rhythm of my heart: heart rhythm disorders

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The heart is like an intricate machine—controlled by electrical impulses that must occur at regular intervals to work properly. When that doesn’t happen, the result is a rhythm disorder, also known as an arrhythmia. These abnormalities can range from common and harmless rhythms to serious and potentially life-threatening rhythms. Dr. Eric Mak, specialist in cardiac electrophysiology, discusses these conditions and their treatment methods.

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CardiacElectrophysiologyEric C. Mak, MD

Cardiology

www.SpringfieldClinic.comwww.SpringfieldClinic.com

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Sinus Rhythm

Sinus Rhythm

Heart Rhythm Disorders

• Arrhythmias are abnormal heart rhythms, i.e. rhythms that are not sinus– They can be fast or slow– They can be symptomatic or asymptomatic– They can benign or serious

Heart Rhythm Disorders

• Common Questions– Are arrhythmias bad?– What can I do if I have an arrhythmia?– Do I have to do anything if I have an

arrhythmia?– How do I know if I have an arrhythmia?

Heart Rhythm Disorders

• Common Questions– Are arrhythmias bad?– What can I do if I have an arrhythmia?– Do I have to do anything if I have an

arrhythmia?– How do I know if I have an arrhythmia?

Heart Rhythm Disorders

• Not all arrhythmias cause palpitations

• Not all palpitations are caused by arrhythmias

How do I know if I have an arrhythmia?

Heart Rhythm Disorders

• EKG: 10 sec “snapshot”• Holter monitor: 24-48 hr• Event monitor: 1-4 weeks

• Implantable loop recorder: 3 years

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Ectopy, aka extra beats

PACs / APDsPVCs / VPDs

Ectopy, aka extra beats

• Symptoms• Prognosis• Treatment

Ectopy, aka extra beats

• Symptoms– “skipped beats”– Tired / fatigue

Ectopy, aka extra beats

• Prognosis– VERY common; everyone has a few PACs

and PVCs– Generally benign, though very frequent

PVCs (when PVCs are over 20-25% of total beats) can cause weakening of the heart

Ectopy, aka extra beats

• Treatment– Do nothing– Medicines– Procedures

Ectopy, aka extra beats

• Treatment– Do nothing– Medicines: beta blockers and calcium

channel blockers, though the side effects can sometimes be as bad or worse than the ectopy

– Procedures: very effective if the ectopic beats can be located; the more ectopic beats, the easier to locate them

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Bradycardia, aka slow heart rhythms

Sinus node dysfunctionSick sinus

Heart block

Bradycardia, aka slow heart rhythms

• Symptoms• Prognosis• Treatment

Bradycardia, aka slow heart rhythms

• Symptoms– Tired / fatigue (worse with exercise)– Shortness of breath (worse with exercise)– Fainting / passing out

Bradycardia, aka slow heart rhythms

• Prognosis• Treatment

– Do nothing– Medicines– Procedures

Bradycardia, aka slow heart rhythms

• Treatment– Do nothing– Medicines: stop medications that slow the

heart rate– Procedures: pacemaker

Bradycardia, aka slow heart rhythms

• Prognosis– Sinus node dysfunction: pacing improves

symptoms, but does not prolong life– Heart block: pacing improves symptoms

and prolongs life

Bradycardia, aka slow heart rhythms

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Tachycardia, aka fast heart rhythms

Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

SVTs (Supraventricular Tachycardias)Atrial FibrillationAtrial Flutter

AVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

SVTs (Supraventricular Tachycardias)

• Symptoms• Prognosis• Treatment

SVTs (Supraventricular Tachycardias)

• Symptoms– Palpitations, usually starts and stops

abruptly– Sometimes with chest pain, shortness of

breath, and lightheadedness– Fainting and passing out is rare

SVTs (Supraventricular Tachycardias)

• Prognosis– Generally very symptomatic, but benign

SVTs (Supraventricular Tachycardias)

• Treatment– Do nothing: sometimes coughing, Valsalva

maneuvers can stop episodes– Medicines: adenosine given in the hospital

can often stop episodes; beta blockers and calcium channel blockers to prevent episodes at home

– Procedures: EP study and ablation

Tachycardia, aka fast heart rhythms

Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

Tachycardia, aka fast heart rhythms

Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

Atrial Fibrillation and Flutter

• Symptoms• Prognosis• Treatment

Atrial Fibrillation and Flutter

• Symptoms– Palpitations– Tired / fatigue– Shortness of breath

Atrial Fibrillation and Flutter

• Prognosis– Increased risk of stroke in patients with

other medical problems• Congestive heart failure• High blood pressure• Older patients• Diabetes• Prior strokes• Patients with previous heart stents• Women

Atrial Fibrillation and Flutter

• Treatment– Blood thinners / aspirin to reduce risk of

stroke– Rate Control

• Beta blockers and calcium channel blockers to control heart rate

• Ablate AV node and implant pacemaker

– Rhythm Control• Antiarrhythmic drugs• Catheter Ablation

Atrial Fibrillation and Flutter

• Catheter ablation success rates– Atrial flutter: 90%– Paroxysmal atrial fibrillation: 70-80%– Long persistent atrial fibrillation: <50% with

most patients requiring multiple procedures

• Ablation of atrial fibrillation has not been proven to reduce stroke risk, so generally need to continue blood thinners

Tachycardia, aka fast heart rhythms

Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

Sudden Cardiac DeathAtrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

Sudden Cardiac Death

• Symptoms• Prognosis• Treatment

Sudden Cardiac Death

• Symptoms– Cardiac arrest– Passing out without warning– But most people have no symptoms

Sudden Cardiac Death

• Symptoms• Risk Factors• Prognosis• Treatment

Sudden Cardiac Death

• Risk Factors– Cardiomyopathy– Ejection Fraction of 35% or less

Sudden Cardiac Death

• Treatment– Do nothing– Medicines: heart failure medicines (beta

blockers, ace inhibitors, statins)– Procedures: implantable defibrillator

Sudden Cardiac Death

Sudden Cardiac Death

• Symptoms• Risk Factors• Prognosis• Treatment

Sudden Cardiac Death

• Prognosis– One third of patients that meet criteria for

ICD will die within 5 years– ICDs reduce the risk of death by over half

Hearth Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

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