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  Irregular heartbeat

Cardiac arrhythmia implies “no rhythm” and described appropriately as a condition wherein the heart beat is irregular or is faster or slower than normal. The other term which is more technically correct is cardiac dysrhythmia, although this is not used frequently.

Irregular heartbeat Heart diseases
Irregular heartbeat

Arrhythmias may range between benign normal forms up to life-threatening medical emergencies that can cause cardiac arrest and sudden death. Others cause aggravating symptoms, such an awareness of a different heart beat, or palpitation. A benign and mild form of arrhythmia is sinus arrhythmia. This condition is characterized by mild acceleration followed by slowing of the normal rhythm that occurs with breathing. The heart beat is controlled by the intrinsic conduction system of the heart particularly by a small area in the upper heart chamber called the sinoatrial node or sinus node. The sinus node (SA node) is termed as the pacemaker of the heart. In adults, the normal heart rate ranges from 60 to 100 beats per minute. Any rate less than 60 beats or more than 100 beats per minute is termed bradycardia and tachycardia respectively.

Arrhythmias that are due to fast, abnormal electrical activity can cause tachycardias that are dangerous. If the ventricles (lower heart chambers of the heart) experiences one of these tachycardias for a long period of time, it can be detrimental to the heart. In this case, the heart eventually gets tired and cause impairment of it major function which is to pump blood out to the systemic circulation effectively. Eventually, the heart fails because of decreasing diastolic end filling time and decreasing ejection fraction. Then the blood pressure drops and patient may undergo cardiac arrest due to cardiogenic shock which is a circulatory collapse. Initially individuals may sense a tachycardia as a pounding sensation or awareness of fast heartbeat known as palpitations. If blood pressure drops then it may cause lightheadedness or dizziness, or even fainting spells (syncope).

Most tachycardias are not dangerous. Another system which can affect the heart rate is the extrinsic conduction system where the autonomic nervous system belongs to. Autonomic nervous system consists of the parasympathetic and sympathetic nervous system. Adrenaline or epinephrine is the major neurotransmitter that is involved in the sympathetic nervous system which accelerated heart beat and increases blood pressure. So anything that increase the adrenaline or its effects on the heart will cause an increase in cardiac rate and potentially cause palpitations or tachycardias. Examples are: stress (“fight or flight reaction), too much caffeine, alcohol, thyrotoxicosis or hyperthyroidism). Therefore it is advisable for these patients to remove or limit exposure to any of the causative agents mentioned above.

Bradycardia (less than 60 beats/min) which is a slow rhythm is usually not life threatening but may also cause symptoms. When bradycardia causes symptoms and does not respond to medications, implantation of a permanent pacemaker may be needed. Any form of dysrhythmia requires medical attention to evaluate the risks associated especially with life threatening arrhythmias.

List of common cardiac dysrhythmias

• Atrial Arrhythmias
o Atrial fibrillation
• Atrial Dysrhythmias
o Premature atrial contraction
o Atrial flutter
o Supraventricular tachycardia
o Sick sinus syndrome
• Ventricular Arrhythmias
o Ventricular fibrillation
• Ventricular Dysrhythmias
o Premature ventricular contraction
o Pulseless electrical activity
o Ventricular tachycardia
o Asystole
• Junctional Dysrhythmias
o Premature junctional contraction
o Junctional tachycardia
• Heart Blocks
o First degree heart block
o Second degree heart block
 Type 1 Second degree heart block, also known as Mobitz I or Wenckebach
 Type 2 Second degree heart block, also known as Mobitz II
o Third degree heart block, also known as complete heart block

Dysrhythmias are treated with a variety of antiarrhythmic medications. It may also be treated electrically with the following: cardioversion, defibrillation, and Cardiac pacing (pacemaker implantation). Cardioversion is the application of electrical current across the chest wall to the heart and it is used for treatment of supraventricular or pulsed ventricular tachycardia. The recipient in cardioversion is either sedated or lightly anesthesized. Defibrillation is used more for ventricular fibrillation and pulseless ventricular tachycardia wherein the recipient has already lost consciousness. Cardiac pacing is indicated for very slow heartbeats, from drug overdose (digitalis toxicity) or myocardial infarction. This is performed in situations where the bradycardia is not expected to recover. In general, the goal of the treatment either medications, application of electrical current or through cardiothoracic surgery is the conversion of the irregular heart rhythm to the regular/normal sinus rhythm and prevent sudden cardiac death.

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