diease

Irregular Heart Beat


OVERVIEW OF Irregular Heart Beat :

Arrythmia: Problem with the electrical conduction system of the heart which can lead to abnormal heart rhythms or heart rates. The electrical conduction system of the heart monitores the transmission of impulses needed for the heart to function properly.


CAUSES :

High blood pressure: Increase in blood pressure increases the loss of blood supply to vital organs

High cholesterol: Intake of high amount of low density or very low density lipoprotein (VLDL and LDL)

results in blockages of vessels leading to loss of blood supply to vital organs.

Tobacco use

Diabetes

Familial history of heart disease

Obesity

Diet high in sodium, sugar and fat

Stress

Excessive alcohol use

Pre Eclampsia: Seizures occurring during the pregnancy which might me sometimes fatal to the pregnant women

Gestational diabetes: The diabetes occurring during pregnancy is termed as gestational diabetes.

Chronic Inflammatory or Autoimmune diseases:  Autoimmune diseases are the diseases which occurs when the individuals own immune system acts against oneself.

 


PATHOPHYSIOLOGY :

Types of arrhythmias:

The type is based on the speed of the heart rate:

This includes Tachycardia and Bradycardia.

Tachycardia : This refers to a fast heartbeat a resting heart rate grater than 100 beats a minute.

Bradycardia: This refers to slow heartbeat a resting heart rate less than 60 beats a minutes.  During exercises the heart works fast to provide the  tissues with more oxygen rich blood.  During sleep the heart beat is slower.

Tachycardia in the Atria:

Atrial Fibrillation:

Atrial fibrillation is a rapid heart rate cased by chaotic electrical impulses in the atria. These signals result in rapid, uncoordinated weak contraction s of the atria. These improper electrical impulses resulting in bombardment of the AV node, usually resulting in an irregular, rapid rhythm of the ventricles.

Atrial flutter:

It is similar to the atrial fibrillation. The heartbeats are organized and more rhythmic electrical impulses than in the atrial fibrillation. This may also lead to the serious complications such as stroke.

Supraventricular tachycardia:

     These types of tachycardia originates above the ventricles in the atria or AV node. These might result in palpitation

Wolff Parkinson White syndrome:

In this syndrome there is an extra electrical pathway between the atria and ventricles.  This might result in the pathway of the electrical signals to pass between the atria and ventricles without passing through the AV node leading to short circuits and rapid heartbeats.

 

Tachycardia in the Ventricle.

Ventricular tachycardia:

It is a rapid, regular heart rate that originates with abnormal electrical signals in the ventricles. The rapid heart rate doesn't allow the ventricles to fill and contract efficiently to pump enough blood to the body.

 

Ventricular fibrillation:

 Ventricular fibrillation occurs when rapid, chaotic electrical impulses cause the ventricles to quiver ineffectively instead of pumping necessary blood to the body. This serious problem is fatal if the heart isn't restored to a normal rhythm within minutes.

 

Tachycardia in the ventricles:

Ventricular tachycardia:

It starts from the abnormal electrical signals in the ventricles.

Long QT syndrome:

It is the heart disorder that carries an increased risk of fast , chaotic heartbeats. These rapid heartbeats caused by changes in the electrical system of the heart that might lead to the fainting .

Bradycardia:

It is termed as the slow heartbeat.

Sick sinus syndrome:

The sinus node if does not works properly it might leads to both tachycardia and bradycardia. Sick sinus syndrome can also be caused by scarring near the sinus node that's slowing, disrupting or blocking the travel of impulses

Conduction block:

 A block of your heart's electrical pathways can occur in or near the AV node, which lies on the pathway between your atria and your ventricles. A block can also occur along other pathways to each ventricle.

Premature heartbeats:

Although it often feels like a skipped heartbeat, a premature heartbeat is actually an extra beat. Even though you may feel an occasional premature beat, it seldom means you have a more serious problem


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • pain or discomfort in the centre of the chest,
  • pain or discomfort in the arms, the left shoulder, elbows, jaw, or back.

 Difficulty in breathing

  • Shortness of breathe
  • Nausea or vomiting
  • Light-headedness or faintness
  • A cold sweat
  • Turning pale

The common symptom of stroke:

  • Numbness of the face, arm, or leg, especially on one side of the body
  • Confusion, difficulty speaking or understanding speech
  • Difficulty seeing with one or both eyes
  • Difficulty walking, dizziness and/or loss of balance
  • Coordination
  • Severe headache with no known cause
  • Fainting or unconsciousness

 


DIAGNOSTIC :

Electrocardiogram:

The heart transmits electrical impulses and electrodes on the skin can capture these recorded impulses generated as the electricity travels throught the heart muscle. The heart which has  decreased blood supply has lower energy and conducts the electricity in a different way.

Stress tests:

During exercise the heart needs more amount of energy and it should work harder and if the heart could be monitored and evaluated during the execise a test might uncover abnormalities in heart function. The patient is asked to walk on a treadmill, to ride a bicycle while simultaneously electrocardiogram is performed. Medications such as persantine, dobutamine and adenosine can be used to stimulate the heart if the heart cannot carry out such difficult tasks.

Echocardiography:

Ultrasound examination of the heart to evaluate the anatomy of the heart valves, muscles and its function are observed. This test might carried solely or it might be combined with other test such as the stress test.

Nuclear Imaging:

A radioactive tracer is injected into the vein and that can be used to indirectly assess blood flow to the heart. Technetium or thallium can be injected while a radioactive counter is used to map out how heart muscle cells absorbs the radioactive chemical and how it is distributed in heart muscle cells may help to determine indirectly whether the blockage exists or not. An area with no uptake of radioactive element suggest that the area is not getting the proper blood supply.

Cardiac Computerized Tomography and Magnetic Resonance Imaging:

Using these test the coronary arteries can be evaluated including hoe much calcium is present in the artery walls and whether blockage or narrowing of artery are present.

Cardiac Catheterization:

A thin tube is inserted through an artery in the groin, elbow, wrist into the coronary arteries. Dye is injected to assess the anatomy and whether blockages are present. This is called as Coronary Angiogram.

If the blockage exist it is called as angioplasty and the treatment to dilate the constricted vessel is known as Angiogram, a balloon is positioned at the site of obstructing the plaque.

A stent can be place din the blood vessels to dilate the narrowed blood vessels.

Holter and Event monitors:

These are portabale monitors and records the electrical activity during normal daily activity. A Holter monitor records the heart’s electrical activity for 24 -48 hours. An event monitor record the electrical activity of the heart only at certain times.

Myocardial Biopsy:

During this procedure your doctor might place a piece of heart in the microscope and he might look for the oppurtunities.

Genetic testing:

The genetic testing might reveals that the cardiomyopathy runs in the family or not.

The heart is made up of 4 chambers it includes two upper chambers which is called atrium and two lower chambers which is called as ventricles. The heart rhythm is normally controlled by a natural pacemaker is called as Sinus node located in the right atrium. The sinus node produces electrical impulses that is the starting each the heartbeat. These impulses cause the atria muscles to contract and pump blood into the ventricles.

The electrical impulses then arrive at a cluster of cells called the atrioventricular node(AV). The AV node slows down the electrical signal before sending it to the ventricles. this slight delay allows the ventricles to fill the blood. When electrical impulses reach the muscles of the ventricles , they contract, causing them to pump blood either to the lungs or to the rest of the body.


TREATMENT AND PROGNOSIS :

Vagal maneuvers:

Holding the breath and straining dunking the face with ice water or coughing.

Cardioversion:

A shock is delivered to the heart through paddles or patches on the chest. the current retores the normal electrical conduction of the heart and restores the normal rhythm of the heart.

Catheter ablation:

One or more threads is placed in the blood vessels in the heart.  Electrodes at the catheter tips gets heated or becomes cool or radiofrequency can cause the ablation in the heart.

Pacemaker:

 A pacemaker is an implantable device that helps control abnormal heart rhythms. A small device is placed under the skin near the collarbone in a minor surgical procedure. An insulated wire extends from the device to the heart, where it's permanently anchored.

Implantable cardioverter defibrillator:

An ICD is a battery-powered unit that's implanted under the skin near the collarbone — similar to a pacemaker. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors your heart rhythm.

Maze procedure:

 In the maze procedure, a surgeon makes a series of surgical incisions in the heart tissue in the upper half of your heart (atria) to create a pattern or maze of scar tissue. Because scar tissue doesn't conduct electricity, it interferes with stray electrical impulses that cause some types of arrhythmia.

        By pass surgery:

    It  treats blocked arteries by removing arteries or veins from other parts of the body    and using them to reroute blood around arteries that are clogged in order to improve blood flow to the heart.


PROGNOSIS :

When followed with regular checkup and medications, lifestyle are maintained properly it might give good prognosis. The 15 year survival rate who is diagnosed with heart attack is 45%.

 


PREVENTION :

Avoid alcohol consumption

Avoid smoking

Reduce the fat foods

Be physically active

Reduces the stress

Reduce the intake of salt

Maintain good sleep


REFERENCE :

https://www.heart.org/en/health-topics/cardiomyopathy/what-is-irregular-heartbeat-in-adults

https://my.clevelandclinic.org/health/diseases/16841-irregular-heartbeat

https://www.nhlbi.nih.gov/health-topics/irregular-heartbeat

https://www.cdc.gov/heartdisease/irregualr-heartbeat.htm