Feeling dizzy? Short of breath? Have tightness in your chest? You may have an abnormal or irregular heart beats. If these are symptoms of heart arrhythmia, they can lead to a stroke or even sudden cardiac death. But how do you know if you have heart arrhythmia? And if you know you have this condition, how do you treat it? “Today” on MSNBC.com asked Dr. Jennifer E. Cummings of the Cleveland Clinic in Cleveland, Ohio, to help better understand this condition and tell us about the latest treatments. As part of our series, “Modern Medical Miracles,” we look at exciting new ways doctors can monitor their heart patients. But what about the rest of us? Dr. Cummings helps us understand a common, but silent heart condition — arrhythmia.
MSNBC.com: What is an arrhythmia?
Dr. Jennifer E. Cummings: An arrhythmia is an irregular or abnormal heart beat that occurs when the heart’s electrical system does not function properly, causing it to beat too slowly or too quickly. Arrhythmias have many causes, including coronary artery disease, changes in the heart muscle (heart failure or cardiomyopathy), valve disease, electrolyte imbalances in the blood (such as sodium or potassium), injury from a heart attack or the healing process after heart surgery. A fast or slow heart rate does not always mean heart rhythm is abnormal. They can also stem from anxiety, activity, medications or other normal causes.
MSNBC.com: What are common arrhythmia symptoms?
Dr. Cummings: An arrhythmia may be “silent” and not cause any symptoms. A doctor can detect an irregular heartbeat during physical exam by taking a patient’s pulse, listening to the heart or by performing diagnostic tests such as an electrocardiogram or Holter monitor.
If symptoms occur, they may include:
- Palpitations — a feeling of skipped heart beats, fluttering, “flip-flops” or feeling that the heart is racing or "running away"
- Pounding in the chest
- Dizziness or lightheadedness
- Shortness of breath
- Chest discomfort
- Weakness or fatigue
MSNBC.com: When do most people first notice an arrhythmia?
MSNBC.com: Does arrhythmia occur more often with women or men? Is it hereditary?
Dr. Cummings: Arrhythmias occur in both men and women. There are many different kinds of arrhythmias. Many arrhythmias are present at birth. Although physicians do believe that some arrhythmias have a genetic component or are hereditary, further research is needed before physicians know for sure.
MSNBC.com: Can an arrhythmia be life-threatening?
Dr. Cummings: There are many different kinds of arrhythmias. Physicians determine the type of arrhythmia causing a patient’s symptoms by “capturing” a picture of the arrhythmia with a heart monitor as the patient is experiencing symptoms. Once physicians have identified the type of arrhythmia a person has, they can determine the gravity of a patient’s condition and if it is life-threatening. For example, some arrhythmias have been linked to sudden cardiac death, while others are associated with strokes. Some arrhythmias are characterized as normal variants and do not require treatment.
MSNBC.com: What are the best ways to determine if a patient has arrhythmia? Wireless monitors? Stress tests?
Dr. Cummings: If you have symptoms of an arrhythmia, you should make an appointment with a cardiologist. You may want to choose an electrophysiologist, a cardiologist who has received additional specialized training in the diagnosis and treatment of heart rhythm disorders. After evaluating your symptoms and performing a physical exam, your cardiologist may perform a variety of diagnostic tests to help confirm the presence of an irregular heart rhythm and help determine its causes.
Some tests that may be done to confirm the presence of an arrhythmia include:
- Electrocardiogram (EKG): A picture, on graph paper, of the electrical impulses traveling through the heart muscle, recorded by electrodes attached to the skin on the chest, arms and legs.
- Ambulatory monitors: There are several types:
1. Holter monitor: A small portable recorder that is attached to electrodes on the chest. It records the heart rhythm continuously for 24 hours.
2. Transtelephonic monitor: A small monitor is attached to electrode leads, usually on the finger or wrist. Your heart’s rhythm is transmitted over the phone line, with the aid of this device, to your doctor’s office.
3. Transtelephonic monitor with a memory loop: A small, portable recorder, worn continuously for a prolonged period; records and saves the heart rhythm around the time that an event button is activated. The rhythm is recorded, saved and transmitted over the phone line.
- Stress test: A test used to record arrhythmias that are brought on or are worsened by stress or with exercise. This test also may be helpful in determining if there is underlying heart disease or coronary artery disease associated with an arrhythmia.
- Echocardiogram: A type of ultrasound used to provide a view of the heart to determine if there is heart muscle or valve disease that may be causing an arrhythmia. This test may be performed at rest or with activity.
- Cardiac catheterization: During this test, using a local anesthetic, a catheter (small, hollow, flexible tube) is inserted into a blood vessel and guided to the heart with the aid of an x-ray machine. A contrast dye is injected through the catheter, so X-ray movies of the coronary arteries, heart chambers and valves may be taken. This test helps your doctor determine if the cause of an arrhythmia is coronary artery disease. This test also provides information about how well the heart muscle and valves are working.
- Electrophysiology study (EPS): A special heart catheterization that evaluates the heart's electrical system. The catheters inserted into the heart record the electrical activity. The EPS is used to find the cause of the abnormal rhythm and determine the best treatment. During the test, the arrhythmia may be safely reproduced and terminated.
- Head upright tilt test (HUT): A test used to safely reproduce fainting spells in people that may be prone to these episodes (syncope). During the test, the patient is tilted upright on a special table at different angles (usually 30 to 60 degrees). Blood pressure and heart rhythm are recorded. In some people, a fainting spell may be provoked. A medication that may bring on these spells also may be used during the tilt procedure.
MSNBC.com: If you think you have arrhythmia, what should you do?
Dr. Cummings: If you suspect you have an arrhythmia, you can begin by making an appointment with your primary care doctor. He or she can order a heart monitor to “capture” a picture of your heart rhythm when you have an (arrhythmia) episode. After recording your heart rhythm via monitor, your doctor can refer you to the appropriate specialist(s). Often this is a cardiologist, or in some cases, an electrophysiologist, a cardiologist who specializes in arrhythmias.
MSNBC.com: What are common treatments?
Dr. Cummings: The type of treatment depends on the type of arrhythmias. Some arrhythmias do not require treatment. Others require the use of medication to suppress them. Certain types of arrhythmia require patients to undergo a procedure called an "ablation" during which specialized cardiologists (electrophysiologists) put catheters inside the heart to burn the abnormal cells that are causing the arrhythmias. In addition, some arrhythmias can require the implantation of devices called pacemakers or defibrillators inside the heart to regulate and/or monitor patients’ heart beats. The first step in determining the appropriate treatment for a patient is to identify the nature of the arrhythmia.
MSNBC.com: Do doctors have new ways to treat this condition?
Dr. Cummings: There are new ways being developed every day. New safer ways to perform ablation are currently being tested and evaluated. New devices are always being developed. At Cleveland Clinic, physicians are doing a significant amount of research in arrhythmias to find easier, safer means to diagnose, treat and cure patients, such as the heart monitor vest shown in the piece.
MSNBC.com: Is this a life-long condition?
Dr. Cummings: There are some arrhythmias that patients will live with their whole lives. However, the majority of arrhythmias can be successfully treated using a wide variety of medications and/or procedures. Once you have an arrhythmia diagnosed on a monitor, you should talk to your doctor about all the options that are specific to you and your arrhythmia. Every patient is different and treatment is still very individualized.
Jennifer E. Cummings, MD, is the director of electophysiology research in the section of cardiac electrophysiology and pacing at the department of cardiovascular medicine at Cleveland Clinic in Cleveland, Ohio.
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