Important to know the way your heart works
The heart has four chambers, is a muscular organ that supplies blood that is rich in oxygen and nutrients to different parts of the body. The upper two chambers of the heart i.e. the right atria and left atria. The blood is taken and gathered by the upper chambers. The lower chambers i.e. the left atria and left ventricles to help in the pumping of the blood. The oxygen-deprived blood goes in the right-atria from the body, which is then pumped from the right ventricle into the lungs via the pulmonary artery, the oxygen is taken up from there. Then the left atria receive the oxygen from the lungs and the left ventricle passes the oxygen-rich blood to different parts of the body via aorta.
The blood is pumped as a result of muscle contractions, with electrical activation. The normal heart rate is 60 to 100 beats per minute. Fast or slow heartbeat results in risk or complications.
What is Arrhythmia?
Arrhythmia is defined as an irregularity of the heartbeat in terms of its timing and pattern. Arrhythmias are also termed as Dysrhythmia. It results in the heart beating too fast, slow or not regular. The symptoms that occur due to arrhythmias are “racing, skipping or fluttering (when a bird flaps its wings very rapidly and lightly) feeling i.e. palpitations” that happen in the chest. Rapid heartbeat is termed as Tachycardia and slow heart-beat is termed as Bradycardia.
Individuals who have arrhythmias might feel like fainting, dizziness or light-headed. Few of the arrhythmias do not cause any harm whereas some could be serious and life-risking.
Causes of Arrhythmia
Coronary Artery Disease (CAD), Imbalance of the electrolytes, Modifications seen in the heart muscles, heart attack resulting in injury, to heal after heart surgery.
To diagnose Arrhythmia
To diagnose an arrhythmia, the tests we do are electrocardiogram (ECG or EKG), a Holter Monitor, an Event Monitor, Stress Test, A tilt table test or an Electrophysiology (EP) Study.
You could also consult an electrophysiologist i.e. a cardiologist. He is a specialized cardiologist with proper training in analyzing the diagnosis and treatment of the heart rhythm problems/issues.
Physical Examination
A physician may follow the below-given steps such as:
- One of the signs or symptoms for heart failure or heart enlargement is swelling of legs and feet.
- To check the heart-beat, monitor the pulse.
- Important to keep a check on the rate and the rhythm of the heart.
- To keep a track, hear the sound of the heart i.e. heart murmur.
- Keep a check on other medical conditions such as Thyroid issues, which could be a result of arrhythmia.
Tests are done to diagnose Arrhythmias
Electrocardiogram (ECG)
This test gives an idea to the physician about the way your heartbeats. This procedure is done in the office of the doctor. To different places of the body such as chest, arm, and legs the electrodes or patches are connected. The function of the electrodes or patches is to document the activity of the heart and comes up with a photo of the way the heartbeats. The pattern of the heart activity will be studied by the physician or the doctor and decides whether you having any heart condition or no. In other words, the ECG test keeps a check on the electrical activity of the heart. This test done is small and not painful.
Event Monitors and Devices
Sometimes only with ECG, it becomes difficult to graph the uneven/uncontrolled heartbeats, because the dysrhythmias can occur at any time. It is sometimes important to detect the heart over a longer time. To record your heart, three kinds of monitors can be used such as:
Holter Monitor
This is a constant recording of the heart activities for approximately 24 to 48 hours while doing your regular, routine activities. This can keep a track of the arrhythmias through-out these many hours. In this procedure, wires are attached to the chest and which then connects to a tiny recording device or equipment that is easily carried around with you. If at any point in time, the signs or symptoms are observed, the button needs to be pressed for the symptom to get recorded at the time of heart rhythm. An expert in the arrhythmia will then examine the electrical recordings, to find out the heart rhythm at that point of time and the signs and symptoms faced by the patient. Another thing checked is abnormal heart rhythms without any symptoms while using the Holter monitor device.
Event Monitor
This is the same as the Holter monitor, but where the heart rhythm is not recorded constantly. In this case, the heart rhythm is monitored only when the heartbeat is too fast or slow or when it is initiated. This works only for one or two months, during this time it is required to activate the device, put it near the chest and document the symptoms if they happen by pressing the button. Once the documentation is done, the ECG tracing can be transferred via phone to a monitoring device that will study the ECG documentation and transfer it to the dysrhythmia expert for understanding and analyzing. This can also be used by those whose signs and symptoms are not so frequent and cannot go to the doctor on time can make use of this monitor (event monitor) to document the signs and symptoms.
Implantable Monitor
This is a tiny device that is put under the skin (same as a pacemaker) and the functioning is the same as an event monitor. It is placed underneath the collar bone in the left chest. The battery life is of greater than three years. This device is suggested to those individuals who have “passing-out spells” i.e. fainting sensations, every three to twelve months and by doing any other tests, no causes have been identified.
Used also for those individuals who have had an undefined stroke, and no proof for atrial fibrillation while detecting for short term basis. This is done on an outpatient basis and no wires are inserted in the heart.
Other tests
The other tests are mentioned below and they will analyze the cause and type of dysrhythmia.
Stress Test
This test is done to see the performance of your heart under any sort of stress or work-out on the treadmill and analyze whether dysrhythmia is due to exertion. Just like an ECG, electrodes will be attached to your body, and you will be asked to run on a treadmill or exercise on a still bicycle for some duration of time while observing the heart condition. This test can be done with medicines instead of exercise. The medications given will increase the rate of the heart, which will be then monitored with an ECG or Echocardiogram.
Echocardiogram and Transesophageal Echocardiogram (TEE)
This is not an invasive or painful test, which will allow the cardiologist to check if your heart is working appropriately, whether it has become larger or weak or the valve is damaged. The waves of the ultra-sound are transferred from the chest to the heart. The photos of the heart are formed once the echoes of the sound waves are into the process.
There will be an extra echocardiogram done i.e. transesophageal, where the patient has to gulp the “ultrasound probe” (sedation or numbing medicines are given). The TEE provides close photos of the heart from the esophagus. This is a good method to identify clots of blood in the atrium.
MRI Scan
Magnetic Resonance Imaging (MRI), is a method that is not painful and done to understand the structure and function of the heart. It can evaluate the condition of the heart which is very rarely known as arrhythmogenic right ventricular dysplasia and cardiac sarcoidosis. No radiation is involved here. MRI’s are used in several procedures, for example like catheter ablation of atrial fibrillation to keep away from radiation.
MRI in patients with Implanted Cardiac Pacemakers and Defibrillators
Initially, MRI was not performed in patients with implanted cardiac pacemakers and defibrillators, but with the advancement in the researches, MRI can now be done in numerous patients with implanted cardiac pacemakers and defibrillators. Before entering the MRI room, patients to test for implanted cardiac pacemakers and defibrillators need to keep their device/equipment completely tested and programmed properly to “MRI-Safe Settings”. During the on-going treatment, ECG is constantly analyzed by a doctor or nurse who is an expert in both MRI and management of heart devices. After the MRI is done, the pacemaker or defibrillator is again checked, to confirm no damage happened at the time of MRI and the initial settings are put back.
CT scan
Computerized Tomography (CT) Scanning is done by clicking “high-resolution X-ray photos using a multi-slice scanner. This helps identify coronary artery disease (CAD), analyzes congenital heart condition, and to analyze a patient’s heart before the complicated catheter ablation method.
PET scan
A Positron Emission Tomography (PET) is a method that is not painful. This helps to detect the inflammation in the body or heart. It is a major procedure used to identify cardiac sarcoidosis.
Tilt Table Test
This method helps identify an issue with blood pressure maintenance resulting in “fainting.” This is mentioned by various names such as “neurally mediated syncope”, “neurocardiogenic syncope” or “vasovagal syncope.” This test is also done to identify the Postural Orthostatic Tachycardia Syndrome (POTS).
In this an IV is placed in the arms and ECG is connected to your chest. Till the time heart rate and blood are regulated, lie down flat on the table for ten to fifteen minutes. At that time, the table will be tilted upright, very similar to standing. Till the time blood pressure and heart rate are regulated, you will be told to stay still. If the reaction is normal, medicines are given through IV and the tests are redone again.
If the symptoms aroused by the tilt-test than the physicians will take a note of it and your blood pressure and heart rhythm is noted once the tilt table comes back to its position. The recovery will happen immediately and the patient returns home soon.
Electrophysiology Study
This study is done when sometimes arrhythmias are difficult to identify. This study is done when patients have a feeling of fainting or felt an irregular fast heart rhythm. This is recommended to those whose functioning of the heart is not proper and irregular excess heartbeats, even though no symptoms. In other possibilities, it can be done on those with high-risk assessment i.e. for patients who are prone to inherited heart issues. This study identifies those individuals who are at risk of getting dysrhythmias, depicting the need for treatment to prevent it.
In this study, IV is inserted into large veins by electrophysiologists. Then various catheters that are electrical are passes through the IVs and passes them to the heart via X-ray imaging. This helps the electrophysiologist to identify the electrical activity that is happening in the heart to check the rhythm of the heart. Depending on this, the physician can help you with proper treatment. For this test, the physicians may ask you to avoid eating or drinking the night before. I need to consult the doctor for the medications to be taken or no. While doing this study, the patient will lie flat on the X-ray table, on the arm will be the cuff to measure blood pressure, to monitor oxygen levels clip will be attached on the finger and the legs, arms, and chest the wires will be connected to measure the heart rate. Sedation will be given by the nurse to decrease the discomfort feeling before and during the treatment.
The areas on which the doctors will work will be shaved and cleaned. From top to bottom the body will be covered with sterile drapes. The areas where the wires are inserted will be numbed. The wire will go to the heart via the veins. As soon as the catheter is put in its place, that is attached to a computer that depicts the internal ECGs (Electrocardiogram).
To document and activate the electrical stimulation, catheters are used. The symptoms seen will be a rapid heartbeat, skipped beat, or symptoms such as dizziness and palpitation.
The study goes for approximately one to three hours. Once everything is done, some amount of pressure is given in the area which was numbed to avoid bleeding. Then take proper rest for the next three to four hours with legs straight. After recovery, the nurses will check all the important parameters. Depending on the study results, the physicians will recommend the treatment.
Blood Tests
A doctor will also ask to do the Blood Tests, to check the levels for different nutrients like calcium, magnesium, potassium, sodium, which plays a major role in the electrical system of the heart. Apart from that also the cholesterol levels and the quantity of carbon dioxide in the body.
Conclusion
Arrhythmias could be harmless as well as life-threatening. It is important to consider showing your doctor if you see any of the symptoms related to arrhythmias. The best is to diagnose it as an initial stage for the treatment to be started. Faster the detection of arrhythmias helps lead a healthy and quality life.
Sirisha B