Rhythm Disorder Arrhythmias

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What are rhythm disorders/arrhythmias?

Rhythm disorders/arrhythmias refer to any change from the normal sequence of the electrical impulses. The electrical impulses may happen either too fast, too slow or erratically causing your heart to beat too fast, too slow or erratic. When the heart doesn’t beat properly, it can’t pump blood effectively. The lungs, brain and all other organs can’t work properly and may shut down or get damaged.

What are the Causes of Arrhythmias?

Arrhythmias can be caused by the following:

  • High blood pressure
  • Coronary artery diseases
  • Cardiomyopathy (Changes in the heart muscle)
  • Injury from a heart attack
  • Valve Disorders
  • Electrolyte imbalance in the blood such as potassium or sodium
  • Healing process after heart surgery
  • Other medical conditions

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Symptoms of Arrhythmias:

An arrhythmia may be silent and not cause any symptoms. Your doctor can detect an irregular heartbeat during an examination by taking your pulse, listening to your heart or by performing the diagnostic tests. If the symptoms of arrhythmias occur, they include the following:

  • Shortness of breath
  • Palpitations: a feeling of skipped heartbeats, flip-flops, fluttering or a feeling that the heart is running away.
  • Dizziness or feeling light headed
  • Pounding in the chest
  • Weakness or fatigue (feeling very tired)
  • Chest discomfort

How is an Arrhythmia diagnosed?

If you have the symptoms of an arrhythmia, you should make an appointment with a cardiologist. You can also see an electrophysiologist, a cardiologist having an additional specialized training in the diagnosis and treatment of the heart rhythm disorders.

Your cardiologist will evaluate your symptoms and perform a physical examination. He may also perform some diagnostic tests to help confirm the presence of an arrhythmia or an irregular heart rhythm. Some of the diagnostic tests include the following:

Electrocardiogram (ECG or EKG): A picture of the electrical impulses traveling through the heart muscle. An ECG is recorded on a graph paper, through the use of electrodes that are attached to your skin on the arms, chest and legs.

Stress Test: This is used to record the arrhythmias that begins or worsens with exercises. This test is also helpful to determine the underlying heart disease or the coronary heart disease related to arrhythmia.

Cardiac Catherization: A local anesthesia is used, a catheter is inserted into a blood vessel and guided to the heart with the help of an x-ray machine. A contrast dye is injected through the catheter, so that the X-ray of the heart chambers, valves and coronary arteries may be taken. This test helps your doctor to determine if the cause of an arrhythmia is coronary artery disease. This test also provides the information about how well your heart muscles and valves are working.

Echocardiogram: This is a type of an ultrasound that is used to provide a view of the heart to determine if a heart muscle of a valve disease is causing an arrhythmia. This test is performed at rest or with activity.

Tilt Table Test: Also called as a passive head-up tilt test or head upright tilt test. It records your blood pressure and heart rate on a minute-by-minute basis while the table is tilted in a head-up position at different levels. The results of the test may be used to evaluate the blood pressure, heart rhythm and other measurements as you change the position.

Electrophysiology Study (EPS): It is a special heart catherization which evaluates the electrical system of your heart. During this test, catheters are inserted into your heart for recording the electrical activity. EPS is used to determine the cause of rhythm disorder and the best treatment for you. During the tests, arrhythmias can be safely reproduced and terminated.

Ambulatory Monitors: These include

  • Transtelephonic monitor: A small monitor is attached to the electrode leads, usually on your wrist or fingers. Your heart’s rhythm is transmitted over the phone line to your doctor’s office using this device.
  • Holter monitor: A small portable recorder is attached to the electrodes on your chest. This will continuously record your heart’s rhythm for 24 hours.
  • Transtelephonic monitor with a memory loop: It is a small, portable recorder which is worn continuously for an extended period of time for recording and saving information about your heart’s rhythm around the time you experience an arrhythmia. The recording is triggered by the push of a button, the rhythm is recorded, saved and transmitted over the phone line.

What is my pulse?

Your pulse indicates your heart rate, or the number of times your heart beats in one minute. Pulse rate varies from person to person. The pulse rate is slower when you are at rest and increases when you exercise, because more oxygen-rich blood is required by the body during exercise.

How do I take my pulse?

You can tell how fast your heart is beating by feeling your pulse on your wrist or neck. Place the tips of your index and middle fingers on the inner wrist of your other arm, just below the base of your thumb or place them on your lower neck, on either side of your windpipe. Press lightly with your fingers until you feel the blood pulsing beneath your fingers. You may move your fingers around slightly up or down until you feel the pulsing. You can count the number of beats in 10 seconds and multiply by 6 to determine your heart rate in beats per minute.

Your Heart Rate: Pulse in 10 seconds x 6= __________

A normal heart rate at rest is 50 to 100 beats per minute.?

Heart Rhythms on ECG:

The electrical system of the heart triggers the heartbeat and each beat of the heart is represented on the electrocardiogram (ECG or EKG) by a wave arm.

Normal heart rhythm shows the electrical activity in the heart is following the normal pathway as the rhythm is regular and the node is normal, about 50 to 100 beats per minute.

Tachycardia indicates the fast heart rhythm, greater than 100 beats per minute.

Bradycardia shows the slow heart beat rhythm less than 60 beats per minute.

The Heart’s Electrical System:

The upper and lower chambers of the heart called as atria and ventricles work together, alternately contracting and relaxing to pump the blood through the heart. The electrical system is the power source which makes it possible. Let us check what happens during a normal heartbeat:

The irregular heart rhythms can occur in normal, healthy hearts. Arrhythmias are caused by certain medications, nicotine, caffeine, cocaine, diet pills, inhaled aerosols, cough and cold remedies. Emotional states like fright, shock or stress can also cause rhythm disorder. Arrhythmias are recurrent or related to an underlying heart condition and should always be evaluated by a doctor.

Types of Arrhythmias:

Tachycardia: A fast heart rhythm with a rate of more than 100 beats per minute.

Bradycardia: A slow heart rhythm with a rate below 60 beats per minute.

Ventricular arrhythmias: The arrhythmias, which starts in the ventricles (heart’s lower chambers).

Supraventricular arrhythmias: Arrhythmias that starts in the atria (heart’s upper chambers).

Bradyarrhythmias: Slow heart rhythms that may be caused by the disease in the heart’s conduction system like the atrioventricular (AV) node, sinoatrial (SA) node or HIS-Purkinje network.

Treatment Options:

The treatment depends on the type and severity of your arrhythmia. In some cases, no treatment in necessary. Treatment options include the following:

Lifestyle Changes:

Arrhythmias may be related to certain lifestyle factors. The following lifestyle changes can help reduce your risk:

  • Stop smoking
  • Limit or stop using caffeine
  • Limit your alcohol intake
  • Avoid using stimulants that are present in cough and cold medications and herbal or nutritional supplements as they can cause irregular heart rhythms.
  • If you notice that your irregular heart rhythms occur more often with certain activities, then you should avoid them.
  • Your family may want to be involved in your care by learning to recognize your symptoms and how to start CPR when needed.


Antiarrhythmic drugs are medications used to convert arrhythmias to a normal sinus rhythm or to prevent an arrhythmia. Other medications include heart-rate control drugs, antiplatelet or anticoagulant drugs like aspirin or warfarin, that reduces the risk of stroke or developing blood clots. It is important to know the names of your medications, why they are prescribed, how often to take them and at what times, what side effects may occur and what medications you have taken previously for your arrhythmia.

Invasive Therapies:

Electrical cardioversion and the catheter ablation are invasive therapies used for treating or elimination irregular heart rhythms. Your doctor will determine the best treatment for you by discussing the benefits and risks of these therapies.

  • Electrical cardioversion: The patients having persistent arrhythmias like the atrial fibrillation may not be able to achieve a normal heart rhythm with drug therapy alone. It delivers an electrical shock to your chest wall, that synchronizes the heart and allows the normal rhythm to restart. This procedure is done after you will receive a short-acting anesthesia.
  • Catheter ablation: During ablation, the energy is delivered through a catheter to the tiny areas of the heart muscle. This energy will either disconnect the pathway of the abnormal rhythm, block the abnormal pulses and promote the normal conduction of impulses or disconnect the electrical pathway between the atria and ventricles.

Electrical Devices

  • Permanent pacemaker: A device having a pulse generator and leads that sends small electrical impulses to the heart muscles to main a normal heart rate. These are used to prevent the heart from beating too slowly. Newer pacemakers have many sophisticated features that are designed to manage arrhythmias, optimize the heart rate-related functions and improve synchronization.
  • Implantable cardioverter-defibrillator (ICD): This is a sophisticated electronic device used to treat life threatening abnormal heart rhythms-ventricular fibrillation and ventricular tachycardia. The ICD constantly monitors the heart rhythm. When it detects a very fast, abnormal heart rhythm, it delivers energy to the heart muscle so that it beats again in a normal rhythm.

Heart Surgery:

Surgery may be needed to correct the arrhythmias that cannot be controlled with medications or non-surgical treatment methods. Arrhythmia surgery is also recommended if you need valve or bypass surgery to correct the other forms of heart disease. The Maze and modified Maze procedures are two surgeries that are used to correct the atrial fibrillation. Discuss with your doctor to determine the best treatment for you.

Why Choose an Indian Hospital for Treating Arrhythmias?

Indian hospitals have state of the art, world class infrastructures and well-equipped with the latest technology for treating arrhythmias. The hospitals are backed up with a team of highly qualified cardiologists and heart specialists who have experienced in performing  cardiac surgeries. The Indian Cardiac Hospitals are capable to provide 24/7 care for all the cardiac conditions and emergency cardiac care. The advantage lies in the fact that these hospitals in India are fully equipped to deal with any type of arrhythmias and other cardiac emergency round the clock.


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