Cardiac arrhythmias, or abnormal heart rhythms, can occur at any age and can have a variety of symptoms including chest pain, fainting and shortness of breath. The most common serious arrhythmia, atrial fibrillation, is estimated to occur in more than 2.6 million Americans and the risk for developing it only increases with age.
“Emergency physicians see a lot of people who may have a serious arrhythmia, while other patients have no symptoms at all and are completely unaware of their condition,” says Steven Higgins, MD, a Scripps Health electrophysiologist. “Common symptoms of a potentially dangerous arrhythmia may be dizziness or fainting, while other people clearly feel their heart racing or fluttering. Unfortunately, by the time they get to the hospital, the episode may have ended, which makes it difficult to diagnose the problem.”
There are many different kinds of arrhythmia. Many are minor and temporary, while others can be dangerous—even deadly. Knowing the difference takes time since a majority of arrhythmias occur sporadically. A few common types of cardiac arrhythmia include:
When the heart beats too fast—more than 100 beats per minute in adults—this may cause symptoms like dizziness, lightheadedness, shortness of breath, angina (chest pain) and/or a noticeable sensation of a racing, rapid heartbeat or “palpitations.”
In this form of arrhythmia, the heart beats too slowly. In adults, a heartbeat slower than 60 beats per minute may result in not enough blood flowing to the brain. This can cause fainting or near-fainting spells, fatigue, dizziness and lightheadedness. In extreme cases, bradycardia may lead to sudden death.
Among the most serious of irregular heartbeats, atrial fibrillation is a quivering or irregular rhythm in the upper chamber of the heart. It raises the risk of stroke and other complications because blood can pool in the upper chamber, where it can form clots that travel to other parts of the body.
This form of arrhythmia is often described as a heart “fluttering” and is the most common cause of sudden death. During ventricular fibrillation, the lower chamber of the heart loses its rhythm, quivers, and cannot pump blood. This causes cardiac arrest and death within a matter of minutes. Symptoms are a sudden loss of consciousness, a lack of responsiveness and lack of breathing. Ventricular defibrillation needs to be treated immediately with cardiopulmonary resuscitation (CPR) and defibrillation using an electrical shock to the heart.
Other rhythm disorders
Some arrhythmias are rarer than others. Rapid regular racing can develop from supraventricular tachycardia, atrial flutter or ventricular tachycardia. Specific treatments are tailored to the specific arrhythmia making diagnosis the key to proper treatment.
A new FDA-approved device called the Zio® Patch was designed to help physicians document heart rhythm abnormalities for a more accurate diagnosis. Dr. Higgins, along with physicians at two other nationally renowned medical centers, participated in a study recording the benefits of this new easy-to-use heart monitor.
“In the past, if we couldn’t diagnose an arrhythmia when a patient was in the office or emergency room, we commonly sent them home wearing a Holter monitor,” says Dr. Higgins. The Holter is a relatively bulky device the size of a paperback book worn on the waist, with electrodes that attach to the patient’s chest to monitor the heart’s rhythm over a period of time. It is typically worn for only 24-48 hours, because patients with a monitor cannot shower or engage in activities that may cause the electrodes to loosen, like exercise.
“When it was introduced more than 60 years ago, the Holter monitor was a miracle,” says Dr. Higgins, “but today the Zio Patch is more convenient for patients to wear and collects more data. Typically, patients wear it until it no longer sticks to the skin or falls off, which is usually 7 to 14 days. This makes it more likely that we will catch an episode of arrhythmia and be able to make a clear diagnosis.”
The Zio Patch is essentially a 2 × 5 inch stick-on patch with an electronic monitor embedded in it. When completed, the patient drops the device in a pre-paid envelope to return for analysis, avoiding the need for a repeat visit to the doctor’s office or hospital. The prescribing physician receives the readings from the patch within a few days so they can review and analyze.
Ultimately, Dr. Higgins believes the new wire-free technology will replace the older Holter monitors entirely because of its ease-of-use and longer monitoring period. “We can’t use our modern advances in treatment if we don’t know the problem. The more arrhythmias we can document, the more deaths we can prevent.”