Everything You Need to Know About Arrhythmia

Arrhythmia is used to describe any heartbeat rhythm that is either irregular–i.e. not steady–or outside the range of a normal heartbeat of 60-100 beats per minute. While many types of arrhythmia are non-life-threatening and even common, other types are much more serious and can cause sudden cardiac arrest. A variety of diagnostic tests and imaging can help identify if you have an arrhythmia and why type it is.

At CardioVascular Health Clinic, our multidisciplinary team includes national-caliber physicians, interventional radiologists, and cardiovascular experts with decades of experience in identifying, diagnosing, managing, and treating arrhythmia. By combining our comprehensive, whole-person approach to treatment with the most advanced modalities available, we are setting a new standard of heart health and cardiovascular care for arrhythmia patients throughout Oklahoma and the country. 

The Heart’s Electrical System and Your Heart Rate

The conduction system is the heart’s built-in electrical system, a specialized network of cells that are responsible for sending electrical signals throughout the heart to regulate its pumping action and coordinate the contraction of the various chambers of the heart. The conduction system controls the heart rate, increasing or decreasing it to meet the body’s needs, and controls the rhythmic pattern of the heart beat.

For the heart to squeeze and pump blood, it needs an electrical impulse or “spark plug” to get started. Here’s how it works.

1. Cells within the conduction system generate electrical impulses in the sinoatrial (SA) node in the heart’s upper right chamber (atria). The sinus node is the heart’s natural pacemaker, and the electrical impulses that start there determine the heart’s beating rate and trigger the atria to contract and squeeze blood into the lower chambers.
2. The signal then moves down to the atrioventricular (AV) node in the middle of the heart, where it spreads into the ventricles, or lower chambers, causing them to contract and send blood through the body.
3. The entire heartbeat starts again with a new impulse from the sinus node.

The heart conducts electricity in a very specific way, and doing it in this sequence is critical to proper heart function, including a normal, steady, and healthy heart rhythm of about 70 beats per minute.

Problems with the electrical impulses or with the sequence of events can cause arrhythmias, which are abnormal heart patterns and rhythms.

Types of Arrhythmias

Arrhythmias are typically separated into two types–bradycardia, which is characterized by slower-than-normal heart rates; and tachycardia, with higher than normal heart rates. They are also classified by where they start in the heart, either the atria (upper chambers) or ventricles (lower chambers). In general, arrhythmias that start in the atria tend to be less severe and less likely to cause sudden death, but will still require treatment and management. Ventricular arrhythmias interrupt the heart’s ability to effectively pump blood and can lead to sudden cardiac arrest.

Bradycardias are:

• Heart rates that are slower than normal–less than 60 beats per minute
• Caused by problems related to the SA or AV node
• Usually the result of damage or scarring in the heart’s electrical pathways, slowing or even stopping the current of electricity

Some types of bradycardia are normal, such as while you are sleeping and in elite athletes, and are unlikely to cause complications. However, if it is causing your heart to pump insufficient blood and oxygen to your muscles and organs, you could experience symptoms like fatigue, shortness of breath, fainting, or dizziness. 

Types of bradycardia to be concerned about include:

• Sinus pause/sinus arrest, in which the SA fails to activate the electrical system
• Heart block, or AV block, which prevents the electrical signal from reaching the ventricles
• Sinus bradycardia caused by heart attack, sleep apnea, heart disease, or thyroid problems and that slows the heart rate to 40 beats per minute or less

Tachycardias are:

• Heart rates that are faster than normal or irregular, usually over 100 beats per minute
• Often caused by re-entry, where the electrical signals travel in a circular path or through a separate, extra pathway

As with bradycardia, some types of tachycardia (sinus tachycardia) are normal, such as in response to stressors like exercise, fever, fear, or any physiological response that increases blood flow. Supraventricular tachycardia can cause the heart to beat faster and limit blood flow to the rest of the body, but it’s rarely life-threatening. Other types of tachycardia that don’t usually require treatment are premature atrial contractions (PACs) and premature ventricular contractions (PVCs), which simply feel like a skipped or extra beat on occasion.

However, tachycardia can also develop as the result of a health issue like myocarditis, heart failure, or high blood pressure, or because of excessive use of alcohol, caffeine, nicotine, or illegal stimulants.

Types of tachycardia to be concerned about include:

• Ventricular tachycardia, which can cause heart beats of 110 beats per minute and is the primary culprit for the majority of sudden cardiac deaths in the U.S.
• Ventricular fibrillation, which can cause blood pressure to drop dramatically, pulse and breathing to stop, and unconscious or death, and requires immediate medical attention

2 Common Types of Tachycardia

Atrial Fibrillation (AFib)

Atrial fibrillation, or AFib, is the most common type of arrhythmia, affecting between 3 and 6 million people. The atria beat irregularly and rapidly, with the upper chamber beating out of sync with the lower chambers and causing a “fluttering” or “quivering” of the heart rate. While not immediately life-threatening, it can lead to more serious complications like heart failure and stroke if it is left untreated. 

Postural orthostatic tachycardia syndrome (POTS) 

Postural orthostatic tachycardia syndrome (POTS) is a form of tachycardia that is triggered by orthostatic stress. Most common in women between the ages of 15 and 25, POTS is an autonomic dysfunction in which someone who likely already has low blood pressure experiences dramatic fluctuations in heart rate when standing or sitting up. It is characterized by both a drop in blood pressure and a heart rate that exceeds 120 beats per minute or increases more than 30 beats per minute within 10 minutes of standing.

Diagnosing Arrhythmias

If you have an arrhythmia, you may or may not experience any symptoms. Irregular heartbeats are typically first identified during an exam by taking your pulse and listening to your heartbeat, then confirmed with additional diagnostic testing. Even if an arrhythmia is non-life-threatening, it may still require lifestyle modifications, medications, or other measures to help manage it and keep it from causing more serious complications such as weakening of the heart muscle (cardiomyopathy), cardiac arrest (heart attack), or stroke.

Arrhythmias are diagnosed using a variety of tests and diagnostic methods, such as:

Electrocardiogram (EKG or ECG)

The most common test for diagnosing arrhythmias, an electrocardiogram records the heart’s electrical activity via electrodes attached to the chest. It can be performed at rest or while exercising on a treadmill or stationary bike in what’s referred to as a stress test. An EKG can also consist of wearing a small portable recording device for 24 hours or longer.

Holter monitor

A Holter monitor is a small wearable device that can provide more detailed and comprehensive information on your heart’s performance than a traditional electrocardiogram alone by measuring heart rate and blood pressure over an extended period of time. Holter monitors are worn for 24-48 hours under normal conditions.

Tilt table test

The tilt table test measures heart rate and blood pressure in response to a change in position. The test is performed while you lie secured to a table and is designed to mimic the sensations of changing body position. While the table lifts, lowers, and tilts at different angles, various medical devices will measure your oxygen level, blood pressure, and heart rate.

Loop recorders

Loop recorders are implantable devices that record cardiac activity and, unlike a Holter monitor, loop monitors can be worn long-term for months or even years. The loop recorder is a small device that can be implanted during a minor outpatient procedure and it continuously records heart rate and rhythm during your daily life, helping to diagnose rhythm irregularities other tests may not be able to detect.

Cardiac catheterization

Also called a cardiac cath or a coronary angiogram, cardiac catheterization is a minimally invasive imaging procedure during which a catheter is inserted into a blood vessel in your arm or groin then into your coronary arteries. Contrast material is then injected through the catheter. As it moves through your heart’s chambers, valves, and major vessels, the material allows for visualization and assessment of coronary vasculature via fluoroscopy. This allows your doctor to identify problems in your heart’s function.

CardioVascular Health Clinic is one of the leading imaging centers in Oklahoma, providing patients with accessible and affordable screenings and treatments using the latest in advanced technology and diagnostic equipment. Combined with our multi-disciplinary team of experts and specialists, CardioVascular Health Clinic is uniquely positioned and equipped to diagnose, treat, and manage even rare or complex arrhythmia conditions.

Living with Arrhythmia

The treatment for a heart arrhythmia–and whether or not treatment is even needed–largely depends on the type, the cause, and the severity. Some types do not need treatment at all, some can be cured, and others require medication or medical procedures to prevent sudden cardiac arrest. If an arrhythmia cannot be cured, the goal will be to treat and manage it with medications, medical procedures, and/or lifestyle modifications to minimize its impact on your quality of life.

Here are some of the ways certain arrhythmias can be treated and/or managed.

• Premature ventricular contractions (PVCs) and premature atrial contractions (PACs) rarely need any treatment.

• Arrhythmias caused by electrical problems can be treated with catheter ablation–a minimally invasive procedure that uses precise heating or freezing to eliminate areas of abnormal electrical activity–or radiofrequency ablation, which sends high frequency radio waves into the heart via a catheter to restore normal heart rhythm.

• Atrial fibrillation often requires medication and lifestyle changes, as well as specific procedures such as minimally invasive ablations or electrical shock (cardioversion).

• Bradycardia is often treated with pacemakers.

• POTS is typically managed via lifestyle modifications, exercise, and compression stockings, with treatment focused on maintaining a healthy, stable blood pressure and addressing any secondary or underlying conditions to help mitigate the worst of the side effects.

Advanced Arrhythmia Diagnosis and Treatment from CardioVascular Health Clinic

The specialists at CardioVascular Health clinic have been at the forefront of cardiovascular care for decades, pioneering diagnostic technologies and treatment procedures that redefine patient care. With a commitment to innovation, minimally invasive techniques, and a whole-patient, multidisciplinary approach, we’re able to offer real, sustainable solutions to patients who have had heart or arrhythmia conditions but no answers.

If you or a loved one have been experiencing an abnormal or irregular heartbeat, don’t wait another day to see what happens. Schedule an appointment today and get the answers you need to live your healthiest tomorrow.