Arrhythmia: A Condition Anyone Can Develop

Arrhythmia is a broad term that describes an abnormal heartbeat. It can be divided into several types, including a heart that beats faster than normal, slower than normal, or irregularly. This condition can affect anyone regardless of gender or age.

Why does the heart beat irregularly?

The causes of arrhythmia can be divided into

External factors

These include certain drugs and substances such as cannabis, energy drinks, and caffeine found in tea and coffee. Acute illnesses, stress, or anxiety can also contribute to arrhythmia symptoms.

Internal factors, mostly due to

• Abnormalities in the electrical origin points within the heart, which can cause the heart to beat too fast, too slow, or irregularly.
• Abnormalities in the electrical conduction pathways within the heart.
• Other structural heart abnormalities such as congenital heart muscle defects, valve leakage or stenosis, abnormal thickening of the heart walls, or coronary artery disease.

How dangerous is arrhythmia?

Some may think arrhythmia is not very dangerous, but in reality, it varies in severity from mild to severe. In severe cases, it can lead to death. For example, a heart rate that is too slow can cause symptoms ranging from palpitations and dizziness to fainting. A heart rate that is too fast can cause palpitations, easy fatigue, acute heart failure, and may also lead to fainting. Certain types of irregular heartbeats, such as atrial fibrillation, can cause blood clots in the heart, which may lead to ischemic stroke.

Arrhythmia diagnosis must be accurate

Initially, you can use simple tools available at home such as

• Self-palpation of the pulse

Place your fingers on the wrist on the same side as the thumb and count the pulse beats for 1 minute to check the rate and regularity. A normal resting pulse rate should be 60-100 beats per minute.

• Basic home devices such as a blood pressure monitor or fingertip oxygen saturation monitor

These can help measure the initial heart rate but may not be very accurate. For precise diagnosis, it is recommended to visit a hospital for detailed examination.

• Smart Watch

This is another tool that can detect irregular heartbeats and record the results via a smartphone for doctors to review.

In-depth examination by a specialist

The doctor will take a history and perform a physical examination to determine if arrhythmia is present and its type. Then, more specific diagnostic tools will be used, including

• Electrocardiography (ECG or EKG) is a test where electrodes are attached to the chest for about 10 seconds. This helps the doctor clearly assess whether arrhythmia is present. However, this method only records for 10 seconds, so arrhythmias may be missed.
• Holter Monitoring is often used for patients suspected of having frequent arrhythmia symptoms, almost daily. The patient wears a small device, about the size of a camera, with electrodes attached to the chest for 24-48 hours, or in some models, a small patch that can be worn for up to 7 days. The choice depends on the frequency and nature of symptoms. Limitations include no bathing during the 24-48 hour monitoring, but wiping the body is allowed. Patients should record activities such as exercise or sleep to help identify abnormalities accurately.
• Cardiac event recorder is a small device that records ECG only when symptoms occur. It is used for patients with infrequent symptoms, less than once a week. The device records 30-60 seconds of ECG each time it is activated. Limitations include the need for symptoms to last long enough to capture the ECG and it cannot be used in patients who lose consciousness.
• Implantable Loop Recorder (ILR) is a device implanted under the skin of the chest. It records data only when arrhythmia occurs based on preset criteria or when activated by the patient. It is usually considered for patients with symptoms occurring every 2-3 months.
• Electrophysiology Study is a test of the heart’s electrical system by inserting catheters through blood vessels into the heart to locate the cause of arrhythmia. It is used when other methods fail to diagnose arrhythmia.
• Exercise Stress Test (EST) records ECG while walking or running on a treadmill. It is suitable for diagnosing arrhythmia during exertion or unexplained chest pain and fatigue. It also helps diagnose ischemic heart disease.

Other special tests may be considered by the doctor as appropriate, such as echocardiography, chest X-ray, and blood tests.

Can arrhythmia be treated?

Treatment depends on the type and severity of the condition and includes

1. Medication to normalize heart rhythm or control fast heartbeats.
2. Cardioversion uses electrical shocks delivered externally via pads on the chest to restore normal heart rhythm. It is often used in patients with severe fast arrhythmias.
3. Radiofrequency Catheter Ablation (RFCA) involves inserting a catheter into the heart through blood vessels to locate and ablate abnormal electrical pathways.
4. Automated Implantable Cardioverter-Defibrillator (AICD) is a device implanted in the chest that detects dangerous fast ventricular arrhythmias and delivers shocks to stop them. It is used in patients with severe ventricular arrhythmias or weak heart muscle contraction.
5. Permanent Pacemaker is implanted under the skin below the collarbone with leads into the heart. It stimulates the heart to beat faster when the heart rate is too slow or pauses. It is used in patients with slow or intermittent arrhythmias.
6. Cardiac Resynchronization Therapy (CRT) stimulates both left and right ventricles to contract synchronously, improving heart function. It is suitable for patients with weak heart contractions and risk of heart failure.

What symptoms indicate arrhythmia?

• Feeling a fast or strong heartbeat, or a heartbeat that is too slow or irregular.
• Chest pain or tightness.
• Shortness of breath, difficulty breathing, or easy fatigue.
• Dizziness.
• Fainting or loss of consciousness.

Who is at risk of arrhythmia?

• People of all genders and ages; this condition can occur in anyone.
• Those with congenital electrical abnormalities of the heart.
• Older age with organ degeneration.
• Coronary artery disease.
• Complications from acute illnesses.
• Alcohol consumption and smoking.
• Excessive caffeine intake.
• Having underlying diseases such as hyperthyroidism.

Although it may seem like a common condition, arrhythmia can be dangerous. Some types may lead to heart failure. Therefore, if you feel your heart beating irregularly, seek help promptly and consult a doctor for accurate diagnosis.

Dr. Jutatip Petchrat
Cardiologist, Heart Center
Phyathai 3 Hospital