A cardiac arrhythmia, or heart palpitations, is a disturbance of the normal heartbeat sequence caused by non-regular processes in the formation and conduction of excitation in the heart muscle. Cardiac arrhythmias occur quite frequently. The heart of an adult beats on average one hundred thousand times per day. The fact that the heart beats faster or slower from time to time is basically normal and not necessarily pathological. Nevertheless, frequently occurring cardiac arrhythmias, which may also occur over a long period of time, should be examined by a doctor.
What are cardiac arrhythmias?
Cardiac arrhythmias occur frequently. Healthy people sometimes notice a heart stutter (palpitations), extra heartbeats (extrasystoles), or a brief cessation of the heartbeat. In cardiac arrhythmias, the heart rate may be either increased (over 100 beats per minute), slowed (under 60 beats per minute), or interrupted or stumbling. Again, these signs do not have to be pathological. For example, endurance athletes usually have a pronounced steady pulse (resting pulse), which can be quite normal at under 60 beats per minute. Cardiac arrhythmias are common. Healthy people sometimes notice a heart stutter (palpitations), additional heartbeats (extrasystoles) or short interruptions of the heartbeat caused by extra beats. Often, however, one does not feel the cardiac arrhythmia at all. Cardiac tachycardia, as in rapid atrial fibrillation, is often described as a regular or irregular palpitation of the heart down to the throat. If a heart is already damaged, an existing cardiac insufficiency can worsen, triggered by the excessively high heart rate. This can manifest itself, for example, as shortness of breath. In severe cases, pulmonary edema can result. Heart pain (angina pectoris) can also occur, as well as a deterioration in cerebral perfusion (dizziness, seizure, disorientation, temporary speech and vision disorders). Dangerous cardiac arrhythmias (e.g., ventricular tachycardia) can severely restrict the ejection of the heart to the point that adequate circulation is no longer possible. Patients lose consciousness. Mechanical malfunctions are present in ventricular flutter or fibrillation with circulatory arrest (asystole). If these cardiac arrhythmias occur without any previously identifiable reason, they are referred to as sudden cardiac death.
Causes
As noted above, the causes of cardiac arrhythmias need not be pathological. Pathological cardiac arrhythmias are usually damage to the sinus node (the heart’s natural pacemaker) or the conduction system. Typical conditions associated with arrhythmias include coronary artery disease, valvular heart disease, myocardial disease, or hyperthyroidism. As with palpitations, a too-fast (tachycardic) heartbeat can occur due to stress, caffeine, excitement, strain, and smoking.
Diseases with this symptom
- Coronary artery disease
- Heart attack
- Pulmonary embolism
- AV block
- Obesity
- Diabetes mellitus
- Acidosis
- Kidney weakness
- Heart muscle inflammation
- Ventricular fibrillation
- Hyperthyroidism
- Bulimia
Complications
Cardiac arrhythmias can cause life-threatening complications especially if the heart is pre-damaged due to a previous disease such as endocarditis or valvular disease. In a healthy heart, cardiac arrhythmias can occur and are usually not even noticed by the affected person, this often manifests itself as an extrasystole in the ECG. In a healthy heart, dizziness, shortness of breath or a brief fainting spell (syncope) may occur, but there are no other serious complications. In the pre-damaged heart, arrhythmias can cause some dangerous complications. For example, in atrial fibrillation, a possible cardiac arrhythmia is a disturbance in atrial excitation, resulting in an irregular, rapid pulse. In this case, blood clots can form in the atrium, these can detach from the wall due to the irregular beating of the atrium and be transported further with the blood stream. In the process, they easily get into important vessels to the brain and can trigger a stroke, which can lead to death.In addition to a stroke, blood flow to the heart is at risk due to the irregular, rapid heartbeat. This can lead to a lack of oxygen supply to the heart and subsequently to a heart attack and, if no treatment occurs, to cardiac death. Another dangerous form of cardiac arrhythmia is ventricular fibrillation, which without treatment by defibrillation can quickly lead to circulatory arrest and thus also cardiac death.
Diagnosis and course
If cardiac arrhythmias are present, targeted diagnostics can determine, among other things, whether corresponding disorders require medical treatment. During the diagnostic process, the physician usually first inquires about the individual medical history and any previous or concomitant diseases. Subsequent physical examinations include, for example, taking the pulse and listening to the heart. Depending on the suspected cause of the arrhythmia, an ECG, ultrasound and X-ray examinations as well as blood analyses may also be useful. The course of cardiac arrhythmias depends primarily on their severity and cause(s) – if left untreated, pathological cardiac arrhythmias can reduce quality of life and shorten life expectancy. Cardiac arrhythmias without pathologic value often progress harmlessly.
When should you see a doctor?
Cardiac arrhythmia refers to a disturbance of the usual heartbeat sequence. In parallel, the terms cardiac stuttering and arrhythmia are also commonly used. Cardiac arrhythmias also occur in healthy people, especially after exertion or excitement. Cardiac arrhythmias manifest themselves as irregular heartbeats, additional heartbeats or a brief cessation of the heartbeat. However, if cardiac arrhythmias occur more frequently and a triggering cause is not always known, they should be clarified by a doctor. The general practitioner is the first point of contact for diagnosing a possible cause of cardiac arrhythmia. On the basis of a detailed medical history, he can easily assess whether a heart disease is suspected. For further diagnosis, he will consult a specialist such as a cardiologist. A pulmonologist or neurologist may also be considered. If the heartbeat is accelerated, it may be atrial fibrillation. A weakened heart can also beat too fast and this alone can make it worse. In addition to other various heart diseases, cardiac arrhythmias can be due to pulmonary edema as well as a poorly perfused brain. Since cardiac arrhythmias are potentially life-threatening, a visit to the doctor should therefore not be delayed for too long. If necessary, hospitalization for intensive inpatient evaluation of the cardiac arrhythmia may also be advisable.
Treatment and therapy
Defibrillation is a treatment method for cardiac arrhythmias such as ventricular fibrillation or palpitations, atrial fibrillation, and atrial flutter in which strong electric shocks are used to restore healthy heart activity. Cardiac arrhythmias should always be examined by a physician. With the help of various examinations, the physician determines whether the cardiac arrhythmia is harmless or serious. The first step is to talk to the patient to determine the symptoms and possible previous illnesses. After that, the doctor usually measures the pulse and heart rate and creates an electrocardiogram (ECG), which can also be used in the form of long-term ECG or stress ECG. Furthermore, ultrasound examination of the heart (echocardiography), blood tests and X-rays also provide further information about the status of the cardiac arrhythmia. The subsequent treatment of the cardiac arrhythmia depends on its cause. The top priority is to treat the symptoms of cardiac arrhythmias and to eliminate dangers or complications caused by the heart. Drugs such as antiarrhythmics alter the conduction of the heart’s excitation through their action. In the case of cardiac arrhythmias, the therapy depends on their type and cause. The aim of treatment is, on the one hand, to alleviate the symptoms and, on the other, to avoid the risk of complications (e.g. sudden cardiac death). Cardiac arrhythmias can be treated with antiarrhythmic drugs, among others. Antiarrhythmics change the conduction of excitation in the heart in various ways. In rare cases, the use of a pacemaker must also be considered.In some cases, the implantation of a pacemaker is advisable in the case of disease-related cardiac arrhythmias. If the cause is psychological stress, relaxation measures and stress avoidance are recommended. Autogenic training is particularly promising in this regard.
Outlook and prognosis
The multitude of different cardiac arrhythmias affecting either the atria or the ventricles is united by the fact that either the electrical excitation, which should lead first to contraction of the atria and then of the ventricles, fails to occur or the transmission is defective. The outlook and prognosis of individual arrhythmias depend largely on the treated or untreated course of the underlying disease. Rather harmless arrhythmias, manifested by single beats “out of sequence” or occasional heart stumbles (palpitations), do not require treatment, and normal rhythm returns on its own. A common cardiac arrhythmia is atrial fibrillation, which affects older males more often than females. Atrial fibrillation, with a typical beat rate of 140 per minute, is not immediately life-threatening but, if left untreated, leads to irreversible damage to the overworked heart muscle. Ventricular fibrillation, on the other hand, with a pulse that can no longer be felt by hand, is immediately life-threatening. The prognosis for arrhythmias triggered by external factors such as electrolyte disturbances, medications, psychovegetative factors, hypoxia, and others tends toward self-healing once the external triggering factors have been corrected. If the causative factors are unknown or cannot be corrected, the prognosis is unfavorable. Prospects and prognosis are good if the normal sinus rhythm of the heart can be restored, for example, by electrical intervention such as electrocardioversion or defibrillation.
Prevention
Cardiac arrhythmias that are not pathological can be well prevented by leading a healthy, stress-free life with plenty of exercise, fresh air, a healthy diet, and abstaining from smoking and alcohol. Preventive is likewise the autogenous training, which serves not only for the calming down but can bring also altogether more relaxation in the everyday life.
What you can do yourself
In the case of severe cardiac arrhythmias, it is better to do without self-help. Cardiac arrhythmias pose a very high health risk to the human body and should therefore always be treated by a doctor. Especially in case of severe pain in the heart or chest or in case of spasmodic attacks, a doctor must be consulted urgently. In this case, surgical intervention is most likely necessary to correct the arrhythmia. Treatment at home is not possible in this case. In many cases, cardiac arrhythmias can be corrected by medical treatment, often this is done with a pacemaker. To relieve the heart and prevent problems with the heart, the patient should generally pay attention to a healthy diet and exercise. This can prevent many heart problems. Likewise, the heart should be examined at regular intervals by a cardiologist, especially at an older age. This can also help to prevent subsequent damage. If the cardiac arrhythmias occur suddenly and unexpectedly, an emergency doctor should be called. In the worst case, the cardiac arrhythmias can lead to death without treatment. Therefore, home treatment is not provided.
