Arrhythmias

What is an arrhythmia?

An arrhythmia is an abnormal heart rhythm. Your heartbeat is set by an electrical signal. That signal starts in the upper chambers of the heart and travels down to the lower chambers. It tells the muscle when to squeeze. The signal can start in the wrong place, move along the wrong path or get blocked. The beat then becomes too fast, too slow or irregular. Doctors group arrhythmias by speed and origin. Tachycardia means a resting rate above 100 beats per minute. Bradycardia means a rate below 60. Premature beats are early extra beats that feel like a skip or a thud. Atrial fibrillation is the most common sustained arrhythmia, and it comes from the upper chambers. Ventricular rhythms come from the lower chambers and are more dangerous. Many arrhythmias are harmless. Others raise the risk of stroke, fainting or cardiac arrest. That is why the National Heart, Lung, and Blood Institute advises having a persistent irregular rhythm evaluated.

Symptoms to watch for

Some arrhythmias produce no symptoms at all and turn up on a routine tracing. When they are felt, patients describe them in a few consistent ways.

Call the office to be seen if you have:

• Fluttering, pounding, racing or skipping beats that keep coming back.
• A pulse that feels persistently fast or unusually slow.
• Shortness of breath with ordinary activity.
• Unusual fatigue, lightheadedness or a brief woozy spell.
• A racing heartbeat that starts and stops abruptly.

Call 911 if you have:

• Chest pain or pressure along with a racing or irregular heartbeat.
• Fainting, or a near faint where you lost awareness.
• Severe shortness of breath at rest.
• Sudden weakness on one side, trouble speaking or a drooping face, which are stroke warning signs.

If someone collapses and is not breathing normally, call 911 and start CPR. The American Heart Association notes that immediate CPR can double or triple survival from cardiac arrest.

How Dr. Nanavati diagnoses it

Rhythm problems are intermittent. The goal is to record your heart during a symptom. Dr. Nanavati selects the monitor that matches how often your symptoms occur.

• Electrocardiogram (ECG or EKG) takes about ten seconds and captures the rhythm at that moment. It is done in the office at the first visit.
• Holter monitoring records every beat for 24 to 48 hours. That suits daily symptoms.
• 7 to 10 day ambulatory rhythm monitoring covers symptoms that come only a few times a week.
• Loop recorder implantation and interrogation uses a small device under the skin for rare events or unexplained fainting. It can watch for years.
• Echocardiogram shows the pumping strength and valves. A weak or thickened heart muscle can drive arrhythmias.
• Treadmill stress testing reveals rhythms that appear only with exertion. Advanced stress testing is used when a plain treadmill study is not enough.
• Pacemaker interrogation and defibrillator interrogation download stored rhythm data if you already have a device.
• Advanced lipid testing and blood work help identify contributing causes such as thyroid or cholesterol problems.

Treatment options

Treatment depends on the type of arrhythmia, your symptoms and your stroke risk. Many patients need only the first step.

Lifestyle. Caffeine, alcohol, stimulants, decongestants and poor sleep all trigger extra beats. Treating sleep apnea often reduces episodes on its own. So does treating untreated high blood pressure. The habits in Life's Essential 8 apply here directly.

Medication. Beta blockers and calcium channel blockers slow a fast rate. Antiarrhythmic drugs help hold a normal rhythm. An anticoagulant may be recommended if you have atrial fibrillation. It lowers stroke risk, following current American College of Cardiology guidelines.

Procedures. Cardioversion resets a fast rhythm. Catheter ablation treats the tissue causing it. A pacemaker corrects a rhythm that is too slow. An implantable defibrillator protects against dangerous ventricular arrhythmias. A temporary pacemaker may be used in urgent situations. Some patients with atrial fibrillation cannot stay on blood thinners. For them, left atrial appendage closure is an alternative. Procedures are performed at affiliated hospitals. Your evaluation and follow up are handled in the office.

What to expect at your visit

Bring your medication list, including supplements and over the counter cold remedies. Note when your episodes happen, how long they last and what you were doing. Recordings from a smart watch are useful, so bring them. Your visit includes an exam, a blood pressure check and an ECG. Staff place any ordered monitor before you leave. They also explain how to mark symptoms. When the recording is read, you get a plain language explanation of what your heart was doing and what happens next. Common questions are answered on the FAQs page.

When to see a cardiologist

See a cardiologist for repeated palpitations or a persistently irregular pulse. Unexplained fainting is another reason. So are palpitations with chest pain or breathlessness. A family history of sudden cardiac death deserves prompt evaluation. Request an appointment online or call the Bonita office at (619) 585-0476.

Dr. Vimal Nanavati, MD, FACC is board certified in cardiology and interventional cardiology. He has 32 years of experience. He founded Advanced Heart Care, Inc. in 1997. He practices at three locations. The Bonita office is in South San Diego. It serves Chula Vista, Eastlake, Otay Ranch, National City, Spring Valley, Imperial Beach, San Ysidro and Coronado. The North San Diego office at 5190 Governor Dr serves University City, La Jolla, Clairemont and Mira Mesa. The Redding office serves Shasta County, Anderson, Red Bluff, Palo Cedro and Cottonwood.

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