Your heart rate dropping without reason, or increasing occasionally causing fatigue and palpitation are not symptoms that can be ignored. You could have a condition called cardiac arrhythmia where your heart could beat either too fast or too slow.
Dr Shashidhar, electrophysiologist and cardiologist at Fortis Hospitals, says that the two types of arrhythmia could arise due to various reasons including sudden disruption of the electrical activity in the heart and if ignored, could lead to a cardiac arrest. “When heart rate increases beyond the normal range of 60 to 100 beats per minute, it is tachycardia and if it falls too low (below 60) it is bradycardia,” explains Dr Shashidhar.
“A fall or rise in heart rate without reason, when the heartbeat goes ‘out of rhythm’ is called arrhythmia. It is important to note the symptoms people may present. In case of bradycardia, the person feels dizzy, fatigued, and may even lose consciousness and fall. In case of tachycardia, they experience palpitation, low blood pressure, and lose consciousness,” he says.
Dr Deepak Krishnamurthy, Consultant - Interventional Cardiology, Department of Cardiac Sciences, Sakra World Hospital says that when arrhythmia does not present clear symptoms, it is usually ignored by patients which can be dangerous. “All arrhythmias should be evaluated in detail by a physician or cardiologist. People who have suffered heart attacks and those who have undergone angioplasty or bypass surgeries should be carefully examined from an arrhythmia perspective,” he urges.
Arrhythmia as tachycardia should not be confused with a simple increase in heart rate, Dr Krishnamurthy says. When people exercise, their heart rate increases and when they stop, it is restored.
The regularity in heart rate is maintained even at higher rates. But in case of arrhythmia, the heart rate becomes very high (120 to 150 per minute) and there is no correlation between exercise intensity and that rate and the heart rate does not come back to normal when the person stops exercising. “It can happen during recovery or rest also,” he says.
Doctors say that Cardio Pulmonary Resuscitation or CPR is a basic skill that people should learn to administer and is something that can save lives if done properly. When arrhythmia takes life-threatening forms, it leads to cardiac arrest. People should learn CPR according to guidelines, says Dr Shashidhar.
“Confirm if the person is not breathing and if there is no pulse, call for ambulance and start compressing the person’s chest. Keep your thumb on lower one third portion of the breast bone and the other hand over the patient’s other arm and press 100 times a minute. Push the breast bone 1 to 1.5 inches down, and in between, give mouth to mouth respiration and also check pulse,” he says. In case a person experiences an abnormal awareness of his or her own heartbeat, and any of the mentioned symptoms, it is best to get an ECG or Echo test done, he adds.
Arrhythmia can be benign or dangerous. “People are genetically predisposed to arrhythmia and those with a family history of heart problems are usually at risk,” says Dr Shashidhar.
Dr Krishnamurthy says that arrhythmia can also be caused by a brain stroke resulting in paralysis. “In case of Atrial Fibrillation (AF), a blood clot forms inside the heart and blocks the brain blood supply. As a bystander, if you notice someone with symptoms of palpitation or loss of consciousness, check the person’s wrist for pulse rate. You should see if it is fast or slow, regular or irregular and contact medical care immediately. Doing this is very helpful as doctors can easily diagnose the problem,” he says. “The abnormalities in the pulse rate are very transient and may not exist a few seconds or minutes later so medical intervention should be immediate.”
Causes of arrhythmia
The heart’s complex electrical system has a normal pacemaker, connecting nodes between its chambers, specialised muscle bundles and several types of ionic channels of sodium, potassium and calcium. “Arrhythmia can affect people of any age. While degenerative changes and ischemia usually affect those aged over 60 years, birth defects and genetic causes affect younger age groups including very young children,” Dr Krishnamurthy says.
It can be caused by:
■ Birth defects in any of these structures in the heart which control electrical activity.
■ Genetic defects in ion channels.
■ Ischemia or lack of blood supply, metabolic and electrolyte disturbance due to any cause like low or high potassium or magnesium.
■ Degenerative changes in the heart due to age, electric shock, diabetes, high blood pressure, thyroid disease, some heart valve diseases, cardiomyopathy (dilated or hypertrophic) where there is disease of heart muscle, certain medications or toxins and excessive alcohol consumption.
Treatment options for arrhythmia
Dr Krishnamurthy says that the underlying cause for the arrhythmia should first be found and investigated before proceeding with any form of treatment.“Using angioplasty or bypass surgery, blocks can be relieved or valve replacement should be done,” he says. Non-interventional methods are also available to reduce or completely eliminate arrhythmia. These are electrophysiological studies and radiofrequency ablation to treat tachycardia or a pacemaker implantation to correct a bradycardia.
“Another option is to implant an Implantable Cardioverter Defibrillator (ICD), a special pacemaker which internally monitors the rhythm and brings the heart back to normal in case of dangerous arrhythmia. When a patient has atrial fibrillation, a blood thinner is recommended to prevent a brain stroke,” says Dr Krishnamurthy.
Symptoms one should look out for
■ Palpitations
■ Restlessness
■ Chest discomfort and breathlessness
■ Fatigue
■ Light headedness
■ Giddiness
■ In extreme cases there can be loss of consciousness (syncope) or even sudden cardiac arrest and death
what you can do
■ Maintain a healthy lifestyle.
■ Keep diabetes, high blood pressure and cholesterol under control
■ Do not smoke
■ Maintain healthy body weight
■ Manage stress
■ If you have been diagnosed with arrhythmia, follow up with your cardiologist and take medication regularly
■ Avoid heavy physical exertion if you have a severe heart valve disease or cardiomyopathy