How is cardiac arrhythmia treated

Cardiac arrhythmias

Arrhythmias: Where Do They Come From?

Usually the sinus node, a small area in the right atrium, generates electrical impulses for the heart to beat. They first spread over the atria, which then contract. There is a lot of connective tissue of the heart skeleton between the atria and the ventricles. It acts as electrical insulation. The impulses are only conducted into the ventricles at a special connection node, the AV node.

From there, the charges on the bundle of His, the ventricular limbs and the Purkinje fibers run towards and along the apex of the heart. From there, the heart muscle contracts and pumps the blood into the large bloodstream. Arrhythmias can occur when the sinus node does not generate electrical impulses properly, the impulses are not transmitted properly, or additional impulses develop in the atrium or ventricle. There are dangerous and harmless cardiac arrhythmias.

How do I recognize an arrhythmia?

Cardiac arrhythmias can cause different symptoms. Palpitations, palpitations, dizziness, chest pain or fainting are some of the typical signs. You can read more about this in the article Cardiac arrhythmias: Symptoms.

What are the causes of cardiac arrhythmias?

You can read everything you need to know about the causes of a cardiac arrhythmia in the article Cardiac arrhythmias: Causes.

Cardiac arrhythmias: what are they?

Arrhythmias can be divided into two main categories. If the heart beats too fast (more than 100 beats per minute), doctors speak of one Tachycardia. A heartbeat that is too slow (less than 60 times per minute), on the other hand, is referred to as Bradycardia. Doctors only see relevant bradycardia when the heart beats even more slowly (at least less than 50 beats per minute. It should not be forgotten that some well-trained hearts (athletes) can beat so slowly without being sick.

Another important term is "arrhythmiaDoctors mean cardiac arrhythmias with an irregular heartbeat. If the heart beats too fast, it is called tachyarrhythmia. If the heartbeat is very slow, it is called bradyarrhythmia.

Ventricular arrhythmias

Cardiac arrhythmias are usually classified according to where they occur first. Doctors refer to changes in the heartbeat originating in the chambers of the heart (ventricles) as ventricular arrhythmias. If the excitement arises about it, one speaks of supraventricular arrhythmias.

Typical ventricular arrhythmias are:

  • Extra beats (ventricular extrasystoles)
  • Ventricular flutter
  • Ventricular fibrillation
  • Ventricular tachycardia (e.g. torsade-de-pointes tachycardia)

The Deadliest Heart Diseases

  • Particularly dangerous heart diseases

    Heart attack, sudden cardiac death, atrial fibrillation - most people in Germany die as a result of heart disease. Read here which complaints they cause and which heart diseases are particularly dangerous.
  • coronary heart desease

    Six million Germans have coronary heart disease (CHD). It is the cause of many other heart diseases such as heart failure, heart attacks or sudden cardiac death. In CHD, the blood vessels that supply the heart muscle with oxygen "calcify". In medical terms, it is arteriosclerosis of the coronary arteries. The result is insufficient blood flow and the associated lack of oxygen in some parts of the heart muscle.
  • Angina pectoris

    Angina means something like chest tightness. Typical of this are sudden pain in the heart area and a feeling of tightness, burning or pressure in the chest. This is not a disease in its own right, but a major symptom of coronary artery disease. If you experience sudden chest pain, you should call an emergency doctor immediately. Because only a doctor can determine whether it is possibly a heart attack.
  • Heart attack

    112 - a heart attack is always an emergency. It occurs when a blood vessel in the heart becomes blocked by a blood clot. Within a very short time, the heart muscle is no longer adequately supplied with oxygen. If it is not possible to open the closed vessel again within a very short time, the area supplied by this vessel threatens to perish. Every year around 280,000 Germans suffer a heart attack. The main cause is CHD.
  • Heart failure

    Around 1.8 million people in Germany suffer from cardiac insufficiency, also known as heart failure. In this disease, the pumping capacity of the heart muscle is weakened. Then the entire body is no longer adequately supplied with blood and oxygen. In the advanced stage, the patient gets breathless even with low exertion, water retention and a feeling of weakness come on top of this. The most common causes of heart failure are CHD and high blood pressure.
  • Cardiac arrhythmias

    If the heart gets out of sync, one speaks of cardiac arrhythmia. The heart then beats too quickly, too slowly or irregularly. There are many causes. However, coronary heart disease is particularly common.
  • Atrial fibrillation

    With atrial fibrillation, the heart beats irregularly. This is the most common form of a disturbed heart rhythm: a million Germans suffer from it - but more than half do not notice it. Some feel a palpitations or palpitations and suffer from dizziness, shortness of breath, chest pain or feelings of anxiety. Atrial fibrillation can also lead to cardiac insufficiency. Above all, however, clots form in the heart with atrial fibrillation - then there is a risk of a stroke.
  • Racing heart

    Palpitations, also called tachycardia by doctors, is a cardiac arrhythmia in which the heart beats very quickly over a long period of time - more than 100 beats per minute. Various diseases can make the heart beat faster, including atrial fibrillation, CHD and high blood pressure. If your heart continues to beat too fast, see a doctor. Because palpitations can also cause sudden cardiac death.
  • Bradycardia

    The counterpart to tachycardia is bradycardia. The heart beats too slowly here: the heart rate is below 60 beats per minute. Sometimes the heart rate is so low that too little blood is being pumped into the body. As a result, the oxygen demand, especially of the brain, can no longer be adequately met. Headache, dizziness, loss of consciousness, nausea and vomiting can result.
  • Ventricular fibrillation

    Ventricular fibrillation is an often fatal cardiac arrhythmia. It occurs when the electrical signals that control the work of the heart are severely disturbed. Then frequencies of up to 800 signals per minute can occur - an effective heartbeat is then no longer possible. The result: cardiac arrest and loss of consciousness. Only an immediate chest compressions followed by defibrillation can save your life.
  • Sudden cardiac death

    Sudden cardiac death suddenly kills a person from life. 100,000 to 200,000 people in Germany strive for this every year. It is always caused by a severe arrhythmia. The affected person suddenly becomes unconscious because their brain is no longer supplied with oxygen - it dies within a short time.
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    Medical editor and biologist

Supraventricular arrhythmias

Above all, supraventricular cardiac arrhythmias are further classified in some places; namely according to where pathological processes take place in the conduction system:

Normo- or orthotopes Irritation disordersare cardiac arrhythmias that originate from the sinus node. The formation of the electrical impulses is changed, for example in:

  • Sinus arrhythmia (e.g. sick sinus syndrome)
  • Sinus bradycardia (less than 60 beats per minute, sometimes less than 50 beats)
  • Sinus tachycardia

Heterotopic irritation disorders originate outside the sinus node. Then the impulses arise either in the atrial muscle itself, in the AV node or in the bundle of His. These include, for example:

  • Extra beats (extrasystoles)
  • Atrial tachycardias (e.g. in the case of an overactive thyroid)
  • Atrial fibrillation / flutter
  • AV rhythm / extrasystole (as a secondary pacemaker approx. 40-50 beats per minute)
  • His bundle rhythm / extrasystole (as a tertiary pacemaker approx. 30-40 beats per minute)

Conduction disordersare present when the transmission of impulses from the sinus node via the AV node into the heart chamber is disturbed, as in these clinical pictures:

  • Sin astrial block (SA block)
  • Atrioventricular block (AV block)
  • Intraventricular block (e.g. (in) complete right bundle branch block and / or left bundle branch block)

This also includes arrhythmias that seizure (paroxysmal) occur. In this case, some patients have additional "lines" for the electrical impulses.

  • AV nodal reentry tachycardia
  • AV reentry tachycardia (additional trunk groups as in WPW syndrome)

resuscitation

If the heart stops beating at all, doctors speak of one Asystole. Sometimes there are individual electrical discharges that can also be seen in an EKG, pulseless electrical activity (PEA). But it is no longer enough for a heartbeat. As with ventricular tachycardias without a pulse or ventricular fibrillation, a PEA or asystole must be resuscitated immediately.

How dangerous are arrhythmias?

Some arrhythmias are harmless, others are life-threatening. If a cardiac arrhythmia persists, it can have several consequences. For example, the heart becomes weaker and weaker (heart failure). The risk for Heart attacks. For example, there is a risk of a heart attack because fast-beating hearts consume more oxygen. The heart muscle gets this from the coronary vessels. If the coronary arteries or the heart muscle itself are abnormally changed, the oxygen supply is no longer sufficient over time and there is a risk of an undersupply (ischemia).

With irregular and rapid cardiac arrhythmias, the blood swirls in some places in the heart. If this condition persists, the blood clumps and it forms thrombus. It can be released from the heart and migrates to other parts of the body via the bloodstream. There the vessels become increasingly narrow, so that the blood clot gets stuck and clogs the vein. As a result, the organ in question or at least parts of it are no longer adequately supplied with oxygen and perish. The consequences are a stroke in the brain, a pulmonary embolism in the lungs or a kidney infarction with subsequent kidney failure.

Cardiac arrhythmias: sport

Especially in children and young people, the heart rate rises and falls when inhaling and exhaling. These changes in heart rate are called Respiratory sinus arrhythmia. This process is normal and does not require therapy. During sport, but also in everyday life, the heart sometimes beats extra, so-called extrasystoles. They are sometimes uncomfortable, but usually harmless. In addition, a real athlete's heart is sometimes so well trained that it gets the circulation going properly even with fewer beats. This form of sinus bradycardia also has no disease value.

Arrhythmias: diagnosis

The first point of contact is usually the family doctor. He takes the first steps to get to the bottom of cardiac arrhythmias. For more detailed clarification, however, he will refer you to a specialist in heart disease, a cardiologist. At the beginning, the doctor asks the patient about symptoms:

  • Do you often get dizzy? Have you already collapsed?
  • Do you keep racing your heart? If so, how often and how long does an attack last?
  • Does your heart stumble often?
  • Do you occasionally experience shortness of breath or chest pain?

The doctor is also interested in the medical history (in summary, the doctor collects a so-called anamnese):

  • What medications are you taking?
  • Do you have any known heart disease?
  • Have you ever been treated for cardiac arrhythmias?
  • Do you suffer from other diseases, such as a thyroid dysfunction?

The doctor will then examine you. He measures blood pressure and feels the pulse. He also listens to the heart.

Apparative investigations

The doctor records the electrical activity of the heart and thus also cardiac arrhythmias with aElectrocardiogram (EKG) on. Sometimes, however, patients suffer from temporary attacks of a cardiac arrhythmia that do not occur when they visit the doctor. Then one is Long-term ECG- It is advisable to have an examination that records the heart's actions continuously for about 24 hours.

Under certain circumstances, no cardiac arrhythmias will occur during this period either. Then so-called Event recorder help. There are external and implantable recording devices. They automatically save cardiac arrhythmias that correspond to a certain pattern (this is programmed in beforehand). Some external devices only save the heart's actions at the push of a button, i.e. when the patient notices something unusual.

Doctors use stress tests to test how cardiac arrhythmias behave during physical exertion. A bicycle ergometer is usually used for this. Next to the Exercise ECG this examination also includes measuring blood pressure. In addition, the examinations can be carried out with a Cardiac ultrasound (Echocardiography).

Doctors often use this to identify underlying heart disease. You can possibly also in one X-ray image of the rib cage. In some cases, the doctor performs one Electrophysiological examination by. In this context, he can not only assess the cardiac arrhythmias well, but also treat them immediately if necessary (catheter ablation).

Read more about the examinations

Find out here which examinations can be useful for this disease:

Cardiac arrhythmias: what helps?

If a rapid heartbeat occurs very suddenly, you can first try to see whether certain maneuvers slow the pulse. For example, you can put an ice pack on your face or neck, or press while holding your breath. This irritates special sensors in the vessels. They give feedback to the central nervous system, which throttles cardiac activity via the vagus nerve.

Sometimes doctors also have to prescribe drugs that prevent or at least contain the cardiac arrhythmia. Depending on the type of cardiac arrhythmia, they are taken permanently or only when the abnormal heartbeat occurs. Choosing the right remedy is complex and depends on many factors. Known Medicationthat are used for cardiac arrhythmias are:

  • Beta blockers (controls and generally lowers the heart rate)
  • Sodium channel blockers (especially flecainide as "pill in the pocket" for attack-like supraventricular tachycardias)
  • Potassium channel blockers (e.g. amiodarone for atrial fibrillation)
  • Calcium channel blockers (e.g. verapamil)
  • Digitalis (lowers atrial tachycardia, especially good when beta blockers are insufficient or low blood pressure does not allow them to be used)
  • Parasympatholytics such as atropine or sympathomimetics such as orciprenaline (for bradycardia)

Sometimes patients need one because of their irregular heartbeat Pacemaker, one Defibrillator or a device that includes both. These devices are implanted under the skin. Wires run from there into the heart in order to set electrical impulses permanently or if necessary. Cardiac resynchronization therapy is mainly used for severe cardiac insufficiency and left bundle branch block. With this device, two probes - one per heart chamber - let the ventricles beat again in the same rhythm.

Doctors can identify additional pathways, for example in the case of AV node reentry tachycardia, as part of an electrophysiological examination desolate (High frequency catheter ablation). This method often prevents recurring cardiac arrhythmias in the long term. Treatment and prognosis do not only depend on the type of illness, but also on comorbidities and symptoms. There are also harmless ones Cardiac arrhythmias (e.g. extrasystoles) that do not have to be treated at all.

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