Dr Swapnil Mate Angioplasty

Types Of Arrhythmia

Heartbeats differ in speed, duration, and mechanism. They are briefly classified into four groups :-

This group comprises Arrhythmias that are caused due to premature heartbeats. This involves premature atrial contraction where premature heartbeats arise from the atrium(upper heart chamber), premature ventricular contraction where premature heartbeats arise from the ventricles, and premature junctional contraction where premature cardiac impulses arise from the atrioventricular node known as 'junction'. The normal contraction of the heart takes place when the electrical polarity of the cell membrane of a group of cells, located on the upper region of the right atria, is reversed(this is also known as depolarization of cell membrane). These cells are known as pacemaker cells of the sinoatrial node that is responsible for the heart to contract. When the cells of another region of the heart chambers depolarize before the pacemaker cells, then it triggers a premature heartbeat. This interferes with the normal cardiac rhythm. This sometimes happens naturally due to stress or the use of drugs like cocaine, intake of caffeine, etc. But in some cases, it causes a heart attack or complete heart failure.

Tachycardia is a term used to describe fast heart rhythms. This group comprises atrial fibrillation, where rapid and irregular heartbeats arise from the upper chambers of the heart(atria), atrial flutter, where abnormal heart rhythm arises from the atrial chambers of the heart. A person having atrial flutter may sense that the heart is either beating too fast or too slow or skipping heartbeats. It also comprises paroxysmal supraventricular tachycardia, where occasional sessions of abrupt onset and termination of heart rhythms take place, and Wolff-Parkinson-White Syndrome, where there is an additional electrical connection between the atria and ventricles. This pathway conducts all the electrical impulses which result in extremely fast heart rhythms, leading to cardiogenic shock.

This group comprises rapid and irregular heartbeats in the lower chambers of the heart. It includes premature ventricular contraction where premature heartbeats arise from the ventricles, Ventricular tachycardia where fast heart rhythms arise from the ventricles, accelerated idioventricular rhythm where the heart beats at the rate between 40 to 120 beats per minute and affects the cardiac muscle alone, Arrhythmogenic Cardiomyopathy which It primarily affects the tissues of the right ventricle, with associated irregular heartbeats. It first attacks the right ventricle, which puts a lot of stress on the left ventricle, and then, if not treated, stiffens and weakens both the ventricles. It also includes ventricular fibrillation which refers to disorganized electrical activity in the ventricles and torsades de pointes, which is a specific type of abnormal heart rhythm that leads to sudden cardiac death.

This is a term used to describe slow heart rate, which is when the heart rate is at 60 beats per minute. Even though it does not affect the individual, it causes symptoms like weakness, fatigue, sweating, when the rate drops below 40. The types of disorders include in this category are respiratory sinus bradycardia which is caused due to changes in the activity of the vagus nerve during respiration, sinus bradycardia is referred to as heart rhythm that goes at the rate of 60 beats per minute, sick sinus syndrome caused due to malfunction in the primary pacemaker of the heart, the sinus node, idioventricular rhythm when the heart rhythm is less than 50 beats per minute.

Signs And Symptoms

The signs and symptoms that indicate arrhythmia are

Chest pain(angina) - described as a sensation of heartburn, tightness, pressure, or squeezing. Even though chest pain may also arise due to non-cardiac causes, if that pain travels to the left arm, right arm, jaw, neck, then there might be a possibility of a heart attack. Chest pain is the first and the most common symptom of a heart attack
Shortness of breath - As the heart rate changes, the breathing pattern will also change simultaneously. If the heart is not pumping blood efficiently, this causes shortness of breath. Therefore, shortness of breath mainly arises due to low oxygen in the blood.
Sweating
Fatigues, dizziness
Nausea or vomiting
Cardiogenic shock due to defects in the ventricles of the heart
Heart palpitations(irregular beatings of the heart)
Sudden death due to ventricular fibrillation(irregular electrical activity of the heart)
Increased rate of heart rhythm(tachycardia)
Reduced rate of heart rhythm(bradycardia)

Risk Factors Contributing To Arrhythmia

Risk factors contributing to irregular heartbeat are :

Lifestyle choices - lifestyle choices like getting less sleep, consumption of alcohol, smoking, consumption of a high cholesterol diet can impair the electrical activity of the heart.
High blood pressure - High blood pressure or hypertension makes the coronary arteries less elastic, which reduces blood flow to the heart. This makes the heart work harder, causing stiffening of the heart muscle and death of the cells present in the cardiac muscle.
Coronary artery disease - narrowing of the arteries or blockage of the arteries due to cholesterol deposits can put a great amount of stress on the upper and lower chambers of the heart. This interferes with the depolarization of the pacemaker cells present at the upper region of the right atrium.
Congenital disorders - inherited disorders like hypertrophic cardiomyopathy can lead to irregular heart rhythm.
Imbalance in the electrolytes of the body like sodium and potassium since electrolytes help in sending electrical impulses in the heart.
Sleep deprivation - when a person sleeps, their heartbeat is reduced. Not getting the required amount of sleep can lead to either slowed or fast heart rhythm.
Intake of too much caffeine or drugs like cocaine increase the heart rate which can lead to more serious cases of arrhythmia.
Cardiomyopathy - this is referred to as defects in the cardiac muscle. Any defect in the cardiac muscle can interfere with the cardiac rhythm, leading to arrhythmia

Further Complications

The complications associated with arrhythmia are

Cardiac arrest - arrhythmia cause an increase in the formation of blood clots. Blood clots can obstruct the blood flow to the heart, which can cause cardiac arrest due to loss of blood flow throughout the body.
Stroke - A blood clot, if it breaks loose from the coronary arteries, can also travel to the brain, causing a stroke.
Heart Failure - Arrhythmia can cause the failure of the heart to pump blood efficiently

Diagnosis And Treatment

This includes :

Electrocardiography - Electrocardiography measures the electrical activity of the heart by placing electrodes on the skin. This detects the minute changes that take place as a result of the contraction and relaxation of the cardiac muscle. This helps to check the electrical activity of the heart and arrhythmia.
Echocardiogram - In this procedure, a device called a transducer is placed on the top of the chest and ultrasonic waves are sent to the heart bounce off and show the live image of the heart, using a monitor. Intravascular ultrasound uses a catheter instead of a transducer to capture the images of coronary arteries. This helps the specialists to see whether the blood flow is obstructed or not.
Blood Tests - Blood tests like Low-Density Lipoprotein and High-Density Lipoprotein test, C-Reactive Protein test, International Normalized Ratio(INR) test, Blood pressure test, etc, are done to check the amount of glucose, cholesterol, sodium, and calcium deposits in the bloodstream.
Cardiac Stress test - This test is done by an exercise physiologist who checks the heart's response to vigorous exercises by monitoring the heart's electrical activity.
Genetic testing - This is done when the disorder is inherited from the parent. This is done only on first degree relatives, like father, mother, siblings, etc
Artificial Pacemaker - This device generates electric impulses by the electrodes present in the device that makes the lower and upper heart chambers contract to pump blood. This device regulates the normal function of the electrical system of the heart. Its main purpose is to restore the normal rate of the heart which was either very slow or very fast earlier due to a defect in the natural pacemaker of the heart.
Catheter Ablation - This procedure involves inserting a catheter through any blood vessels(femoral or radial artery). Electrical impulses are sent through the catheter to induce arrhythmia and local heating or freezing is done to destroy the tissue that is causing this condition.
Minimize Procedure - This procedure is used to treat atrial fibrillation by destroying the tissue in the atria that are caused by arrhythmia

The cardiology team of Dr. Swapnil Mate's Cardiology clinic includes experienced cardiologists, cardiac surgeons, cardiac imaging specialists who help detect the problem and recommend the ideal surgery to the patients. They mention the advantages and risks associated with the surgeries they plan to do on their cardiac patients. Consult Dr. Swapnil Mate for the best medical assistance.