World Heart Day: Poor sleep quality & stress cause arrhythmia, can leave you paralysed

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By Dr Nikesh D Jain

Cardiovascular diseases are known as the major cause of mortality in India and around the world, according to World Health Organization. While the conditions range from cerebrovascular disease due to stroke and raised blood pressure because of hypertension, arrhythmia remains a common cardiovascular problem in people of the country.

Arrhythmia, also known as Heart Rhythm Disorder, occurs when the heart beats too fast, slow or with in irregular patterns. Tachycardia is a condition when the heart beats faster than normal, and in Bradycardia, the heart beats are slow paced. Few of the major symptoms include skipping or fast/slow heart beats, sweating, shortness of breath, among others.

The condition should be treated immediately. If not, it can cause serious problems, and would require a surgery. The condition can be cured by medication in the early stages.

On World Heart Day, here’s every thing you need to know about arrhythmia.

What is Arrhythmia?

Arrhythmia means abnormal heart beat. In arrhythmia, normal sequence of electrical impulse generation or conduction is disturbed, giving rise to abnormal heart beat. It is different from heart attack in which there are blockages in arteries supplying blood to the heart.

Causes of Arrhythmia

Arrhythmia can occur even in a healthy person. It also affects people who are suffering from disease in the heart or other organs.

Heart diseases which cause arrhythmia are blockages in arteries that supplying blood to the heart, previous cases of heart attack, patients with low-pumping heart, valvular problems, disease of electrical connections of heart which can happen due to ageing, and/or genetic manifesting at any age.

Other secondary (lifestyle) factors causing arrhythmia are diabetes, hypertension, infection, thyroid conditions, low sodium or potassium levels, medication, drug abuse, smoking, alcohol, stress and obstructive sleep apnoea, among others.

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Types of Arrhythmia

There are various types of arrhythmia

– Intermittent irregular beats: from upper (Premature Atrial contraction) or lower (Premature Ventricular contraction) chamber of heart

– Slow heart rate or bradycardia (
– Fast heart rate or tachycardia (>100) : which can be benign like Sinus Tachycardia or serious such as Supraventicular Tachycardia (SVT), Atrial Fibrillation (AF), Atrial Flutter (A-Fl), Ventricular Tachycardia (VT), Ventricular Fibrillation (VF)

Symptoms, and how serious it is

Arrhythmia lasting for brief period may not produce any symptoms, but it is important to determine the type of arrhythmia for prognosis treatment strategy. Ectopic beats, sinus bradycardia, sinus tachycardia are not life threatening and may cause palpitations, discomfort in chest. If frequency of ectopic arrhythmia is significant or is secondary to underlying heart disease, it will require treatment.

Arrhythmia persistent for long time like SVT, AF, A-Fl will cause symptoms like palpitations, fatigue, sense of thumping in chest, chest discomfort/pain, dizziness, syncope, etc. These decrease pumping capacity of the heart and thereby decreasing the blood supply to vital organs including brain.

Patients with AF can get paralysed as the blood clot forms in the heart and affects the brain.

Few cases of persistent arrhythmia can decrease the pumping of the heart, which is usually reversible with treatment. Meanwhile, VT and VF require urgent medical attention. Patient with VT/VF can collapse suddenly which is life-threatening. CPR should be started and patients should be taken to the nearby hospital immediately in such cases.

Master - World Heart Day: Poor sleep quality & stress cause arrhythmia, can leave you paralysed
Arrhythmia can occur even in a healthy person.

Think you have arrhythmia? Here’s what you need to do

Patient should get an ECG done immediately in any nearby hospital once the symptoms start as arrhythmia can be transient and may not get detected if the ECG is done when the symptoms subside.

Doctor may advise tests like ECG, 2D Echocardiography, Holter Monitoring to diagnose the type and treatment for arrhythmia. Experts may also advise Electrophysiology which is a small procedure to study electrical connections of the heart if other tests are inconclusive.

Treatment

Treatments differ based on the type of arrhythmia. Transient and benign types with normal heartbeat usually do not require treatment.

Arrhythmia like SVT, AF, A-Fl are usually treated with medicines. If persistent Ablation Therapy is done, abnormal focus of impulse generation is burnt electrically.

Slow heart rate arrhythmia like heart block will require permanent pacemaker to maintain normal heart rate.

VT/VF is a medical emergency, and once patient stabilises, AICD (Automatic Implantable Cardioverter Defibrillator) should be implanted. It is a device implanted in the chest which gives shock therapy on detection of VT/VF through a wire connected in the heart. In few heart diseases and in some genetic conditions of electrical connections of the heart, it is recommended to implant AICD as primary prevention.

(The author is Consultant Cardiologist at Jaslok Hospital and Research Centre)

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