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How does a normal heart beat?

Heart muscle cells are activated by electrical impulses that cause them to contract regularly and in sync. This contraction produces a heartbeat, allowing blood to be pumped out to the entire body.

Electrical impulses originate from specialized cells called the sinoatrial (SA) node, which is the heart’s natural pacemaker.

The SA node is located in the upper right chamber of the heart, the right atrium. From the SA node, the impulse spreads across the upper chambers of the heart to reach the atrial-ventricular (AV) node located between the atria and lower ventricles. After leaving the AV node, impulses spread across the pumping chambers of the heart, the ventricles.

As impulses are spread along the heart, the cardiac muscle cells are stimulated to contract, producing a heartbeat.

Normal Conduction

Arrhythmias

Conditions in which the heart beats with an irregular or abnormal rhythm. Some arrhythmias occur without symptom while others have symptoms of increasing severity.

Understanding normal electrical conduction through the heart

Causes of Arrhythmias

Disease, injury or any condition that disrupts normal conduction or creates a lack of oxygen to the heart tissue cells responsible for heart rate. Excessive physical and mental stress. Alcohol and drug abuse may also be a factor to consider in causes of some arrhythmias

Common Symptoms

Include, but not limited to, palpitations, chest tightness or peain, shortness of breath, lightheadedness, fainting or black-out, fatigue, exercise intolerance and excessively slow or fast heart rates, Symptoms may be constant, persist frequently or be infrequent and random which may require patient to be monitored to catch the moments when symptoms appear, This may be done with a Holter or Event monitor, or an implanted event recorder to capture the specific arrhythmia with it happens to confirm diagnosis.

Please see Devices

EKG

The electrocardiogram is used to measure conduction through the heart and help identify any aberrancy.

Examples of Arrhythmias

  • Bradycardia
  • Tachycardia
  • Atrial Flutter
  • Atrial Fibrillation
  • Ventricular Tachycardia
  • Ventricular Fibrillation

What is Bradycardia

abnormally slow heart action.

What is Tachycardia

an abnormally rapid heart rate.

What is it?

Atrial flutter is a relatively common abnormal heart rhythm where the atria beat quickly, but evenly. This is similar to atrial fibrillation, but the atria beat quickly and unevenly.

Atrial flutter and fibrillation always have some degree of atrial-ventricular (AV) block with a 2:1 pattern meaning the rate of the ventricles is usually 150 beats per minute while the atria beat at 300 beats per minute. In other words, every other atrial beat reaches the ventricle.

Both of these arrhythmias impair blood flow out of the heart (cardiac output) and promote clot (thrombus) formation.

How does atrial flutter occur?

Sometimes the electrical impulses ‘short circuit’ and travel across the heart in an abnormal way. Abnormal electrical pathways produce irregular heartbeats and rhythms known as arrhythmias.

Arrhythmias occur when other areas of the heart, other than the SA node, begin sending out their own impulses and take over the pacemaker function of the SA node. The sites that take over could be from any area of the atria, AV node, or ventricles.

The rapid fluttering of the atria does not allow the complete filling of the ventricles, that pumps blood out to the entire body. Symptoms of atrial flutter such as lightheadedness or dizziness may be felt.

Also, some amount of blood remains in the chamber that leads to clot formation.

How is it classified?

Atrial flutter is classified into two types:
Type I (Typical) – more common, atrial flutter rate 240-340 beats/minute, circular (clockwise or counterclockwise) re-entry of electrical patterns in the atria
Type II (Atypical) – rare, atrial flutter rate 340-440 beats/minute, different re-entry pathways

Most patients with atrial flutter will have only one of these. Rarely a patient may present with both types, although they can only occur one at a time.

What are the causes?

Atrial flutter can be due to abnormalities or diseases of the heart, or by diseases elsewhere in the body affecting the heart. Atrial flutter may occur after open heart surgery or substance abuse.
Heart abnormalities and diseases include:

  • Congenital heart defects (heart defect from birth)
  • Coronary artery disease (decreased blood supply to the heart) or atherosclerosis
  • High blood pressure
  • Heart attack
  • Cardiomyopathy and congestive heart failure
  • Rheumatic fever and pericarditis (inflammation of the heart)
  • Abnormalities of the heart valves, especially mitral stenosis and mitral regurgitation
  • Hypertrophy (enlarged heart)

Diseases elsewhere in the body affecting the heart:

  • Hyperthyroidism
  • Pulmonary embolism (blood clot in lung)
  • Chronic obstructive pulmonary disease (COPD) and emphysema
  • Sleep apnea

Substance abuse:

  • Consuming large amounts of alcohol (binge drinking)
  • Cocaine, amphetamines, diet pills, caffeine, or cold medicines
  • Carbon monoxide intoxication

Surgery

  • First week following open heart surgery

Who is at risk?

  • Increasing age
  • Men are at more risk of developing atrial flutter than women
  • Family history of atrial flutter
  • Drinking alcohol or binge drinking
  • Atrial flutter is greatest when an underlying heart disease is associated with left atrial enlargement, left ventricular or biventricular failure
  • Heart failure patients and COPD patients
  • Other chronic conditions including thyroid disorders and sleep apnea

What are the symptoms?

Some patients may be unaware of their heart beating abnormally.

Although characteristic symptoms include:

  • Palpitations (pounding sensation in the chest)
  • Fluttering sensation in the chest
  • Shortness of breath
  • Anxiety
  • Weakness
  • Dizziness, light-headedness
  • Fainting
  • Confusion
  • Fatigue
  • Intolerance to exercise
  • Nausea
  • Nervousness
  • Swelling of the legs or abdomen

What are the complications?

The complications of atrial flutter include:

Syncope (fainting)
Heart failure
Thrombus (clot formation)
Stroke

When should I seek medical care?

If you experience symptoms of atrial flutter, call your physician.
If you have already been diagnosed and being treated for atrial flutter, seek medical help at the hospital as soon as possible if you have the following symptoms:

Severe chest pain
Feeling faint or light-headed
Have an actual episode of fainting
How is it diagnosed?
The diagnosis of atrial flutter will be based on your history, physical examination, and certain tests.

1. Patient history

Most patients will give a history of characteristic symptoms like palpitations, dizziness, fatigue, shortness of breath, etc.

2. Physical Examination

Maj. (Dr.) David Rice, a pulmonary and critical care physician at Wilford Hall Medical Center, Lackland Air Force Base, Texas, listens to a patient's heart beat during an exam Aug. 4 in the pulmonary clinic. (U.S. Air Force photo/Senior Airman Josie Kemp)

You will be examined for signs of atrial flutter including:

Rapid, irregular, fast pulse
Heart rate of 100-175 (Normal heart rate = 60-100)
Normal to low blood pressure
Varying heart sounds heard over chest

3. Tests

Certain tests can be performed to determine the cause and severity of your condition including:

Blood tests- to check potassium and thyroid hormone levels
Electrocardiogram- this is a very useful and simple test that records the electrical activity of the heart and reveals atrial flutter or atrial fibrillation. Also shows signs of heart attack, conduction abnormalities, hypertrophy, and electrolyte imbalances.

afib

 

Chest X-ray- a simple test performed in our office showing the size and shape of the heart. Also reveals the presence of fluid in the lungs.
Echocardiogram (ECHO) – a noninvasive test performed in our office to determine the size and function of the heart’s chambers and the structure and function of the heart valves.
24-Hour Holter monitor- records the electrical events of the heart during your normal daily activities. This is useful in detecting evidence of arrhythmias.
Event monitor- If symptoms of arrhythmia are infrequent and do not occur within 24 hours, an event recorder may be ordered for you for up to 30 days.
Stress test- determines how well the heart works during exercise.

How is it treated?

Atrial flutter treatment goals include restoring the heart to normal rhythm, regulating heart rate, preventing blood clot formation, and treating the underlying cause.

This is done by the use of medications and procedures.

Medications

Some medications are used to slow an irregularly fast heart beat. These decrease the heart rate by slowing the conduction of impulses through the AV node.

These drugs include:

Beta Blockers
Calcium channel blockers
Digoxin

Medications are used to reduce the frequency and duration of atrial flutter and prevent future episodes.

These include:

Amidarone
Sotalol
Propafenone
Flecainide

Medications are used to prevent the formation of blood clots.

These drugs include:

Heparin
Warfarin
Dabigatran
Aspirin
Clopidogrel

Procedures

Cardioversion- atrial flutter is sensitive to a low electrical energy direct-current (DC) or medical cardioversion (using an antiarrhythmic drug). DC cardioversion converts atrial flutter into a normal sinus rhythm with high a success rate. Cardioversion may be delayed until starting treatment with an anticoagulant. This medication is usually given for 3-4 weeks, allowing pre-existing clots to resolve. A transesophageal echocardiogram (TEE) is an alternative way of delaying cardioversion, if no blood clots are present, cardioversion may be started. A mild anesthetic is first given, pads are applied over the chest, and then the heart will be shocked into the correct rhythm.

Blausen_0169_Cardioversion
Catheter radiofrequency ablation- is a hospital procedure done to destroy areas on the heart that are causing irregular heart rhythms. A thin flexible tube is inserted into a blood vessel to access the heart. Heat is applied to the tip of the catheter to permanently destroy small areas of abnormal heart tissue. The damaged tissue is no longer capable of generating electrical impulses. A pacemaker may be placed after this procedure
Pacemaker or ICD- a small implantable device used to regulate the heart rate and rhythm. Therefore, the heart contracts in a regular way. An ICD shocks the heart out of the dangerous rhythm.

What is the prognosis?

Atrial flutter can be controlled with treatment.

With treatment, many patients do well.

How can I prevent this?

Atrial flutter can not always be prevented, but there are ways of reducing the risk of developing atrial flutter.

Leading a healthy lifestyle may reduce the chance of coronary artery disease, which can cause atrial flutter.

Some ways you can do this is by:

No smoking!
Be physically active. Engage in moderate physical activity for at least 30 minutes a day
Eat nutritious foods low in cholesterol and fats
Maintain a BMI below 25
Control high blood pressure, cholesterol, and sugar

What is it?

What is it?
Atrial fibrillation is a relatively common abnormal heart rhythm where the atria beat quickly, irregularly, and unevenly.
Atrial fibrillation always has some degree of atrial-ventricular (AV) block with a 2:1 pattern meaning the rate of the ventricles is usually 150 beats per minute while the atria beat at 300 beats per minute. In other words, every other atrial beat reaches the ventricle. AF is an atrial rate of greater than 300 bpm with an irregular transmission of electrical impulses through to the ventricles, causing a fast, irregular heart beat. this differs from atrial flutter, which causes a fast, regular heart rhythm.
This arrhythmia impairs blood flow out of the heart (cardiac output) and promotes clot (thrombus) formation.

How does atrial fibrillation occur?

In atrial fibrillation, chaotic electrical signals travel across the heart in an abnormal way. Abnormal electrical pathways produce irregular heartbeats and rhythms known as arrhythmias.

Arrhythmias occur when other areas of the heart, other than the SA node, begin sending out their own impulses and take over the pacemaker function of the SA node. The sites that take over could be from any area of the atria, AV node, or ventricles.

The rapid fibrillation of the atria does not allow the complete filling of the ventricles, that pumps blood out to the entire body. Symptoms of atrial fibrillation such as lightheadedness or dizziness may be felt.

Also, some amount of blood remains in the chamber that leads to clot formation.

 

Fibrilating-atria

What are the types?

Atrial fibrillation can occur in different patterns.

These include:

Paroxysmal (intermittent) atrial fibrillation: recurrent (2 or more) episodes, spontaneously terminates and converts back to normal sinus rhythm within a week, lasting for less than 24 hours, typically related to a reversible cause.
Persistent atrial fibrillation: occurs in episodes, does not spontaneously convert back to sinus rhythm and is unrelated to a reversible cause.
Permanent atrial fibrillation: the heart is always in atrial fibrillation and is unrelated to a reversible cause.

What are the causes?

Atrial fibrillation can be due to abnormalities or diseases of the heart, or by diseases elsewhere in the body affecting the heart. Atrial fibrillation may occur after open heart surgery or substance abuse.
Heart abnormalities and diseases include:

Congenital heart defects (heart defect from birth) 2009_Congenital_Heart_Defects
Coronary artery disease (decreased blood supply to the heart) or atherosclerosis
High blood pressure
Heart attack
Cardiomyopathy and congestive heart failure
Rheumatic fever and pericarditis (inflammation of the heart)
Abnormalities of the heart valves, especially mitral stenosis and mitral regurgitation
Hypertrophy (enlarged heart)
Sick sinus syndrome

Diseases elsewhere in the body affecting the heart:

Hyperthyroidism
Pulmonary embolism (blood clot in lung)
Chronic obstructive pulmonary disease (COPD) and emphysema
Sleep apnea

Substance abuse:

Consuming large amounts of alcohol (binge drinking)
Cocaine, amphetamines, diet pills, caffeine, or cold medicines
Tobacco
Carbon monoxide intoxication

Surgery

First week following open heart surgery

Medications

Theophylline

Who is at risk?

The following are at risk of developing atrial fibrillation:

Increasing age
Men are at more risk of developing atrial fibrillation than women
Family history of atrial fibrillation
Drinking alcohol or binge drinking
Atrial fibrillation is greatest when an underlying heart disease is associated with left atrial enlargement, left ventricular or biventricular failure
Heart failure patients and COPD patients
Other chronic conditions including thyroid disorders and sleep apnea

What are the symptoms?

Some patients may be unaware of their heart beating abnormally.

Although characteristic symptoms include:

Palpitations (pounding sensation in the chest)
Chest pain
Shortness of breath
Anxiety anxiety1
Weakness
Dizziness, light-headedness
Fainting
Confusion
Fatigue
Intolerance to exercise
Nausea
Nervousness
Swelling of the legs or abdomen

What are the complications?

The complications of atrial fibrillation include:

Syncope (fainting)
Heart failure
Thrombus (clot formation)
Stroke

When should I seek medical care?

If you experience symptoms of atrial fibrillation, call your physician.
If you have already been diagnosed and being treated for atrial fibrillation, seek medical help at the hospital as soon as possible if you have the following symptoms:

Severe chest pain
Feeling faint or light-headed
Have an actual episode of fainting

How is it diagnosed?

The diagnosis of atrial fibrillation will be based on your history, physical examination, and certain tests.

1. Patient history

Most patients will give a history of characteristic symptoms like palpitations, dizziness, fatigue, shortness of breath, etc.

2. Physical Examination

You will be examined for signs of atrial fibrillation including:

Rapid, irregular, fast pulse
Heart rate of 100-175 (Normal heart rate = 60-100)
Normal to low blood pressure
Varying heart sounds heard over chest

3. Tests

Certain tests can be performed to determine the cause and severity of your condition including:

Blood tests- to check potassium and thyroid hormone levels
Electrocardiogram- this is a very useful and simple test that records the electrical activity of the heart and reveals atrial fibrillation. Also shows signs of heart attack, conduction abnormalities, hypertrophy, and electrolyte imbalances.
BHVH_EKG_of_AF (1)

Chest X-ray- a simple test performed in our office showing the size and shape of the heart. Also reveals the presence of fluid in the lungs.
Echocardiogram (ECHO) – a noninvasive test performed in our office to determine the size and function of the heart’s chambers and the structure and function of the heart valves.
24-Hour Holter monitor- records the electrical events of the heart during your normal daily activities. This is useful in detecting evidence of arrhythmias.
Event monitor- If symptoms of arrhythmia are infrequent and do not occur within 24 hours, an event recorder may be ordered for you for up to 30 days.
Stress test- determines how well the heart works during exercise.

How is it treated?

Atrial fibrillation treatment goals include restoring the heart to normal rhythm, regulating heart rate, preventing blood clot formation, and treating the underlying cause.

This is done by the use of medications and procedures.

1. Medications

Some medications are used to slow an irregularly fast heart beat. These decrease the heart rate by slowing the conduction of impulses through the AV node.

These drugs include:

Beta Blockers
Calcium channel blockers
Digoxin

Medications are used to reduce the frequency and duration of atrial fibrillation and prevent future episodes.

These include:

Amidarone
Sotalol
Propafenone
Flecainide

Medications are used to prevent the formation of blood clots.

These drugs include:

Heparin
Warfarin
Dabigatran
Aspirin
Clopidogrel
Apixaban
Rivaroxaban
Edoxaban

Procedures

Cardioversion- atrial fibrillation is sensitive to a low electrical energy direct-current (DC) or medical cardioversion (using an antiarrhythmic drug). DC cardioversion converts atrial fibrillation into a normal sinus rhythm with a high success rate. Cardioversion may need to be delayed until starting treatment with an anticoagulant. This medication is usually given for 3-4 weeks, allowing preexisting clots to resolve. A transesophageal echocardiogram (TEE) is an alternative way of delaying cardioversion, if no blood clots are present, cardioversion may be started. A mild sedative is first given, pads are applied over the chest, and then the heart will be shocked into the correct rhythm.

Blausen_0169_Cardioversion

 

Catheter radiofrequency ablation- is a hospital procedure done to destroy areas on the heart that are causing irregular heart rhythms. A thin flexible tube is inserted into a blood vessel to access the heart. Heat is applied to the tip of the catheter to permanently destroy small areas of abnormal heart tissue. The damaged tissue is no longer capable of generating electrical impulses. A pacemaker may be placed after this procedure.

Pacemaker or Implantable Cardiac Defibrillator (ICD) – a small implantable device used to regulate the heart rate and rhythm. Therefore, the heart contracts in a regular way. An ICD shocks the heart out of the dangerous rhythm.

What is the prognosis?

Atrial fibrillation can be controlled with treatment.

With treatment, many patients do well.
However, atrial fibrillation tends to return and get worse. It may come back even with treatment.

How can I prevent this?

Atrial fibrillation can not always be prevented, but there are ways of reducing the risk of developing atrial fibrillation.

Leading a healthy lifestyle may reduce the chance of coronary artery disease, which can cause atrial fibrillation.

Some ways you can do this is by:

No smoking!
Be physically active. Engage in moderate physical activity for at least 30 minutes a day
Eat nutritious foods low in cholesterol and fats
Maintain a BMI below 25
Control high blood pressure, cholesterol, and sugar

What is it?

Ventricular tachycardia is an abnormal heart rhythm where the ventricles beat quickly, but evenly. This is similar to ventricular fibrillation, but the ventricles beat quickly and unevenly. The term tachycardia refers to a fast heart rate.

Ventricular tachycardia may develop as a complication of a heart attack because scar tissue can form in the ventricle muscle within days, months, and or years after a heart attack. Additionally, it can occur in patients with cardiomyopathy, heart failure, heart surgery, myocarditis, and valvular heart disease.

In ventricular tachycardia abnormal electrical signals originate in the ventricles, instead of the normal pathway from the atria down to the ventricles. If left untreated, ventricular tachycardia may lead to a dangerous and life-threatening ventricular fibrillation.

Both of these arrhythmias impair blood flow out of the heart (cardiac output) and are both medical emergencies.

How does ventricular tachycardia occur?

Sometimes the electrical impulses ‘short circuit’ and travel across the heart in an abnormal way. Abnormal electrical pathways produce irregular heartbeats and rhythms known as arrhythmias. Arrhythmias occur when other areas of the heart, other than the SA node, begin sending out their own impulses and take over the pacemaker function of the SA node. The sites that take over could be from any area of the atria, AV node, or ventricles, in this case the ventricles.

The rapid rate does not allow the complete filling of the ventricles to pump blood out to the entire body. Symptoms of ventricular tachycardia such as lightheadedness or dizziness may be felt.

How is it classified?

Ventricular tachycardia can be classified in several ways.

Based on the morphology: (shape of the beats on EKG)

Monomorphic ventricular tachycardia: all the beats appear to match each other on an electrocardiogram (EKG). i.e. right ventricular outflow tract (RVOT)

Polymorphic ventricular tachycardia: beat to beat variability seen on an EKG. i.e. torsades de pointes (“twisting of the points”)

By the duration of the episode:

Non-sustained ventricular tachycardia- a fast heart rhythm which terminates within 30 seconds
Sustained ventricular tachycardia- a fast heart rhythm that lasts for more than 30 seconds

On the basis of symptoms:

Pulseless ventricular tachycardia- no effective cardiac output and no effective pulse, causing cardiac arrest. Pulseless VT requires defibrillation.

Idiopathic ventricular tachycardia- occurs in younger individuals; cause of ventricular tachycardia is unknown, but presumed to be due to congenital causes

What are the causes?

Ventricular tachycardia can be due to abnormalities or diseases of the heart, or by diseases elsewhere in the body affecting the heart. Ventricular tachycardia may occur after open heart surgery, substance abuse, or medications.

Heart abnormalities and diseases include:

  • Congenital heart defects (heart defect from birth)
  • Coronary artery disease (decreased blood supply to the heart) or atherosclerosis
  • High blood pressure
  • Heart attack
  • Cardiomyopathy and congestive heart failure
  • Rheumatic fever and pericarditis (inflammation of the heart)
  • Abnormalities of the heart valves, especially mitral stenosis and mitral regurgitation
  • Hypertrophy (enlarged heart)

Diseases elsewhere in the body affecting the heart:

  • Hyperthyroidism
  • Pulmonary embolism (blood clot in lung)
  • Chronic obstructive pulmonary disease (COPD) and emphysema
  • Sleep apnea
  • Electrolyte imbalances (low potassium/ magnesium levels)

Substance abuse:

  • Consuming large amounts of alcohol (binge drinking)
  • Cocaine, amphetamines, diet pills, caffeine, or cold medicines
  • Tobacco
  • Carbon monoxide intoxication

Surgery

First week following open heart surgery

Medications

  • Amiodarone
  • Sotalol

Who is at risk?

The following are at risk of developing ventricular tachycardia:

  • Increasing age
  • Family history of ventricular tachycardia
  • Drinking alcohol or binge drinking
  • Use of recreational drugs
  • Electrolyte imbalances
  • Heavy caffeine use
  • Heart failure patients and COPD patients
  • Pericarditis (inflammation of the heart) and autoimmune diseases
  • Other chronic conditions including thyroid disorders and sleep apnea

What are the symptoms?

Symptoms of ventricular tachycardia occur because the heart rate is beating so fast, blood pressure falls; therefore the heart can not pump enough oxygen rich blood to the body causing symptoms. Some patients may be unaware of their heart beating abnormally. Although characteristic symptoms include:

  • Dizziness
  • Shortness of breath
  • Lightheadedness
  • Sensation of neck fullness
  • Rapid pulse rate
  • Palpitations
  • Chest pain (angina)
  • Fainting (syncope)
  • Confusion
  • Fatigue
  • Intolerance to exercise
  • Nausea
  • Nervousness
  • Swelling of the legs or abdomen

What are the complications?

The complications of ventricular tachycardia include:

  • Syncope (fainting)
  • Heart failure
  • Thrombus (clot formation)
  • Stroke
  • Sudden cardiac arrest
  • Death

When should I seek medical care?
If you experience symptoms of ventricular tachycardia, call your physician.
If you faint, have difficulty in breathing, or have chest pain lasting more than a few minutes, call emergency care or call 911. These are urgent symptoms of a potentially fatal ventricular tachycardia and must seek emergency care immediately to avoid the risk of cardiac arrest and death.

How is it diagnosed?
The diagnosis of ventricular tachycardia will be based on your history, physical examination, and certain tests.

1. Patient history

Most patients will give a history of characteristic symptoms like palpitations, dizziness, fatigue, shortness of breath, etc.

2. Physical Examination

You will be examined for signs of ventricular tachycardia including:

Weak or no pulse
Low blood pressure
Rapid breathing
Varying heart sounds heard over chest

3. Tests

Certain tests can be performed to determine the cause and severity of your condition including:

  • Blood tests- to check potassium, magnesium, and thyroid hormone levels
  • Electrocardiogram- this is a very useful and simple test that records the electrical activity of the heart and reveals ventricular tachycardia. Also shows signs of heart attack, conduction abnormalities, hypertrophy, and electrolyte imbalances.
  • Chest X-ray- a simple test performed in our office showing the size and shape of the heart may also reveal the presence of fluid in the lungs.
  • Echocardiogram (ECHO) – a noninvasive test performed in our office to determine the size and function of the heart’s chambers and the structure and function of the heart valves.
  • 24-Hour Holter monitor- records the electrical events of the heart during your normal daily activities. This is useful in detecting evidence of arrhythmias.
  • Event monitor- If symptoms of arrhythmia are infrequent and do not occur within 24 hours, an event recorder may be ordered for you for up to 30 days.
  • Stress test- determines how well the heart works during exercise.

How is it treated?

The treatment goals for tachycardias are to slow a fast heart rate when it occurs, prevent future episodes, minimize complications, and treat the underlying cause.

1. Stop a fast heart rate:

A fast heart rate may terminate spontaneously, or you may be able to slow your heart rate using simple physical methods.

Medications and procedures may be required in addition to these methods.

  • Vagal maneuvers: this maneuver can be done during an episode of a fast heart beat. This includes coughing or bearing down as if having a bowel movement.
  • Medications: anti-arrhythmic medication can be used to restore a normal heart rate. These medications include flecainide or propafenone.
  • Cardioversion: if a pulse is present, a shock is delivered to your heart through pads attached to the chest wall. The current interrupts the electrical impulses in the heart and restores a normal rhythm.

2. Preventing episodes of tachycardia:

  • Catheter ablation: is a hospital procedure done to destroy areas on the heart that are causing irregular heart rhythms. A thin flexible tube is inserted into a blood vessel to access the heart. Heat is applied to the tip of the catheter to permanently destroy small areas of abnormal heart tissue. The damaged tissue is no longer capable of generating electrical impulses. A pacemaker may be placed after this procedure
  • Medications: anti-arrhythmic medications may prevent tachycardia, when taken regularly. These medications include: calcium channel blockers such as diltiazem and verapamil or beta blockers such as metoprolol and esmolol or anti-arrhythmic such as lidocaine and amidarone.
  • Pacemaker or ICD- a small implantable device used to regulate the heart rate and rhythm. Therefore, the heart contracts in a regular way. An ICD shocks the heart out of the dangerous rhythm.

3. Treating the underlying disease:

Treatment of an underlying condition attributing to tachycardia such as some form of heart disease or hyperthyroidism may prevent or minimize tachycardic episodes.

How can I prevent this?
Ventricular tachycardia can not always be prevented, but there are ways of reducing the risk of developing ventricular tachycardia.

Leading a healthy lifestyle may reduce the chance of coronary artery disease, which can cause ventricular tachycardia.

Some ways you can do this is by:

  • No smoking!
  • Drink in moderation
  • Limit caffeine
  • Avoid recreational drugs
  • Be physically active. Engage in moderate physical activity for at least 30 minutes a day
  • Eat nutritious foods low in cholesterol and fats
  • Maintain a BMI below 25
  • Control high blood pressure, cholesterol, and sugar
  • Control stress
  • Have regular physical exams and report any signs or symptoms to your physician

What is it?

Ventricular fibrillation is an abnormal heart rhythm that occurs when the heart beats so rapidly and irregularly that the heart muscle quivers and does not beat at all.

In ventricular fibrillation, the ventricles produce many abnormal circuits, instead of following the normal electrical pathway from the atria down to the ventricles. This usually occurs due to damaged heart muscle.

The ventricles beat very quickly and irregularly, so blood is not pumped out of the heart to vital organs of the body. If the heart is not able to pump at all (cardiac arrest), death may occur if emergency treatment is not given to return the heart rhythm to normal.

How does ventricular fibrillation occur?

In ventricular fibrillation electrical impulses can become chaotic after the heart muscle has been damaged. Damage usually occurs after a first heart attack or due to problems from a scar in the heart muscle from a previous heart attack. Electrical activity is not passed through these scarred areas. The ventricles begin sending out their own rapid and chaotic impulses and take over the pacemaker function of the SA node.

Ventricular fibrillation may also develop if ventricular tachycardia is left untreated.

Rapid, chaotic electrical impulses cause the ventricles to quiver instead of pumping the blood out of the heart. This causes low blood pressure and no blood supply to the vital organs of the body including the brain. Most people lose consciousness within seconds and require immediate cardiopulmonary resuscitation (CPR).

The survival rate in ventricular fibrillation is better if CRP is initiated immediately until the heart can be shocked back into rhythm with the use of a defibrillator. If these measures are not taken immediately, death can occur within minutes.

What are the causes?

In ventricular fibrillation electrical impulses can become chaotic after the heart muscle has been damaged. Damage usually occurs after a first heart attack or due to problems from a scar in the heart muscle from a previous heart attack. Electrical activity is not passed through these scarred areas. The ventricles begin sending out their own rapid and chaotic impulses and take over the pacemaker function of the SA node.

Ventricular fibrillation may also develop if ventricular tachycardia is left untreated.

Rapid, chaotic electrical impulses cause the ventricles to quiver instead of pumping the blood out of the heart. This causes low blood pressure and no blood supply to the vital organs of the body including the brain. Most people lose consciousness within seconds and require immediate cardiopulmonary resuscitation (CPR).

The survival rate in ventricular fibrillation is better if CPR is initiated immediately until the heart can be shocked back into rhythm with the use of a defibrillator. If these measures are not taken immediately, death can occur within minutes.

What are the causes?

Ventricular fibrillation is usually caused after damage to the heart muscle from a previous heart attack.
Ventricular fibrillation can occur whenever the heart does not receive enough oxygen or due to abnormalities or diseases of the heart, or by diseases elsewhere in the body affecting the heart. Ventricular tachycardia may occur after open heart surgery, substance abuse, or medications.

Heart abnormalities and diseases include:

  • Congenital heart defects (heart defect from birth)
  • Coronary artery disease (decreased blood supply to the heart) or atherosclerosis
  • High blood pressure
  • Heart attack
  • Cardiomyopathy and congestive heart failure
  • Rheumatic fever and pericarditis (inflammation of the heart)
  • Abnormalities of the heart valves, especially mitral stenosis and mitral regurgitation
  • Hypertrophy (enlarged heart)

Diseases elsewhere in the body affecting the heart:

  • Hyperthyroidism
  • Pulmonary embolism (blood clot in lung)
  • Chronic obstructive pulmonary disease (COPD) and emphysema
  • Sleep apnea
  • Electrolyte imbalances (low potassium/ magnesium levels)

Substance abuse:

  • Consuming large amounts of alcohol (binge drinking)
  • Cocaine, amphetamines, diet pills, caffeine, or cold medicines
  • Tobacco
  • Carbon monoxide intoxication

Surgery

First week following open heart surgery

Medications

Amiodarone
Sotalol

Who is at risk?

Several factors may increase the risk of ventricular fibrillation.

These include:

Men
Increasing age
Congenital heart disease
Family history of ventricular tachycardia or ventricular fibrillation
Previous episode of ventricular fibrillation
Previous heart attack
Hypertension
Excessive alcohol consumption
Electrolyte imbalance
Heavy caffeine use
Smoking
Substance abuse i.e. cocaine
Heart failure patients and COPD patients
Pericarditis (inflammation of the heart) and autoimmune diseases
Other chronic conditions including thyroid disorders and sleep apnea

What are the symptoms?

An episode of ventricular fibrillation presents with unconsciousness or sudden collapse. This is due to a lack of oxygen rich blood to the brain and other vital organs.
The following symptoms may occur within 1 hour before the collapse:

Chest pain
Dizziness
Nausea
Rapid heartbeat (tachycardia)
Shortness of breath

When should I seek medical care?

If you experience symptoms of ventricular fibrillation, seek emergency care immediately.
If you faint, have difficulty in breathing, or have chest pain lasting more than a few minutes, call emergency care or call 911. These are urgent symptoms of a life-threatening ventricular fibrillation and must seek emergency care immediately to avoid the risk of cardiac arrest and death.
Steps to follow:

Call 9-1-1
Cardiopulmonary resuscitation must be initiated immediately from someone trained in CPR. This can be given by a family member or medical personnel. Chest compressions (30) must be started immediately followed by rescue breaths (2). This cycle is to be repeated until a shock or defibrillator can be given.

What are the complications?

The most common complication of ventricular fibrillation is sudden death. This occurs within 1 hour of symptoms.
Complications in those who survive include:

Neurological damage
Reduced mental perception
Coma

How is it diagnosed?

Ventricular fibrillation is a medical emergency and is not typically diagnosed before hand unless an episode of collapse occurs within the doctor’s office.
Your physician will know if you are in ventricular fibrillation based on history, physical examination, and tests.

1. History

The patient will give history of sudden loss of consciousness or collapse.
History of warning symptoms of fibrillation may be given such as chest pain, dizziness, nausea, fast heart rate, or difficulty in breathing.

2. Physical Examination

After collapse:

Unconscious patient

Before collapse:

Weak or no pulse
Low blood pressure
Rapid breathing
Varying heart sounds heard over chest

3. Tests

Certain tests can be performed to determine the cause and severity of your condition including:

Blood tests- to check potassium, magnesium, and thyroid hormone levels and certain cardiac enzymes
Electrocardiogram- this is a very useful and simple test that records the electrical activity of the heart and reveals ventricular fibrillation. Also shows signs of heart attack, conduction abnormalities, hypertrophy, and electrolyte imbalances.
vfib

Chest X-ray- a simple test performed in our office showing the size and shape of the heart. Also reveals the presence of fluid in the lungs.
Echocardiogram (ECHO) – a noninvasive test performed in our office to determine the size and function of the heart’s chambers and the structure and function of the heart valves.

How is it treated?

Ventricular fibrillation is a medical emergency and must be treated immediately.

The goal of treatment is to restore blood flow as quickly as possible to prevent damage to vital organs.

Once blood flow is restored, treatment is given to prevent future episodes.

Cardiopulmonary Resuscitation (CPR) – this mechanically helps to restore blood flow to vital organs by mimicking the pumping action of the heart.
– Call for emergency help immediately.

– CPR can be performed by anyone trained in CPR including a family member until medical personnel arrives.

– As per new regulations, chest compressions must be initiated first rather than giving rescue breaths. Count 30 chest compressions that must be given hard and fast (at a rate of 100 beats per minute) over the chest. Allow the chest to rise completely between compressions.

After 30 chest compressions are given, mouth-to-mouth breathing must be given with 2 rescue breaths with the person’s neck in an extended position to allow airflow through the airways.

Repeat chest compressions and rescue breaths until help arrives.

Defibrillation- this is a device used to deliver a quick electric shock through the chest wall. This is given to ‘shock’ the heart out of the chaotic rhythm and usually allows the heart to resume a normal heart rhythm.
A shock may be given by medical personnel or may be given through a public-use defibrillator. A public defibrillator can be located in public places including airports, schools, malls, and community centers. A public defibrillator is called an Automated External Defibrillator (AED).

Once a person collapses and CPR is initiated, an AED must be retrieved. Turn the device on by pushing the power button. In the AED kit, two pads will be provided that must be matched up accordingly to the areas over the chest to the pictures given on the pads. The device will detect if the heart is to be shocked or not. If the heart requires a shock, stand clear and press the “Shock” button. CPR must be resumed until help arrives or until the person begins to move.

It is important to take a CPR class especially in those with family members who are at risk.

Cardioversion: if pulse is present, in a hospital setting a shock is delivered to your heart through pads attached to the chest wall. The current interrupts the electrical impulses in the heart and restores a normal rhythm.
Blausen_0169_Cardioversion

Treatment to prevent future episodes
If structural damage has occurred in the heart after ventricular fibrillation episode, medications or a medical procedure may be recommended to reduce the risk of a future episode.

1. Medications

Various anti-arrhythmic drugs may be used in the long term treatment of ventricular fibrillation.

Different classes of medications may be used including beta blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, and anti-arrhythmics (amiodarone).

Since there is a stagnation of blood in the heart during fibrillation, blood clots commonly develop in the heart. Medications are used to prevent the formation of blood clots.

These drugs include:

Heparin
Warfarin
Dabigatran
Aspirin
Clopidogrel

2. Implantable cardioverter-defibrillator (ICD)

After fibrillation has been stabilized, an ICD implantation may be recommended.

This is a small implantable device used to detect abnormal heart rhythms and shock the heart out of the dangerous rhythm.

3. Catheter ablation:

is a hospital procedure done to destroy areas on the heart that are causing irregular heart rhythms.

A thin flexible tube is inserted into a blood vessel to access the heart. Heat is applied to the tip of the catheter to permanently destroy small areas of abnormal heart tissue.

The damaged tissue is no longer capable of generating electrical impulses.

What is the prognosis?

With early detection and effective CPR given before a defibrillator is given, up to 25% of victims are able to leave the hospital without neurological damage.
If ventricular fibrillation occurs within the hospital with a heart attack, defibrillation has a 95% success rate.
If shock and heart failure occur, even with defibrillation only 30% of those shocked will return to a normal heart rate.
The survival rate for a person who has an attack of ventricular fibrillation outside the hospital ranges between 2-25%.

How can I prevent this?

Ventricular fibrillation can not always be prevented, but there are ways of reducing the risk of developing ventricular fibrillation. Leading a healthy lifestyle may reduce the chance of coronary artery disease, which can cause ventricular tachycardia and fibrillation.
Some ways you can reduce the risk is by:

No smoking!
Drink in moderation
Limit caffeine
Avoid recreational drugs
Be physically active. Engage in moderate physical activity for at least 30 minutes a day
Eat nutritious foods low in cholesterol and fats
Maintain a BMI below 25
Control high blood pressure, cholesterol, and sugar
Control stress
Have regular physical exams and report any signs or symptoms to your physician.
Take a CPR course if a family member or friend is at risk of ventricular fibrillation.