Has your heart ever missed a beat? If your heart beats too quickly, too slowly or with an irregular pattern, you may have an arrhythmia. Most people have felt their heart race or skip a beat either with exercise or strong emotion. That type of arrhythmia is usually not cause for alarm. However, arrhythmias that occur often or accompany other heart problems may be more serious and should be discussed with your healthcare provider.
The heart is a strong muscular pump that contracts and relaxes to a regular beat, constantly pumping blood throughout your body. In a normal day, the average heart pumps 100,000 times, pumping 2,000 gallons of blood. For a 70-year old person, that adds up to 2.5 billion beats! In order for the heart to function properly, all four chambers of the heart must beat in a highly-organized way.
An arrhythmia occurs when there is an abnormal rhythm of the heart and the four chambers do not pump in an organized way. Arrhythmias can be caused by damage to the heart from heart attack or surgery, birth conditions, high blood pressure, metabolic imbalances, chemical agents (such as caffeine, tobacco or alcohol) or viral infections. Arrhythmias can cause the heart rate to be too slow, bradycardia, or too fast, tachycardia, or to cause and early beat or premature contraction.
Atrial fibrillation (A Fib) is the most common type of arrhythmia. A Fib can affect both men and women and is most common in older people. In A Fib, the two upper chambers or atria of the heart don’t beat the way they should. Instead of beating in a regular, normal pattern, the atria beat irregularly and too fast. As a result, A Fib creates a disorganized electrical signal that disrupts the communication between the upper and lower chambers of the heart, preventing them from working together. With A-Fib, instead of the body receiving a constant, regular amount of blood from the ventricles, the lower heart chambers, it receives rapid, small amounts and occasional random larger amounts, depending on how much blood has flowed from the atria to the ventricles with each beat.
With some types of arrhythmia, you may not experience symptoms. However, when arrhythmias are severe or last long enough, the effect on the heart may result in it’s not being able to pump enough blood to the body. The symptoms you experience will depend on the type and severity of your arrhythmia. The most common symptoms include: palpitations – an unpleasant awareness of your heartbeat often described as a thumping in your chest, dizziness, fainting or collapsing, shortness of breath, chest pain, fatigue, confusion, and pulmonary edema – fluid in your lungs. If severe, arrhythmias can also cause heart failure or heart attack, stroke or even sudden death. A Fib in itself can be serious because it causes blood to pool in the chambers of the heart and form clots. The clots can break loose and travel to block the arteries in the head and neck depriving the brain of oxygen and as a result, cause a stroke. In fact, A fib increases one’s risk for a stroke fivefold and accounts for 15-20% of strokes in the U.S. totaling 105,000 – 140,000 strokes per year.
The reassuring news is that people with arrhythmias such as A Fib can lead normal and active lives. Treatments are available that can help control symptoms and prevent the complications, such as heart attack and stroke. In addition to knowing the symptoms, it is also important that people are aware of their risk factors for arrhythmias. These risk factors may include: advancing age, family medical history, a personal history of heart disease or heart surgery, high blood pressure and chronic conditions such as diabetes, thyroid problems or sleep apnea. If you find you are experiencing any of the symptoms or have any of the risk factors, discuss them with your provider to determine an accurate diagnosis and treatment plan.
When the diagnosis of arrhythmia is suspected, it is first important for the doctor to know where an arrhythmia starts and whether it’s abnormal. An electrocardiogram (EKG) is often used to diagnose arrhythmias. Using a Holter monitor which is also called an ambulatory EKG; exercise stress test, echocardiogram or electrophysiologic studies (“mapping” the electrical system of your heart) are other ways to find where arrhythmias start and determine the best way to treat them.
Treatment plans will vary depending on the type and severity of the arrhythmia. Your provider may encourage lifestyle changes such as increased physical activity, consuming a heart-healthy diet, eliminate unnecessary stressors, maintain a healthy weight and stop smoking. It may also be advised to limit your consumption of caffeine, alcohol or sugary drinks.
Medications may be prescribed to prevent and control arrhythmias and treat related conditions such as high blood pressure, coronary artery disease and heart failure. Anticoagulants or blood thinners are often given to reduce the risk of blood clots and stroke. Two common examples are aspirin and Coumadin (or Warfarin). It is important to always tell your doctor, dentist and pharmacist that you take either of these medications.
Sometimes surgical interventions may be necessary to attempt to regulate and control the heart’s rhythm. One procedure is called defibrillation or cardioversion and is an attempted way to return an abnormal heartbeat to normal with a very brief electric shock. A pacemaker or implantable cardioverter defibrillator (ICD) may be surgically placed under the skin of the upper chest to give shocks and/or work to control the beat and rhythm when the heartbeat isn’t normal. One final procedure called surgical ablation is a way to attempt to fix an arrhythmia and get your heart to beat normally. It’s done by putting a thin tube (a catheter) in your vein and guiding it to the heart muscle. The tip of the catheter delivers a burst of energy that destroys very small areas of heart tissue that are causing the abnormal electrical signals.
Among the physicians who work at The Heart Center of DuBois Regional Medical Center, Marco Cavagna, MD, stands out as the specialist who can best treat those with abnormal heartbeats. Cavagna is a special type of cardiologist called an electrophysiologist or EP. Because of Cavagna’s expertise along with The Heart Center’s team of nurses, anesthesiologists and radiology technicians, DRMC can now offer EP services to perform heart rhythm management.
Finally, it is vital that everyone is aware of the warning signs of heart attack and stroke. Some heart attacks are sudden and intense but most of them start slowly with mild pain or discomfort with one or more of these symptoms: chest discomfort, discomfort in the upper back, neck or shoulders, shortness of breath, breaking out in a cold sweat, nausea or indigestion or lightheadedness. When a stroke occurs, part of the brain cannot get the blood and /or oxygen necessary and begins to die. It is important to remember to act FAST as “time lost is brain lost.” Using the acronym FAST will help you learn to quickly and easily recognize the warning signs of a stroke. F – sudden numbness of the FACE, change in eye sight or sudden headache.
A – sudden numbness of the ARMS, legs or trouble walking or loss of balance.
S – sudden trouble SPEAKING or understanding or increased confusion
T – TIME – act quickly and call 911 and get to a hospital immediately.
In either case, prompt and early treatment can minimize the damage and limit the devastating outcomes of heart attack and stroke. February is National Heart Health month. Please take the time to learn about your risk for both cardiovascular disease and arrhythmia. The Women’s Health Task Force of Clearfield County meets the first Thursday of each month at noon. The next meeting will be held on February 3 at Children’s Aid Society, 1008 South 2nd Street in Clearfield, and all interested persons are invited to attend.
Lori Rancik, RN, BSN, Case Manager, DRMC Women’s Health Center