Heart arrhythmia

Diagnosis

The diagnosis of heart arrhythmia start from history taking about signs and symptoms, reviewing the medical history or drug use, physical examination, and further can be confirmed by the following tests:

• Electrocardiogram (ECG or EKG): This procedure captures the heart’s electrical activity. Sensors (electrodes) are applied to the chest, wrists, and legs, then it is attached to the monitor to show the heart rhythm.
• Holter monitor: A doctor records the activities of the heart with this portable ECG during normal activities for at least 24 hours.
• Event recorder: Similar to a Holter monitor which records activities of the heart of a patient at times when symptoms appear and is generally required to wear the equipment for 30 days or until you have an arrhythmia.
• Echocardiogram: This is a non-invasive procedure which creates pictures that show the heart’s size as well as its structure and its movement.
• Implantable loop recorder: For patients with rare occurrences, the device will be implanted in the skin of the chest to detect any abnormalities of the heartbeats by persistently recording the heart’s electrical activity.

If any of these methods cannot detect arrhythmia, the doctor might trigger the arrhythmia with some other tests, including:

• Stress test: A patient is required to run on a treadmill while having the cardiac activity recorded and analyzed.
• Tilt table test: Lying down on a table before tilting the table to assess the changes of the heart rate, blood pressure and nervous system while the tilting angle is being changed. This test is generally recommended to those who are suffering from frequent fainting.
• Electrophysiological testing and mapping: This helps to locate where the arrhythmia is happening using catheters with electrodes at the tips, which are sent through the blood vessels to the heart. When the electrodes reaches the heart, they will show how the electrical impulses expand in the heart. The electrodes are also useful for stimulating the heart to beat at a certain rate that can trigger or stop arrhythmia.

Treatment

Only patients with severe type of arrhythmia or at risk of developing other heart conditions due to the disease are recommended to receive treatment which will be chosen based on what type of heart arrhythmia you have (tachycardia or bradycardia). Other patients may just require regular monitoring and checkups. There are many treatment approaches for heart arrhythmia, such as medications, vagal maneuvers, cardioversion, catheter procedures and cardiac surgery.

Medications

Medications will be based on the type of the arrhythmia and the possible complications. For example, your doctor will prescribe blood thinners if you have atrial fibrillation to prevent blood clots or certain medications to regulate the heart rate instead if you have tachycardia.

Therapies

• Vagal maneuvers: This approach might include the process of holding your breath and straining, dunking your face in ice water, or coughing. These activities helps to control the nervous system and slow down the heartbeat and are mostly recommended to those with supraventricular tachycardia that causes an abnormally fast heartbeat.
• Cardioversion: In this process, you will either be prescribed medications or receive a shock to the heart which is sent from paddles or patches on your chest to contain the abnormal electrical signals and normalize how your heart beat and is recommended for a few kinds of arrhythmia, including atrial fibrillation.

Surgery or other procedures

In some cases, catheter procedures or surgery might be required to implant a heart device to treat arrhythmia.

There are many procedures for the disease as follows:

• Catheter ablation: One or more catheters are delivered into the blood vessels before being guided to the heart. The surgeon will then use sensors at the tip of the catheter to create scars on the heart’s lining to block the irregular signals and make your heartbeat return to normal.
• Pacemaker: A doctor will implant small device around the collarbone’s area, sending electrode-tipped wires from the pacemaker into the blood vessels before guiding them to the inner area of the heart. The electrical impulses of this device help regulate the abnormal heart rate. This treatment is used for those with a slow heart rate, or bradycardias.
• Implantable cardioverter-defibrillator (ICD): The doctor will implant a battery-powered device in the collarbone’s area, with its electrode-tipped wires sent to the heart. Energy shocks, high or low, are emitted from the ICD to monitor the heart rhythm and fix any electrical abnormalities present in the heart. This device is mostly recommended to those at risk of severe heart arrhythmia, such as ventricular tachycardia or ventricular fibrillation, which affects the lower heart chambers.
• Maze procedure: This method is used to interfere with the abnormal heart signals that cause certain types of arrhythmia by making a pattern of scar tissue, called the maze, using heat or cold energy, or a scalpel, in the upper chambers of the heart. Maze procedure can interfere with heart signals as it does not send electrical signals. This is recommended for those who have not responded to other treatments or are scheduled for open-heart surgery for other disease.
• Coronary bypass surgery: This approach is effective for regulating the abnormal blood flow to the heart, recommended for those with both heart arrhythmia and severe coronary artery disease.