Treating Cardiovascular Diseases in Wisconsin and Northern Illinois
A heart arrhythmia is an abnormal heartbeat. Although many arrhythmias are harmless, some can interfere with the heart’s ability to pump blood effectively. This may prevent sufficient blood supply and oxygen from reaching the brain, heart and other organs, causing serious or life-threatening conditions.
Even serious arrhythmias can be successfully treated. Most people with abnormal heartbeats are able to live normal, healthy lives.
Signs of arrhythmia can vary dramatically, depending on the type and severity of the condition. While some people experience no symptoms, others may experience one or more of the following:
- A rapid heartbeat (tachycardia)
- A slow heartbeat (bradycardia)
- An irregular heartbeat
- Heart palpitations (skipping a beat or beating too hard or fast)
- Pauses between beats
Other arrhythmia symptoms may include:
- Cardiac arrest and death
- Chest pain
- Loss of consciousness, blackouts or fainting
- Shortness of breath
- Weakness, dizziness and light-headedness
What Causes Arrhythmia?
The heart has its own internal electrical system that naturally controls the heartbeat’s rate and rhythm. With every heartbeat, an electrical signal spreads from the top of the heart to the bottom. As it travels, it causes the heart to contract and pump blood.
The following conditions and disorders can interfere with the heart’s electrical system:
- A severe blow to the chest at the heart
- Congenital heart disease or other inheritable or developmental conditions
- Coronary artery disease
- Electrolyte imbalances in the blood, such as sodium or potassium
- Heart failure
- Heart surgery
- Heart valve disease
- Injury from a heart attack
- Other conditions, such as thyroid disorders or rheumatic heart disease
Arrhythmias can also occur in healthy hearts when triggered by certain substances or emotional states, such as:
- Caffeine, nicotine, alcohol, cocaine, inhaled aerosols, diet pills and cold remedies
- Fright, stress or shock
Types of Arrhythmia
There are four main types of arrhythmia:
Premature beats, or extra beats, are the most common. They are harmless most of the time and rarely cause symptoms other than a slight fluttering in the chest or a skipped beat sensation. There are two types:
- Premature atrial contractions (PACs) are premature beats that occur in the upper chambers (atria).
- Premature ventricular contractions (PVCs) are premature beats that occur in the lower chambers (ventricles).
Supraventricular arrhythmias occur in the upper chambers, or atria. (“Supraventricular” means above the ventricles). Rapid heartbeats that occur in the upper chambers of the heart are known as supraventricular tachycardia, or SVT. There are several types of SVT:
- Atrial fibrillation
- Atrial flutter
- AV nodal reentrant tachycardia (AVNRT) begins in the AV node, which is a group of cells located between the atria and ventricles. It is a very common SVT.
- Wolff-Parkinson-White syndrome, a less common type of tachycardia that uses an extra connection between the atria and ventricles to make a tachycardia called AV reentrant tachycardia (AVRT) or bypass tachycardia
Ventricular arrhythmias start in the heart’s lower chambers (ventricles). The following ventricular arrhythmias are very dangerous and can cause sudden cardiac arrest (SCA) or sudden cardiac death (SCD):
- Abnormal electrolytes
- Accidental electrical shocks
- Cardiomyopathy (enlarged heart)
- Coronary artery disease
- Heart failure
- Long QT syndrome and other congenital electrical disorders of the heart
- Ventricular fibrillation (VF or V-Fib), which occurs when disorganized electrical signals in the ventricles cause the chambers to quiver instead of pumping normally
- Ventricular tachycardia (VT), which is an organized, rapid heartbeat that is started by a condition in the lower chambers. In older adults and people with heart conditions, VT can be a dangerous condition that prevents from blood circulating properly, resulting in a weak pulse and leading to ventricular fibrillation and sudden cardiac death. If it occurs in otherwise healthy people, the condition can be tolerated.
WARNING: People experiencing ventricular arrhythmias lose consciousness in seconds due to sudden cardiac arrest. This can lead to sudden cardiac death within minutes unless someone intervenes. If someone you’re with loses consciousness, call 911 immediately. Police and emergency medical technicians are trained and equipped to use defibrillators, which provide an electric shock to the heart to restore a normal heart rhythm. Also, many public places now have automatic external defibrillators that people without special training can safely use to help those in need.
Bradyarrhythmias occur if the heart rate is too slow. Without sufficient blood flow to the brain, you can become confused, dizzy, disoriented and even pass out.
Who is at Risk?
Older adults are more likely to have heart disease and other health conditions that can lead to arrhythmias. Sudden cardiac arrest and sudden cardiac death occur more often in adults with arrhythmias, but in at least half of these cases, there were no prior heart disease symptoms. Ventricular arrhythmias in children and young athletes are at times tragically fatal and may be due to congenital conditions.
Some supraventricular arrhythmias like AVRT and AVNRT are more common in children and young people. Others like atrial fibrillation and atrial flutter occur more often in older adults.
You should see an arrhythmia specialist if your arrhythmia is recurring, if you have a family history of arrhythmias or sudden deaths, or if you have a known heart condition and are experiencing changes in symptoms. Arrhythmias can occur in people who have no other identifiable conditions. An enlarged heart or primary electrical disorders like long QT syndrome can be associated with sudden cardiac death.
Arrhythmias can be hard to diagnose, especially if symptoms occur only every once in a while. Sometimes this can be frustrating to patients with intermittent symptoms. Doctors diagnose arrhythmias based on medical and family histories, a physical exam and results from various cardiac tests.
Testing may include:
- Blood tests to measure electrolytes or for genetic markers
- Cardiac catheterization
- Coronary angiography
- Electrocardiograph (EKG or ECG) testing, including Holter monitoring for a few days; event monitors which can be worn or carried for a few weeks; or implantable recorders, which are placed under the skin for 12 to 24 months to detect abnormal heart rhythms; and extra sensitive EKGS, such as signal-averaged EKG and T-wave alternans testing
- Electrophysiology studies
- Heart imaging with echocardiography (ultrasound of the heart), CT or MRI scans or nuclear tracer imaging of the heart
- Stress test using exercise or medications that increase the heart’s work
- Tilt table testing
- Implantable Monitoring Device
Treatment depends on the type and severity of the arrhythmia. Doctors often use various medications, devices, procedures and surgery to treat these conditions.
Treating underlying conditions such as thyroid disorders or coronary heart disease may be an important first step in arrhythmia management. Some arrhythmias may be eliminated after coronary interventions in the cardiac cath lab with angioplasty and/or stenting if the arrhythmia stems from coronary artery blockages.
Medications can help slow down a heart that is beating too fast or treat an underlying condition. Other medications called antiarrhythmics are used to change the electrical properties of the heart and can prevent recurrences or decrease the frequency or severity of episodes.
Devices and procedures may include:
- A catheter ablation to treat the source of the abnormal heart rhythm
- A pacemaker to treat a heart that is beating too slow
- An implantable cardioverter defibrillator to control life-threatening arrhythmias
Catheter ablation procedures may be the treatment of choice for many SVTs with 85 to 99 percent success in the elimination of the arrhythmia, depending on the type. Catheter or other types of ablation may successfully treat 60 to 80 percent of atrial fibrillation cases and some types of ventricular tachycardias.
It is very rare that open-heart surgery or minimally invasive transthoroscopic surgical procedure (mini-maze) is needed for SVT. On the other hand, some patients undergoing heart surgery (coronary artery bypass or heart valve procedure) who also have arrhythmia may benefit from having a surgical arrhythmia procedure at the same time. Select patients may also need these alternate arrhythmia procedures.
A Leader in Arrhythmia Management
The Electrophysiology Department of Aurora Health Care provides state-of-the art, comprehensive care for patients suffering from all types of heart rhythm disorders. We also partner with other health care professionals throughout the Midwest, the United States, and the world to help manage and treat patients with arrhythmia.
Starting in 1977, Aurora Health Care’s Cardiac Electrophysiology Department was one of the first programs in the nation to diagnose and treat patients with heart rhythm disorders. We use the most advanced technologies available, some of which we developed. Our program is one of the busiest in the country. We train and educate electrophysiologists and coordinate international seimars in the field.
Aurora doctors are conveniently located throughout eastern Wisconsin and northeastern Illinois. Find a doctor or heart specialist near you. To get a second opinion or if you need assistance finding a provider, please call 888-649-6892.