DIAGNOSIS
Your doctor will perform a physical examination, ask about your symptoms and discuss your medical history. He will suggest one or more diagnostic tests. These include:
- Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. It is the most common test used to diagnose arrhythmias. An ECG shows how fast the heart is beating and its rhythm (steady or irregular). It also records the strength and timing of electrical signals as they pass through the heart.
- In Holter monitoring, you wear a portable monitor for 24 hours as you go about your normal activities. It records the heart’s electrical signals for a full 24- or 48-hour period. This allows the monitor to record your heart for a longer time than a standard ECG.
- An event monitor is similar to a Holter monitor. You wear an event monitor while doing your normal activities. However, an event monitor only records your heart’s electrical activity at certain times while you’re wearing it.
- Blood tests check the level of substances in the blood, such as potassium and thyroid hormone. Abnormal levels of these substances can increase your chances of having an arrhythmia.
- Chest x ray is a painless test that can show whether your heart is enlarged.
- Echocardiogram uses sound waves to produce images of your heart. It provides information about the size and shape of your heart and how well your heart chambers and valves are working. The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren’t contracting normally, and previous injury to the heart muscle caused by poor blood flow.
- Stress test. Some heart problems are easier to diagnose when your heart is working hard and beating fast. During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can’t exercise, you may be given medicine to make your heart work hard and beat fast. The heart tests done during stress testing may include nuclear heart scanning, echo, and positron emission tomography (PET) scanning of the heart.
- Coronary angiography uses dye and special x rays to show the inside of your coronary arteries. To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream. Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels. This helps your doctor find blockages that can cause a heart attack.
- Implantable loop recorder. This device detects abnormal heart rhythms. Minor surgery is used to place this device under the skin in the chest area.
TREATMENT
- Medicines
Medicines can slow down a heart that’s beating too fast. They also can change an abnormal heart rhythm to a normal, steady rhythm. Medicines that do this are called antiarrhythmics.
Some of the medicines used to slow a fast heart rate are beta blockers (such as metoprolol and atenolol), calcium channel blockers (such as diltiazem and verapamil), and digoxin (digitalis). These medicines often are used to treat atrial fibrillation (AF).
Some of the medicines used to restore a normal heart rhythm are amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide, quinidine, procainamide, and disopyramide. These medicines often have side effects. Some side effects can make an arrhythmia worse or even cause a different kind of arrhythmia.
Currently, no medicine can reliably speed up a slow heart rate. Abnormally slow heart rates are treated with pacemakers.
People who have AF and some other arrhythmias may be treated with blood-thinning medicines. These medicines reduce the risk of blood clots forming. Warfarin (Coumadin®), dabigatran, heparin, and aspirin are examples of blood-thinning medicines.
Medicines also can control an underlying medical condition that might be causing an arrhythmia, such as heart disease or a thyroid condition.
- Medical Procedures
Some arrhythmias are treated with pacemakers. A pacemaker is a small device that’s placed under the skin of your chest or abdomen to help control abnormal heart rhythms.
Pacemakers have sensors that detect the heart’s electrical activity. When the device senses an abnormal heart rhythm, it sends electrical pulses to prompt the heart to beat at a normal rate.
Some arrhythmias are treated with a jolt of electricity to the heart. This type of treatment is called cardioversion or defibrillation, depending on which type of arrhythmia is being treated.
Some people who are at risk for ventricular fibrillation are treated with a device called an implantable cardioverter defibrillator (ICD). Like a pacemaker, an ICD is a small device that’s placed under the skin in the chest. This device uses electrical pulses or shocks to help control life-threatening arrhythmias.
An ICD continuously monitors the heartbeat. If it senses a dangerous ventricular arrhythmia, it sends an electric shock to the heart to restore a normal heartbeat.
A procedure called catheter ablation is used to treat some arrhythmias if medicines don’t work. During this procedure, a thin, flexible tube is put into a blood vessel in your arm, groin (upper thigh), or neck. Then, the tube is guided to your heart.
A special machine sends energy through the tube to your heart. The energy finds and destroys small areas of heart tissue where abnormal heart rhythms may start. Catheter ablation usually is done in a hospital as part of an electrophysiology study.
Your doctor may recommend transesophageal echocardiography before catheter ablation to make sure no blood clots are present in the atria (the heart’s upper chambers).
- Surgery
Doctors treat some arrhythmias with surgery. This may occur if surgery is already being done for another reason, such as repair of a heart valve.
One type of surgery for AF is called maze surgery. During this surgery, a surgeon makes small cuts or burns in the atria. These cuts or burns prevent the spread of disorganized electrical signals.
If coronary heart disease is the cause of your arrhythmia, your doctor may recommend coronary artery bypass grafting. This surgery improves blood flow to the heart muscle.
- Other Treatments
Vagal maneuvers are another type of treatment for arrhythmia. These simple exercises sometimes can stop or slow down certain types of supraventricular arrhythmias. They do this by affecting the vagus nerve, which helps control the heart rate.
Some vagal maneuvers include:
- Gagging
- Holding your breath and bearing down (Valsalva maneuver)
- Immersing your face in ice-cold water
- Coughing
- Putting your fingers on your eyelids and pressing down gently
However, vagal maneuvers are not an appropriate treatment for everyone. Discuss with your doctor whether vagal maneuvers are an option for you.
