambers of the heart contract irregularly and uncontrollably. Heart beats are usually fast and unbalanced. Since AF increases stroke risk, most patients require blood-thinning treatment.
• Ventricular arrhythmias originate from the lower chambers (ventricles) of the heart and usually carry vital risk. Ventricular tachycardia causes the heart to beat very fast and regularly. Ventricular fibrillation is a much more urgent and fatal condition. Heart beats become completely irregular and the heart cannot pump blood.
• Premature beats (PACs, PVCs) in the heart are among the most common arrhythmias. The heart goes out of its normal rhythm and an early beat is felt. It is often harmless, but if it becomes frequent, cardiology evaluation is needed.

What are the symptoms of arrhythmias?

Arrhythmia symptoms include complaints such as palpitations, irregular or fast heartbeat, chest pain, shortness of breath, dizziness, feeling of fainting, and fatigue. Some people may also experience lightheadedness, weakness, and sudden fainting.

• Palpitations are the most common complaint. You may feel your heart pounding, accelerating, or beating irregularly in your chest. This condition can be disturbing but is not always dangerous.
• Shortness of breath may occur especially during physical activity. You may have difficulty breathing when climbing stairs, walking, or doing daily tasks. Shortness of breath can develop even at rest.
• Chest pain or pressure sensation in the chest may occur. Pain is usually mild and temporary, but severe and prolonged pain may raise suspicion of heart attack. Neck, jaw, or arm pain may also accompany.
• Dizziness, lightheadedness, or feeling of fainting may occur. These symptoms may increase especially during sudden position changes. If you experience actual fainting, this may be a sign of serious arrhythmia.
• Fatigue and weakness are common in chronic arrhythmias. Your energy level may decrease and you may have difficulty performing daily activities. Exercise capacity may decrease and you may experience early fatigue.

Some patients experience no symptoms. Arrhythmias can be detected incidentally during routine controls or ECG taken for another reason. Therefore, regular health controls are important.

What causes arrhythmias?

The main causes leading to arrhythmias include coronary artery disease, history of heart attack, heart failure, hypertension, and valve diseases. Additionally, thyroid diseases, diabetes, sleep apnea, excessive alcohol consumption, smoking, and some medications can also trigger arrhythmias.

Factors such as stress, caffeine, potassium and magnesium deficiency can also disrupt the heart’s normal rhythm. In some people, arrhythmias can develop without any underlying cause.

Causes of arrhythmias:

• Heart diseases are among the most important causes. Coronary artery disease, previous heart attack, heart failure, valve diseases, and congenital heart diseases can lead to arrhythmias.
• High blood pressure, when left uncontrolled for a long time, causes thickening in heart walls. This condition can disrupt electrical conduction and especially increase the risk of atrial fibrillation. Diabetes can similarly affect heart tissue.
• Thyroid diseases are a common cause of arrhythmias. Hyperthyroidism increases heart rate and can lead to atrial fibrillation development. Hypothyroidism can cause bradycardia. Thyroid hormone levels must definitely be checked.
• Electrolyte imbalances lead to acute arrhythmias. Changes in potassium, sodium, calcium, and magnesium levels directly affect the electrical system. Dehydration, kidney diseases, and medication use can disrupt this balance.
• Medications and substances can cause arrhythmias. Caffeine, alcohol, nicotine, and illegal drugs affect heart rhythm. Some medications can also cause arrhythmias as side effects. Medication history must definitely be evaluated.
• Stress and psychological factors are important triggers. During excessive stress, anxiety, and panic attacks, sympathetic nervous system activation leads to rhythm changes. Lifestyle modifications are therefore an important part of treatment.
• Sleep apnea is an increasingly important cause of arrhythmias. Repeated breathing stops during sleep lower oxygen levels and create stress on the heart. It plays an important role especially in atrial fibrillation development. Snoring, excessive daytime sleepiness, and waking up tired in the morning may be signs of sleep apnea.

What are the risk factors for arrhythmias?

• Age is the most important risk factor. The frequency of arrhythmias significantly increases over age 65. The heart’s electrical system changes with age and can be damaged. Atrial fibrillation is especially common in the elderly.
• Gender factor varies according to the type of arrhythmia. Arrhythmias related to coronary artery disease are more common in men. Supraventricular tachycardias and long QT syndrome are more common in women.
• Family history indicates genetic predisposition. If there is a history of sudden cardiac death, early heart disease, or arrhythmias in the family, your risk increases. Some types of arrhythmias show hereditary transmission.
• Underlying heart diseases are the strongest risk factors. Coronary artery disease, heart failure, and valve diseases facilitate arrhythmia development. Appropriate treatment of these diseases reduces arrhythmia risk.
• Lifestyle factors are risk factors under your control. Smoking, excessive alcohol consumption, and caffeine addiction increase arrhythmia risk. Regular exercise and healthy nutrition have protective effects.
• Obesity is an important risk factor especially for atrial fibrillation. Excess weight creates extra load on the heart and affects the electrical system. Weight loss can reduce arrhythmia risk.

How is arrhythmia diagnosed?

Arrhythmia diagnosis begins primarily with history and examination. Your complaints, onset pattern, duration, and triggering factors are questioned. Pulse control is performed and heart sounds are listened to. Initial evaluation provides important clues for diagnosis.

• ECG is the most important test in arrhythmia diagnosis. 12-lead ECG shows the heart’s electrical activity and detects most types of arrhythmias. Normal ECG does not exclude arrhythmias because they can be intermittent.
• 24-hour Holter monitor records rhythm changes in your daily life. It evaluates heart rhythm during night, day, activity, and rest. Intermittent arrhythmias can be caught with this method.
• Event monitor is a recording device used for longer periods. You can take ECG recordings by pressing a button when you feel symptoms. It is useful for rarely occurring arrhythmias. Implantable monitors are also available.
• Electrophysiologic study examines the heart’s electrical system in detail. This procedure involves placing electrodes in the heart with catheters in the electrophysiology laboratory to measure conduction times. Treatment planning is done by inducing arrhythmias. Since it is an invasive test, it is applied to selected patients.
• Echocardiography evaluates heart structure and function. It is important in detecting underlying heart disease. Conditions such as valve diseases, heart failure, and cardiomyopathy are detected.

How is arrhythmia treated?

Arrhythmia treatment is planned according to the type, severity, and underlying causes of the arrhythmia. While some mild arrhythmias do not require treatment, serious arrhythmias may require emergency intervention. Medication treatment is the first preferred method for most patients. Electrical treatment is applied in emergency situations or when medications are insufficient. Interventional treatment is preferred in patients seeking permanent solutions.

When making treatment decisions, your age, general health condition, underlying heart diseases, and lifestyle are evaluated. While some patients achieve control with a single treatment method, others may require combination treatment.

Medication Treatment

Antiarrhythmic drugs are used to regulate heart rhythm. Class I drugs affect sodium channels, and flecainide and propafenone belong to this group. Class II drugs are beta blockers and slow heart rate. Class III drugs affect potassium channels, and amiodarone and sotalol can be given as examples.

Beta blockers are used for both rate and rhythm control. Metoprolol, atenolol, and bisoprolol are frequently preferred drugs. They slow heart rate and reduce sympathetic nervous system activity.

Calcium channel blockers are especially effective in rate control. Verapamil and diltiazem slow AV nodal conduction. They are used for heart rate control in atrial fibrillation.

Anticoagulant treatment is applied to reduce stroke risk. Anticoagulants are blood-thinning drugs and prevent clot formation. Blood clotting risk increases in atrial fibrillation. Warfarin or new generation anticoagulants are used. INR monitoring or regular blood control is required.

Electrical Treatment

Electrical cardioversion is applied in rapid arrhythmia treatment. An electric shock is given to the heart under sedation to restore normal rhythm. It is effective in atrial fibrillation, atrial flutter, and sustained ventricular tachycardia.

Electrical pacing is used in slow heart rate treatment. Pacing is a technique that sends electrical stimuli to your heart to make it beat. Temporary pacing is applied in emergency situations with electrodes through the skin. Permanent pacemaker is a small electronic device placed under your chest for chronic, long-term bradyarrhythmias. This device works with a battery and automatically sends electrical signals when your heart beats slowly.

Interventional Treatment

Catheter ablation is the procedure of burning the arrhythmia focus. Radiofrequency energy or cryoenergy is used. AVNRT, AVRT, atrial flutter, and atrial fibrillation ablation can be performed. Success rates are high and most patients can live without medication.

ICD provides protection against sudden cardiac death risk. It detects dangerous arrhythmias that can threaten life and treats them by giving shocks. It is used in patients with high risk of heart failure and ventricular arrhythmias.

Surgical Treatment

Maze surgery is surgical treatment for atrial fibrillation. During heart surgery, arrhythmia foci are isolated by creating lines in atrial tissue. It can be applied to patients requiring open heart surgery.

How to maintain daily life with arrhythmias?

After being diagnosed with arrhythmias, you need to regulate your lifestyle. Taking your medications regularly is the most important rule. Don’t miss your medication times and never stop medication without doctor approval.

Avoid triggering factors. Excessive caffeine, alcohol, and nicotine can trigger arrhythmias. Stay away from stressful situations as much as possible. Get enough sleep and set regular sleep hours.

Regulate physical activity according to doctor recommendations. Most patients can exercise regularly, but you should avoid excessively intense activities. Aerobic exercises like walking, swimming, and cycling are generally safe.

Learn to monitor your pulse. By taking regular pulse measurements, you can detect rhythm changes early. Digital pulse measuring devices or smartwatches can help in this regard.

Organize your work life according to your condition. You can continue most professional activities, but special evaluation is needed for safety-requiring professions like driver or pilot. Share your condition with your employer.

What is good for arrhythmias?

Healthy nutrition plays an important role in arrhythmia management. Prefer foods rich in potassium. Foods like bananas, oranges, avocados, and spinach maintain electrolyte balance. Include nuts, seeds, and whole grains containing magnesium in your diet.

Limit your salt intake because excessive sodium leads to fluid retention and blood pressure increase. Keep your daily salt consumption below 1 teaspoon. Limit processed foods and prefer fresh meals.

Control your caffeine intake. 1-2 cups of coffee per day is generally considered safe, but don’t overdo it. Completely avoid energy drinks and high-dose caffeine supplements.

Limit alcohol consumption. A maximum of 2 drinks per day for men and 1 for women is considered safe. Excessive alcohol is especially a trigger for atrial fibrillation. Definitely avoid binge drinking style excessive consumption.

Start your exercise program gradually. Aim for 150 minutes of moderate-intensity aerobic activity per week. Walking, cycling, and swimming are safe options. Adjust your pulse according to target zone and don’t overexert yourself.

Don’t neglect strength training. Do muscle strengthening exercises 2-3 days a week. Avoid heavy weights and don’t hold your breath. Don’t perform Valsalva maneuver during exercise.

What are the complications of arrhythmias?

The most serious complication of arrhythmias is sudden cardiac arrest. Especially ventricular fibrillation and ventricular tachycardia can threaten life. If emergency intervention is not performed, death can occur within minutes.

Stroke is the most feared complication of atrial fibrillation. Blood clots can form in the heart due to irregular heartbeats. These clots can block brain vessels and cause paralysis. Anticoagulant treatment significantly reduces this risk.

Heart failure can develop in long-term arrhythmias. Continuous rapid heartbeats tire the heart muscle and pumping function deteriorates. This condition, called tachycardia-induced cardiomyopathy, can be corrected with treatment.

Thromboembolism risk is especially high in atrial fibrillation. Thromboembolism is the condition where blood clots formed in the heart break off and go to body organs. Kidney, intestine, and leg vessels can be affected.

Hypertensive cardiomyopathy can develop in uncontrolled rapid arrhythmias. Hypertensive cardiomyopathy is the thickening of muscle walls as a result of your heart constantly working fast. Heart muscles become stiff instead of strengthening and relaxation ability decreases. This condition leads to shortness of breath, fatigue, and difficulty during physical activity.

Arrhythmia complications:

• Dangerous arrhythmias can cause sudden cardiac arrest and death
• Arrhythmias can lead to clot formation and stroke
• Continuous rapid rhythms tire the heart and heart failure can develop
• Clots in the heart can break off and go to organs like kidneys and intestines
• Irregular heartbeats can reduce exercise capacity
• Symptoms can negatively affect your daily quality of life

When should you consult a doctor?

If you experience sudden onset severe palpitations, consult a doctor immediately. If chest pain, shortness of breath, and dizziness accompany, emergency intervention is needed. Heart rate above 150 per minute can be dangerous.

If you experience fainting or near-fainting sensations, apply without delay. This condition may be a sign of serious arrhythmia. Especially fainting during physical activity carries risk of sudden cardiac death.

If irregular heartbeats recur frequently, go for control. Irregularity experienced several times a day may be normal, but continuous irregularity should be evaluated. If you have a constant skipping sensation in your pulse, ECG should be taken.

If you experience fatigue and decreased exercise capacity, get examined. If you have difficulty doing activities you could do before, this may be a sign of arrhythmia. Excessive fatigue when climbing stairs is an important finding.

If medication side effects develop, inform your doctor. Dizziness, nausea, vision blurriness, and excessively slow pulse may be medication side effects. Medication doses may need adjustment.

Go to routine controls regularly. If arrhythmia diagnosis has been made, it is recommended to go for control every 3-6 months. ECG recording, medication level control, and side effect evaluation are performed. If you use anticoagulants, more frequent control is needed.

Conclusion

Arrhythmias are commonly seen conditions that can often be successfully treated. With early diagnosis and appropriate treatment, you can continue your normal life. Take symptoms seriously but don’t panic.

Lifestyle changes are an important part of treatment. Regular exercise, healthy nutrition, stress management, and staying away from harmful habits are effective in arrhythmia control.

Modern medicine offers very effective treatment options for arrhythmias. From medication treatment to minimally invasive procedures, many successful methods are available. By following doctor recommendations, you can live a long and quality life.

Reference: Arrhythmias