Cardiac Treatment in Sarjapur Road

Cardiac rhythm disorders, often known as heart rhythm disorders or arrhythmias, are irregular or unnatural heartbeats. These disorders interfere with the electrical signals your heart receives and may result in your heart beating too quickly, too slow, or irregularly.

Why does an abnormal rhythm activity happen

Electrical activity of the heart is generated in the ‘Upper power’ house of the heart called sinus node located in the upper part of the Right atrial chamber (minor chamber of the heart). The current then flows down through three functional channels (spreading to the entire two minor chambers) to the lower ‘power house’ called AV node located at the junction of the minor and major chambers of the heart. From here it spreads in an organized fashion to the entire lower major 2 chambers. Any abnormality in this flow pattern or abnormal sparks leads to abnormal rhythm

Arrhythmia can be classified as supraventricular (minor chambers) and ventricular (major chambers) depending on the origin of the problem in a broad sense although many a times, both the major and minor chambers are involved

Supraventricular arrhythmia

• Tachycardia is a fast heartbeat (more than 100 beats per min). It can be physiological (sinus tachycardia) i.e normally seen in anxiety, stress both physical and mental, when having fever and such other situations or due to an abnormal rhythm
• Bradycardia A slow heart rate (fewer than 60 beats per min). Again this can be normally seen in very athletic individuals. When it is caused due to abnormal rhythm (conduction system block) and the person has giddiness or loss of consciousness then he needs to be treated with pacemaker implantation.
• Supraventricular arrhythmias: It is caused by abnormal sparks in the minor chambers or by abnormal bypass circuit tracts which leads to abnormal fast activation of the heart. Medications are first tried and if willing for a more permanent cure, the abnormal pathways and sparks can be ablated by electrophysiological procedure. The specialists are called electrophysiologists who are cardiologists who specialize in treating rhythm disorders.
• Atrial fibrillation (AF) is a chaotic fast electrical activity of the upper chambers of the heart which can lead to palpitation, dizziness,anxiety, heart failure, pulmonary edema (wet lung) and the most dreaded stroke leading to paralysis. AF is more common in the elderly and managed with rate reducing drugs and blood thinners which comes with their inherent side effects let alone increased admissions when the heart weakens or there is a wet lung. But today there is a more permanent solution called *AF ablation* which converts the chaotic signals to a normal rhythm thus eliminating the need for drugs.
• Ventricular arrhythmias originate in the lower chambers (ventricles) of the heart and have to be taken seriously and treated early.
• Ventricular Ectopics – These are abnormal sparks induced heart beats but a small percentage of such beats are normally seen in people and are harmless. When they constitute more than 10% of the normal beats, they can cause palpitations or weaken the heart’s pumping function in which case they have to be subdued with beta-blocker medications or removed by electrophysiological ablation. Ofcourse your cardiologist will try to identify if there are any external instigating factors whose withdrawal will promptly abolish them
• Ventricluar tachycardia /Ventricular fibrillation – These abnormally fast arrhythmias can be life threatening as it results in ineffective heart contractions leading to sudden drop in blood flow to the body /brain causing cardiac arrest. Needs shocking the heart and CPR and aggressive treatment to save the individual

How can your rhythm be monitored and proper diagnosis made?

• Holter monitoring – here the sticker leads are connected to the torso and the device is strapped on to the waist. The heart rhythm is monitored continuously for 24 hours. Recently they can be modified to observe for as many days as needed and with live tracking of the readings.
• Loop recorders- Sometimes the arrhythmias are too few and unpredictable but the abnormal suspected rhythm is life threatening then it becomes incumbent to pick up the episode when it occurs. In such a situation a small device is inserted into the skin on the front left side of chest and kept there for a couple of years. The device can be interrogated periodically for any abnormal rhythm. Such an investigation is important because if dangerous Ventricular arrhythmias are picked up then the patient can be offered life saving implantable defibrillator devices
• Wearable devices like smart watches, health trackers and the like can be used to pick up abnormal rhythms.
  Sometimes a simple device to count your pulse can help pick up an abnormal rhythm like a pulse oxymeter. For example if suddenly a person at rest notices the heart rate to be around 150 then for sure he is having an arrhythmia and should immediately go and get an ECG at the nearest medical center or record the ECG with the smart devices if possible

What complaints will I have if I have an abnormal rhythm?

• FATIGUE
• DIZZINESS
• LIGHTHEADEDNESS
• SWEATING
• FAINTING
• SHORTNESS OF BREATH
• CHEST PAIN
• SYMPTOMS OF HEART FAILURE LIKE SWELLING OF FEET, WET LUNGS (IF THE ARRHYTHMIA IS LONG STANDING

What can precipitate an arrhythmia?

Environmental causes may be a result of:

• Smoking
• Alcohol abuse (AF ‘holiday heart syndrome’)
• Certain substance abuse (such as amphetamines or cocaine)
• The misuse of prescription or over-the-counter medications
• A high intake of nicotine or caffeine can cause arrhythmias
• Aging by itself puts one at a higher risk for Atrial fibrillation (AF)
• Any condition affecting the heart structurally or structure surrounding the heart and in contact with it

Other medical conditions that may cause arrhythmias in specific individuals include:

• Heart attack
• Coronary heart disease
• Heart failure
• The thyroid gland is either overactive or underactive (too much or not enough thyroid hormone is produced)
• Rheumatic heart disease

Your physician will help you determine the best treatment method in light of your medical condition and the results of your tests.

Medication

In the beginning, your physician may seek to treat your cardiac rhythm issue with medication that will aid in restoring your heartbeat to normal. In some instances, that medication regimen may also contain blood thinners to prevent blood clots from forming within the heart. It is essential to take these medications according to the directions to minimize the possibility of having adverse side effects.

Cardioversion Procedure

It is also possible that your physician may attempt to "shock" your heart out of its abnormal rhythm.

Pacemaker or Ablation

If your medication or cardioversion cannot keep your heart beating normally, your doctor might recommend the use of an ablation procedure, a pacemaker, or a combination of treatments. Ablation occurs when electrophysiologists attempt to block or reduce the abnormal electrical signals and allow your heart to function through normal channels. This procedure could take a few hours and it's done via blood vessels located in the groin and or neck, using specific devices and instruments and doesn't require surgery.

Surgical intervention may be suggested if these non-invasive techniques aren't working or your medical professionals think that your heart might not respond to these methods. The doctor may recommend you to an expert in cardiothoracic surgery, who will review all options for surgery together with you.

Maze Procedure

Surgical treatment for atrial fibrillation is known as the Maze Procedure. It is similar to ablation. However, it employs various methods to break down the abnormal electrical pathways. One method is to make incisions inside the atrium to prevent chaotic electrical flow.

In patients suffering from atrial fibrillation and other heart diseases, the Maze procedure is often done in conjunction with various open heart surgery procedures, including mitral valve replacement or repair.

AICD implantation- This device gives a shock to the heart to terminate the life threatening arrhythmia. It is implanted under the skin just below the the collar bone and the leads are placed inside the chamber of the heart to pick up the abnormal rhythm and give the shock when needed. AICD is needed in patients who have a high probability of having such arrhythmia in the future. However after AICD implantation, efforts will also be made to optimize medications so that the arrhythmia episode does not happen and to take out the area of abnormal rhythm origin by electrophysiological ablation

Living a healthy and balanced lifestyle can reduce your heart rhythm disorder risks. This could include:

• A heart-healthy diet
• Staying active and a fit
• Lowering blood pressure
• Controlling and lowering your cholesterol levels
• Beating any extra weight
• Quitting smoking

Frequently Asked Questions