Cardiac arrhythmias, referring to abnormal heart rhythms, encompass a range of conditions that can vary in severity from benign to life-threatening. Here’s a detailed overview:
Causes of Cardiac Arrhythmias:
- Ischemic Heart Disease: Including myocardial infarction.
- Electrolyte Imbalances: Hypokalemia, hyperkalemia, hypomagnesemia.
- Cardiomyopathies: Dilated, hypertrophic, or restrictive.
- Heart Failure
- Valvular Heart Diseases
- Hypertension
- Congenital Heart Disease
- Substance Use: Alcohol, caffeine, tobacco, illicit drugs.
- Medications: Certain antiarrhythmics, antibiotics, antipsychotics.
- Endocrine Disorders: Thyroid diseases, particularly hyperthyroidism.
- Autonomic Imbalance: Stress, anxiety.
- Structural Heart Changes: Post-surgery or due to aging.
Diagnosis:
- History:
- Symptoms: Palpitations, dizziness, syncope, chest pain, shortness of breath.
- Onset and Duration: Sudden onset, episodic or persistent arrhythmias.
- Past Medical History: Heart disease, thyroid disorders, diabetes.
- Family History: Of arrhythmias or sudden cardiac death.
- Medication and Substance Use: Prescription drugs, OTC drugs, supplements, alcohol, caffeine.
- Physical Examination:
- Vital Signs: Heart rate, blood pressure.
- Cardiovascular Examination: Irregular rhythm, murmurs, signs of heart failure.
- Respiratory System: Signs of respiratory distress or pulmonary edema.
- Neurological Examination: For signs of embolic events or syncope.
- Investigations:
- Electrocardiogram (ECG): To identify the type of arrhythmia.
- Blood Tests: Electrolytes, thyroid function tests, cardiac biomarkers.
- Echocardiogram: To assess structural heart disease.
- Holter Monitor: 24-hour ECG monitoring.
- Event Monitor: For intermittent symptoms.
- Exercise Stress Test: If ischemic heart disease is suspected.
- Electrophysiological Study (EPS): For detailed intracardiac conduction analysis.
Differential Diagnosis (DDx):
- Atrial Fibrillation
- Atrial Flutter
- Ventricular Tachycardia
- Supraventricular Tachycardia
- Bradycardia (due to AV block, Sinus Node Dysfunction)
- Premature Ventricular or Atrial Contractions
- Long QT Syndrome
Management:
- Acute Management:
- Stabilization: ABCs (Airway, Breathing, Circulation), oxygen, IV access.
- Rate Control: Beta-blockers (e.g., metoprolol), calcium channel blockers (e.g., diltiazem).
- Rhythm Control: Amiodarone, sotalol, flecainide.
- Anticoagulation: For atrial fibrillation/flutter (e.g., warfarin, DOACs like rivaroxaban).
- Cardioversion: Electrical or pharmacological for certain tachyarrhythmias.
- Pacemaker or Defibrillator: For severe bradyarrhythmias or high-risk patients.
- Chronic Management:
- Lifestyle Modifications: Weight management, exercise, limit caffeine/alcohol.
- Rate or Rhythm Control: Depending on the type of arrhythmia.
- Anticoagulation Therapy: Based on risk stratification for stroke.
- Device Therapy: Implantable cardioverter-defibrillators (ICDs) or pacemakers.
- Catheter Ablation: For certain types of SVT, atrial fibrillation/flutter, and VT.
- Surgery: In selected cases, such as arrhythmogenic structural heart disease.
Follow-Up and Monitoring:
- Regular follow-up to monitor the efficacy of treatment, manage drug side effects, and adjust therapy as needed.
- Continuous monitoring for patients with implanted devices.
Referral:
- Electrophysiologist Consultation: For complex cases or potential ablation therapy.
- Cardiologist: Ongoing management and adjustment of therapy.
Managing cardiac arrhythmias requires a personalized approach, considering the specific type of arrhythmia, underlying causes, patient’s overall health, and risk factors for complications like stroke or heart failure.