Cardiac Arrhythmias: Causes, Symptoms & Treatment

Suddenly, there’s a pounding in the chest; the heartbeat stops momentarily. Such short-term changes in the heart rhythm are usually harmless – but sometimes they are also a harbinger of heart disease. Regular heart rhythm disturbances, called arrhythmias, can have different causes. What are they, and how is a cardiac arrhythmia diagnosed and treated? Are there also home remedies and exercises that help in the short term? Read that here!

How does a heartbeat without cardiac arrhythmia?

A healthy heart muscle contracts about 60 to 70 times a minute, only to relax again shortly afterwards and thus pump the blood through the circulatory system.

A collection of cells in the wall of the heart’s right atrium, the sinus node, ensures that this rhythm of life is maintained. This small network of tendons regularly sends out electrical impulses that set the pace for the heart. The human heart, therefore, has specialized cells that are used, on the one hand, to generate electrical impulses and, on the other hand, to spread these impulses over the entire cardiac musculature.

From the sinus node, the electrical impulses reach the AV node (atrioventricular node). This lies between the right atrium of the heart and the right ventricle. The impulses are then transmitted to the heart muscle via specific heart muscle cells (Purkinje fibres). The heart contracts, and oxygen-rich blood is pumped throughout the body. The heart muscle then relaxes again, and oxygen-poor blood flows into the heart.

The body needs certain minerals, the so-called electrolytes, to form and pass on electrical impulses. These include, for example, potassium and magnesium.

 

What happens in an arrhythmia?

An arrhythmia occurs when the sinus node fails to produce an electrical impulse, the impulse conduction is not smooth, or there are too many electrical impulses.

If the sinus node fails, there is no radio silence, but the AV node jumps in. However, if this is the case, the heart will only beat about 30 to 50 times per minute. If this emergency supply also fails, the His fibre bundle, which also consists of special heart muscle cells, can take over the role of the clock generator, albeit with a significantly reduced heart rate of only 20 to 30 beats per minute. That needs to be more in the long run. Doctors then speak of dangerous bradycardia. The circulatory system comes to a standstill, and the person can even lose consciousness.

Even if the heartbeat continues to be too fast during resting phases, in technical terms, tachycardia, something is wrong with the heart. As a rule, this is then due to a faulty impulse transmission.

Individual extra beats of the heart or delayed heartbeats are referred to as cardiac stumbling.

Atrial flutter and fibrillation are common forms of cardiac arrhythmia.

Cardiac arrhythmias that originate in the atrium are relatively harmless. In contrast, cardiac arrhythmias that arise in the ventricles can sometimes be life-threatening, especially in the case of advanced organic heart disease.

The uncoordinated and rapid twitching of the heart atria is the most common form of cardiac arrhythmia. Additional impulses beyond those of the sinus node cause these twitches, meaning that the atria no longer contract completely and less blood is pumped into the ventricles. Older people and people with heart failure are particularly affected by such atrial fibrillation or flutter. In atrial flutter, the frequency of the atrial twitches is lower than in atrial fibrillation, and flutter can transform into fibrillation.

If left untreated, both forms can worsen existing cardiac insufficiencies.

 

Cardiac arrhythmias: causes

There are various diseases in which cardiac arrhythmia can occur as a symptom. A distinction is made between diseases of the heart, i.e. cardiac diseases, and extracardiac diseases, i.e. diseases that lie outside the heart.

cardiac causes

Cardiac arrhythmia can be an expression of an organic disease of the heart muscle or isolated damage to the stimulus formation and stimulus conduction structures of the heart. If the cause lies in a disease of the heart chamber (ventricle), this is a ventricular cardiac arrhythmia. Supraventricular cardiac arrhythmia is present if AV nodes or the atria are affected by a functional disorder.

Possible heart diseases that can trigger an arrhythmia include:

• Coronary Heart Disease (KHK)
• Cardiomyopathy (diseases of the heart muscles)
• Myocarditis (inflammation of the heart muscle)
• Diseases of the heart valves (heart valve defects)

Sometimes, the organic or functional basis for cardiac arrhythmia can be present at a person’s birth. Cardiac arrhythmias can occur in early childhood or later in life.

Extracardiac causes

So-called extracardiac causes more frequently lead to cardiac arrhythmias. These can also be diseases that, if left untreated, damage the heart over the long term (e.g. high blood pressure ).

Other extracardiac diseases can trigger arrhythmias. These include, among others:

• Potassium deficiency or other electrolyte imbalances
• hyperthyroidism
• pulmonary embolism
• Side effects of medication (for example, antidepressants, diuretics, or beta-blockers)
• Corona infection
• too low blood pressure

Since the heart function is also determined to a large extent by influences from the vegetative nervous system, psychological factors such as chronic stress can also play an essential role in the development of cardiac arrhythmias.

But Not every stumble and irregular heartbeat is caused by a disease. Stress and physical exertion, as well as caffeine and alcohol, can temporarily disrupt the “power supply” in the heart. The consequences are usually tachycardia and extra beats, called extrasystoles in technical jargon.

 

Recognize cardiac arrhythmias: possible symptoms.

There are often no noticeable symptoms in the case of short-term cardiac arrhythmias.

Depending on the exact type and duration of the symptoms, cardiac arrhythmia can also lead to the following symptoms:

• heart palpitations
• tachycardia
• irregular heartbeat
• fatigue
• dizziness
• shortness of breath
• chest pain
• fainting spells

If the heart permanently deviates from the normal pumping rhythm, there is a risk of severe damage to health and sometimes even complete heart failure.

Is muscle twitching on the side of the heart – a symptom of cardiac arrhythmias?

If there is a twitching in the chest, which may even be visually perceptible, it is a reaction of the chest muscles in most cases. This works entirely independently of the heart muscle.

Visible muscle cramps that can be identified as a slight vibration under the skin are also called fasciculations. They usually appear on the eyes or the arms and legs but can occur anywhere on the body. Possible triggers are, for example, stress, alcohol, taking certain medications or pinched nerves.

Complications of cardiac arrhythmias

In extreme cases, cardiac arrhythmia can lead to cardiogenic shock or sudden cardiac death. Long-standing cardiac arrhythmias can also cause thrombi, i.e. blood clots, to form in the arteries. These can trigger a kidney infarction or a stroke, for example.

In the case of cardiac arrhythmias, there is often a clear difference between the doctor’s assessment of the disorder and the impairment of the person concerned. Even life-threatening cardiac arrhythmias that last for minutes may be hardly noticed by those affected. Other patients, on the other hand, can feel severely impaired in their well-being due to isolated, completely harmless extra beats of the heart.

 

Life-threatening ventricular fibrillation

Heartbeat disturbances always become dangerous when they lead to a drastic drop in pumping capacity. This happens when, with a racing heartbeat, the heart muscle doesn’t have time to contract thoroughly, and the ventricles can’t fill with blood. The disturbed transmission of the electrical impulses in the heart causes this. The extreme case is the dreaded ventricular fibrillation, in which the heart muscle only twitches uncoordinatedly.

The tempo can increase to up to 320 such irregular beats per minute. At this speed, the heart cannot supply the circulatory system with blood. Affected persons become unconscious within a very short time. Without rapid intervention, there is a risk of heart failure. If ventricular fibrillation is suspected, an emergency call should always be made immediately.

Diagnosis of cardiac arrhythmias

Medical advice should always be sought if cardiac arrhythmias occur regularly (especially during rest periods) and are associated with health problems.

A blood pressure monitor with a so-called arrhythmia detection can also indicate changes in the heartbeat rate. The blood pressure monitor displays cardiac arrhythmia with a warning symbol. This technical aid can be particularly beneficial for people who are already known to have an arrhythmia or who suffer from heart disease.

The general practitioner is the first point of contact if an arrhythmia is suspected. Questions about the symptoms, possible previous illnesses, or medication intake are clarified in an anamnesis interview. Pulse and blood pressure are also measured.

If the diagnosis has to be confirmed after an initial examination, a referral to a cardiology practice is usually carried out. The type of arrhythmia (palpitations, bradycardia, or tachycardia) can be determined more precisely, and an underlying cause can be identified.

As a rule, the heart currents are first measured using an electrocardiogram ( ECG ). This can be done at rest, under stress, or over a week (long-term ECG). On the one hand, the frequency and type of cardiac arrhythmia are measured; on the other hand, the underlying cause can also be partially inferred.

If no arrhythmias occur in the long-term ECG during the examination period, an event recorder can provide information about the heart rhythm. This small device is implanted just under the skin at the breastbone and can record changes in the heart’s rhythm over a long period. An event recorder can record for up to three years. However, only one use over a few months is necessary as a rule.

Echocardiography,  i.e. an ultrasound examination of the heart, may be necessary to detect pathological changes in the heart. Alternatively, an X-ray of the chest (X-ray chest examination) can also be used.

During the electrophysiological examination (EPU ), the doctor can carry out an ECG in some heart regions. A thin electrode is inserted into the heart via a vein, which records data directly.

Therapy for cardiac arrhythmias: treat the cause

Cardiac arrhythmias do not always have to be treated. However, if they contribute to damage to the heart if left untreated, they can trigger a stroke, or if the associated symptoms severely affect the person concerned, treatment should be carried out.

On the one hand, the underlying cause should be treated and, if possible, eliminated. The latter is likely, for example, when stress, medication or alcohol trigger heart palpitations. If the arrhythmia is caused, for example, by high blood pressure, a mineral deficiency or excess or an underactive thyroid gland, appropriate therapy must be applied.

 

Drugs and other therapy options

Some medications can relieve the symptoms of the arrhythmias themselves. In addition to beta-blockers, which inhibit the activity of certain messenger substances and thus reduce the heart rate, so-called antiarrhythmics are used here in particular. A distinction is made between three groups: the calcium, potassium and sodium channel blockers. Depending on which group of active ingredients are used, the electrolyte balance – and thus the transmission of stimuli in the heart – is influenced differently.

Electrocardioversion can help with a permanently increased heart rate, especially atrial fibrillation. The affected person is put under anaesthesia for a short time. A defibrillator is then used to deliver a brief surge of electricity intended to bring the electrical impulses that the sinus node sends out back into the right rhythm.

For example, if some heart regions have to be sclerosed to prevent misdirected impulses, this can be done directly during the electrophysiological examination. This is then called a catheter ablation.

A permanent electronic aid can be a cardiac pacemaker. This is implanted under the collarbone in the subcutaneous fatty tissue. From there, the pacemaker sends out electrical impulses that support the heart in its normal rhythm.

Home remedies and exercises for cardiac arrhythmias

Many sufferers ask themselves what they can do if they have cardiac arrhythmia. There are no effective home remedies for increasing the heart rate in bradycardia.

At least in the case of sporadic heart palpitations, a few simple exercises and tips can help to calm the heart down again:

1. Valsalva Maneuver: Close your mouth and pinch your nose with your fingers. Breathe with your mouth and nose closed for a few seconds. This increases the pressure in the chest, less blood flows into the right ventricle, and the heartbeat slows down. Caution: Use this exercise sparingly in a row to avoid a sharp drop in blood pressure and a collapse.
2. Fizzy Drinks:  Drink fizzy drinks. If you emit it afterwards, this also increases the pressure in your chest for a short time, which slows your heartbeat.
3. Massage in the neck area:  Use your middle and index fingers to gently massage your neck at the level of the left corner of the lower jaw (below the transition between the jaw and the ear). This stimulates the carotid sinus nerve, which calms the heart rate.
4. Reduce stress: Conscious inhaling, exhaling, and relaxation exercises such as autogenic training and yoga can help alleviate the symptoms of psychologically-related cardiac arrhythmias.

A healthy lifestyle with as little stress as possible, sufficient exercise, and a healthy diet strengthen the heart and can help prevent cardiac arrhythmias.

The course of cardiac arrhythmias

Regarding the course of the arrhythmias, no precise predictions are possible in individual cases. Cardiac arrhythmias can either only occur in a certain period of life or become permanent, unpleasant companions as the organic heart disease progresses.

In principle, however, early treatment of cardiac arrhythmias and potentially underlying diseases improves the prognosis and avoids or reduces damage to health.