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What are cardiac arrhythmias?

by Josephine Andrews
Published: Last Updated on 455 views

In the case of cardiac arrhythmias , the heart gets out of sync for a variety of reasons. It then either beats too slowly (bradycardia), too fast (tachycardia), or irregularly (arrhythmia). There are disturbances in the formation of electrical impulses that trigger a heartbeat and disturbances in the transmission of these impulses. Read how the cardiac arrhythmias differ and how they become noticeable.

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

R00 I48 I46 I47 I49 I45 I44

quick overview
  • Symptoms: palpitations , tachycardia, restlessness, fear and nervousness when the heart beats fast, tiredness, dizziness, fainting, blurred vision, outbreaks of sweating when the heart beat is too slow
  • Treatment: Drugs, a pacemaker , or a catheter procedure in which the doctor destroys the diseased cells in the heart muscle
  • Causes and risk factors: heart disease, other diseases such as high blood pressure or hyperthyroidism, stimulants such as nicotine, alcohol and caffeine , medicines and drugs, blood salt concentration disorders
  • Diagnosis: Physical examination, ECG , long-term ECG and stress ECG , cardiac ultrasound, possibly examination of the heart using a catheter
  • Course of the disease: Cardiac arrhythmias are often harmless, but sometimes dangerous and may result in damage to the heart muscle, strokes or pulmonary embolism; if the heart is healthy , the prognosis is often good
  • Prevention: Cardiac arrhythmias can be prevented with a healthy lifestyle.

What are cardiac arrhythmias?

At rest, the human heart normally beats about 60 to 80 times per minute. Physicians speak of cardiac arrhythmias when the heart beats either too fast, too slow or irregularly.

heartbeat occurs when the heart muscle contracts under the influence of an electrical signal. The heart generates the electrical impulses itself. The clock generator is the so-called sinus node , a small area in the right atrium. From here, the impulses first spread through the atria, which then contract and pump blood into the ventricles.

The impulse reaches the so-called AV node (atrioventricular node) via the wall of the atria. It lies roughly in the middle of the heart, where the atria and ventricles meet. Here there is a lot of connective tissue of the heart skeleton, which acts like electrical insulation.

The AV node is the only electrical connection between the atria and the ventricles. Its job is to quickly transmit incoming electrical impulses to the ventricles of the heart. To do this, it first transmits the electrical impulse to the so-called HIS bundle .

The HIS bundle is a group of specialized muscle cells. It runs from the AV node to the septum that separates the two ventricles of the heart (ventricular septum ) . Here it branches into two branches, the right and left ventricular limbs. Both run to the apex of the heart, where they branch into numerous fibers called Purkinje fibers.

They ensure that the electrical impulse is quickly transmitted to the muscle cells of the heart chambers. Under the influence of the electrical impulse, the heart muscle now contracts from the tip and pumps the blood from the ventricles into the large bloodstream.

Arrhythmias occur when the sinus node does not generate the electrical impulses properly, the impulses do not travel properly through the AV node, bundle of His and Purkinje fibers, or additional impulses arise in the atria or ventricles. There are dangerous and harmless cardiac arrhythmias. Which form it is, however, can only be clarified by a cardiological examination .

Cardiac arrhythmias occur in principle in any situation and at any time of the day. However, many people notice symptoms such as palpitations or short heartbeat interruptions more when they are at rest, for example when lying down or at night. This is because a slow pulse encourages extra beats. In addition, those affected perceive this more when they are calm than when they are distracted.

Cardiac arrhythmias: what types are there?

Cardiac arrhythmias fall into two main categories. If the heart beats too fast (more than 100 beats per minute), doctors speak of tachycardia . A heartbeat that is too slow (less than 60 beats per minute), on the other hand, is called bradycardia . This is usually only relevant when the heart is beating even more slowly (less than 50 beats per minute). However, there are also people whose heart beats slowly without being ill. This is especially the case for well-trained athletes.

Another important term is arrhythmia . Doctors mean cardiac arrhythmia with an irregular heartbeat. If the heart also beats too fast, this is called a tachyarrhythmia. If the heartbeat is severely slowed down, doctors speak of bradyarrhythmia. In an absolute arrhythmia , the heartbeat on the ECG is completely arrhythmic and irregular. Since this is often the case with atrial fibrillation, many people use both terms interchangeably.

Ventricular arrhythmias

Doctors usually classify cardiac arrhythmias according to where they first appear. Changes in the heartbeat that originate in the chambers (ventricles) of the heart are what physicians refer to as ventricular arrhythmias . If the excitations arise independently of the heart chambers, one speaks of supraventricular cardiac arrhythmias .

Typical ventricular arrhythmias are:

  • Extra beats (ventricular extrasystoles)
  • ventricular flutter
  • ventricular fibrillation
  • Ventricular tachycardia (for example, the torsade de pointes tachycardia)

Supraventricular arrhythmias

Supraventricular cardiac arrhythmias can be further classified; namely according to where pathological processes take place in the stimulus conduction system:

Nomotopic or orthotopic stimulus formation disorders are cardiac arrhythmias that emanate from the sinus node. The formation of the electrical impulses is changed, as in the case of:

  • Sinus arrhythmia (such as sick sinus syndrome)
  • Sinus bradycardia (less than 60 beats per minute, depending on the definition also less than 50 beats)
  • sinus tachycardia

Heterotopic stimulus formation disorders have their origin outside the sinus node. The impulses then arise either in the atrial muscle itself, in the AV node or in the bundle of His. These include, for example:

  • extra beats (extrasystoles)
  • Atrial tachycardia (e.g. in the case of an overactive thyroid)
  • atrial fibrillation/flutter
  • AV rhythm/extrasystole (as a secondary pacemaker approx. 40-50 beats per minute)
  • His bundle rhythm/extrasystole (as a tertiary pacemaker approx. 30-40 beats per minute)

Conduction disorders are present when the transmission of impulses from the sinus node via the AV node into the ventricle is disturbed, as in the following clinical pictures:

  • Sino-atrial block (SA block)
  • Atrioventricular block (AV block)
  • Intraventricular block (for example, (in)complete right bundle branch block and/or left bundle branch block)

This also includes cardiac arrhythmias that occur in attacks (paroxysmal). In this case, some of those affected have additional lines for the electrical impulses.

  • AV nodal reentry tachycardia
  • AV reentry tachycardia (extra bundles as in WPW syndrome)

Cardiac arrhythmias without pathology

Especially in children and young people, the heart rate rises and falls when breathing in and out. These changes in heart rate are called “respiratory sinus arrhythmias.” This process is normal and does not require any therapy.

During sports or physical exertion, but also in everyday life, extra beats of the heart sometimes occur, so-called extrasystoles. They are sometimes uncomfortable, but usually harmless and usually go away on their own. In addition, a real athlete’s heart is sometimes so well trained that it drives the circulation well even with fewer beats. This form of sinus bradycardia also has no pathological value.

What are the symptoms of cardiac arrhythmias?

The symptoms of an arrhythmia depend mainly on whether the heart is beating too fast or too slow and in which part of the heart the arrhythmia has developed. The physical condition also has a decisive influence. Those affected often do not even notice slight or occasional cardiac arrhythmias.

Symptoms of a slow heartbeat

If the heartbeat is too slow, the heart pumps too little blood per minute. As a result, less oxygen arrives in the body’s circulation, which the brain in particular urgently needs. Affected person feels nauseous and dizzy. Sweating may also occur.

Other symptoms include tiredness, poor performance, drowsiness or even fainting. The eye also reacts to the reduced blood supply. Affected people therefore often suffer from visual disturbances. In some cases, an arrhythmia also occurs, the slow heartbeat is then also irregular (e.g. in bradycardia atrial fibrillation).

Fast heartbeat symptoms

If the heart beats too fast, rapid heartbeat, palpitations and restlessness are the most common symptoms. Cardiac arrhythmias with a heartbeat that is too fast are often accompanied by an arrhythmia. But there are also forms in which the pulse feels like a fast “hammer blow”. Those affected often notice a palpitations. Heart palpitations and palpitations are what physicians call heart palpitations. Some sufferers report that coughing occurs with palpitations.

You may also experience shortness of breath, chest pain, dizziness, drowsiness, confusion or loss of consciousness. The racing heart is often accompanied by anxiety and nervousness. In some cases, people pass urine during or after an attack of rapid heartbeat.

Symptoms in infants and young children

Cardiac arrhythmias do not only occur in adults, babies, children and adolescents are also affected. Parents often ask themselves how they recognize cardiac arrhythmias, especially in infants and young children. In this case, the following signs provide clues, which, however, do not only occur with cardiac arrhythmias:

  • Unexplained behavioral changes
  • reluctance to drink
  • tiredness, lethargy
  • Weakness, paleness, sweating
  • Cough, shortness of breath, blue discolouration

What symptoms to see a doctor for?

Occasionally people feel a palpitations during sport or in stressful situations, but sometimes also at rest. The feeling goes back to isolated extra beats, the extrasystoles. Rarely occurring extrasystoles are nothing unusual and do not require a medical evaluation.

However, if heart palpitations occur frequently or in rapid succession, or are accompanied by persistent tachycardia, chest pain, sweating, shortness of breath, dizziness or nausea, it is important to consult a doctor quickly. Even if those affected feel an irregular pulse or the blood pressure monitor shows irregular heartbeats or an arrhythmia more frequently, it is advisable for those affected to contact a doctor.

If cardiac arrhythmias cause symptoms in children, it is particularly important to act quickly and consult a doctor.

How can cardiac arrhythmias be treated?

The need for treatment for cardiac arrhythmias depends on the cause and the severity of the symptoms. The doctor also assesses whether the cardiac arrhythmias increase the risk of damage to the heart muscle, a stroke or sudden cardiac death. If heart disease or other physical illnesses are the cause of the cardiac arrhythmias, treating them is a priority.

Medical therapy

Cardiac arrhythmias can be treated medically with so-called antiarrhythmics. Depending on the mechanism of action, doctors differentiate between four classes of active ingredients:

  • sodium channel blockers
  • potassium channel blockers
  • calcium channel blockers
  • beta-receptor blockers

Sodium and potassium channel blockers as well as calcium antagonists interfere with the electrolyte balance, which is important for the heart rhythm and thus with the generation and transmission of electrical impulses in the heart muscle. Beta blockers, on the other hand, inhibit certain messenger substances in the nervous system that control heart activity (neurotransmitters). Beta blockers reduce the excitability of the heart muscle. They also slow down the heart rate and the conduction of excitation, i.e. the transmission of electrical impulses.

In addition to the four classes of active ingredients mentioned, there are a number of other substances that are used to treat cardiac arrhythmias. These include, for example, digitalis, a substance found in the foxglove plant that lowers the ventricular rate, as well as atropine , which occurs naturally in deadly nightshade and is used when the heartbeat is dangerously slow.

Pacemaker for cardiac arrhythmias

Cardiac pacemakers are used particularly in cardiac arrhythmias with a reduced heart rate. This is especially true if the heartbeat drops below 40 beats per minute for a long time or if there are pauses of more than five seconds between the individual beats. Pacemakers cause the heart to beat faster. Special devices, the so-called defibrillators, also prevent cardiac arrest.

In some cases, pacemakers are also used for cardiac arrhythmias with an increased heart rate, for example when there is a risk of ventricular fibrillation or sudden cardiac death.

Nowadays it is usually possible to use the cardiac pacemaker in cardiac arrhythmias without general anesthesia only under local anesthesia. Using an incision in the skin, the doctor first introduces one or two probes via the clavicle vein to the heart under X-ray control and anchors them there. He places the actual pacemaker under the skin in the collarbone area and then connects it to the probes leading to the heart.

After a period of about seven to ten years, it is necessary to replace the pacemaker.

catheter ablation

In catheter ablation, the doctor guides a thin tube (catheter) through a vein, usually the groin vein, to the heart. Here he first checks with small devices, which he brings to the heart via the tube, where the cardiac arrhythmias occur in the heart muscle. Once he has identified the affected pathways or cells from which the pathological electrical impulses emanate, he destroys them.

Some forms of cardiac arrhythmias can be permanently cured in this way. Depending on the type of atrial fibrillation, the success rate of the procedure is between about 60 and 95 percent.

electrocardioversion

Electrocardioversion is mainly used in emergency situations. The doctor uses a defibrillator to deliver a short electrical shock to the heart. In the case of cardiac arrhythmias with an accelerated heartbeat, especially ventricular fibrillation, this is able to restore the normal heart rhythm.

Even if you have atrial fibrillation that doesn’t respond to medication, it may be possible to use a defibrillator to bring the heartbeat back under control.

What to do in the event of a sudden cardiac arrhythmia?

If a racing heart occurs very suddenly, it is advisable that those affected first try to slow down the pulse with certain measures and breathing exercises. For example, it helps if you put a pack of ice on your face or around your neck, or breathe out with your mouth and nose closed (Valsalva maneuver). This stimulates special sensors in the blood vessels. They give feedback to the central nervous system, which throttles heart activity via the vagus nerve.

Home remedies and alternative medicine?

Basically, in the case of a cardiac arrhythmia that requires treatment, conventional medical treatment is the priority. Home remedies and alternative medical procedures should at most be used as a support and ideally after consultation with the doctor.

For example, herbal heart remedies such as hawthorn or ginger are said to have a positive effect on the function of the heart muscle. However, this applies above all to functional heart problems that have no underlying organic cause.

If stress and psychological problems lead to cardiac arrhythmias, relaxation techniques may help. There are indications that procedures such as acupressure could also help with cardiac arrhythmias, but whether this is actually the case has not yet been sufficiently researched.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

Causes and risk factors

The causes of cardiac arrhythmia are diverse. Often there is a heart disease behind it, such as

  • Heart failure (heart failure)
  • valvular disease
  • Heart muscle disease ( cardiomyopathy )
  • Inflammatory heart diseases (e.g. myocarditis, sarcoidosis )
  • Congenital disturbances in the conduction system (e.g. the WPW syndrome)
  • Congenital heart defects

Arrhythmias of the ventricles

Cardiac arrhythmias occur either in the so-called atrium or in the ventricles. While those affected with cardiac arrhythmias in the atria usually cope well, arrhythmias in the ventricles can be very dangerous, sometimes even life-threatening.

Ventricular arrhythmias most often occur when muscle tissue of the heart abuts “rigid” tissue such as connective tissue or scar tissue. This occurs, for example, as part of coronary heart disease or after a heart attack, when the heart muscle is not sufficiently supplied with oxygen. At the transition point from muscle to connective or scar tissue, the incoming electrical signals are mistransmitted. This creates additional heartbeats that throw the heart out of rhythm.

In ventricular fibrillation, the most dangerous of all arrhythmias, the ventricles of the heart beat so quickly and inefficiently that they are unable to pump blood to the systemic circulation and the circulatory system fails.

Cardiac arrhythmias caused by other diseases

The causes of cardiac arrhythmias also include some physical diseases such as high blood pressure (hypertension) or an overactive thyroid gland. Thyroid hormones have a significant impact on blood pressure and heart rate. In higher concentrations, they cause restlessness, muscle tremors and cardiac arrhythmia with tachycardia.

Diseases of the spine , especially the cervical and thoracic spine , sometimes trigger cardiac arrhythmias if they affect the autonomic nervous system.

There are also many pressure gauges (baroreceptors) in a certain area (carotid sinus) at the beginning of the internal carotid artery (arteria carotis interna). They register blood pressure and send signals to the central nervous system. This reacts to this and adjusts the heartbeat.

In some people, this mechanism is very sensitive, medically called hypersensitive carotid sinus syndrome. Even slight pressure (e.g. from a tie) slows down the heartbeat to a sometimes dangerous bradycardia. In extreme cases, the heart can even stop beating (asystole).

The blood salts also influence the heart rhythm

The heart rhythm is dependent on various mineral salts (electrolytes). This is because the heart’s electrical signals are transmitted via short-term changes in the levels of these electrolytes. Electrolytes include sodium , potassium , magnesium, chloride , calcium, and phosphate, among others. A lack of potassium or magnesium in the blood in particular quickly triggers cardiac arrhythmias.

The cause of disturbances in the mineral balance is rarely a lack of minerals in the diet. They are more frequently caused, for example, by certain medications, but also by kidney dysfunction, the consumption of alcohol or extensive sport and physical stress.

Sometimes patients are born with diseases that disturb the natural electrolyte shifts in the heart (ion channel diseases).

pregnancy and menopause

Cardiac arrhythmias due to hormonal changes are also not uncommon during pregnancy and menopause. For example, menopausal women often suffer from heart palpitations associated with hot flashes, but this is usually harmless.

Pregnancy is associated with considerable stress on the cardiovascular system. Physical adaptations such as increasing blood volume and heart rate promote cardiac arrhythmias, which are usually harmless in women with a healthy heart. If therapy is needed, it is usually available with drugs that are safe for the expectant mother and fetus.

Attention is required when symptoms such as tachycardia and palpitations are accompanied by other complaints, such as

  • Shortness of breath on exertion, possibly also at rest
  • Swelling in the lower legs and ankles
  • Tiredness, exhaustion, dizziness
  • Multiple urination at night

These symptoms may indicate a pregnancy-related heart failure, the peripartum cardiomyopathy. A possible trigger is the breastfeeding hormone prolactin . With timely treatment, the heart usually recovers completely. If the disease remains undetected, severe courses are possible.

Other causes of cardiac arrhythmias

Various external factors sometimes trigger cardiac arrhythmias. These include, for example, psychological causes such as stress, nervousness or fear. Tension is not one of the typical causes of cardiac arrhythmias, but is often a sign of stress, which in turn promotes arrhythmias.

In addition, some stimulants such as caffeine, alcohol, nicotine and drugs occasionally throw the heart out of rhythm. Since they usually have a stimulating effect on the central nervous system, they stimulate the heart to beat faster. A large number of medications also promote cardiac arrhythmias. These include, for example, medication for asthma, for hypothyroidism, for cancer, antidepressants or medication for cardiac arrhythmia itself.

Some people experience symptoms such as heart palpitations and palpitations, especially after eating. This is often associated with flatulence: the gases that accumulate in the abdomen press on the heart muscle and trigger various heart problems. In this case, doctors speak of Roemheld syndrome.

Many cardiac arrhythmias also have a genetic component. How strong this is, however, is not yet certain. In infants, cardiac arrhythmias also occur due to immaturity or obstructed airways. In some cases, despite thorough investigations, it is not possible to find a cause for the problems. Doctors then speak of idiopathic cardiac arrhythmia.

investigations and diagnosis

The first point of contact is usually the general practitioner. He initiates the first steps to get to the bottom of cardiac arrhythmias. For a more detailed clarification, however, he refers the person concerned to a specialist for heart diseases, a cardiologist. At the beginning, the doctor asks a few questions about the symptoms, such as whether the person affected

  • Often suffers from dizziness or has even collapsed.
  • Suffers from heart palpitations again and again and how long an attack lasts.
  • Suffers more often from heart palpitations.
  • Intermittent shortness of breath or chest pain.

The doctor is also interested in the history of the disease, in particular the intake of medication, known heart diseases or other physical illnesses as well as previous cardiac arrhythmias. This is followed by a physical examination in which the doctor measures blood pressure and pulse and listens to the heart.

Apparative investigations

The doctor records the electrical activity of the heart, and thus also cardiac arrhythmias, with an electrocardiogram (ECG) . However, those affected sometimes suffer from temporary attacks of cardiac arrhythmia. Then a long-term ECG examination is advisable, which continuously registers the heart’s actions over a period of about 24 hours.

Under certain circumstances, no cardiac arrhythmias occur during this period. So-called event recorders help to detect the cardiac arrhythmia. There are external and implantable recorders. They automatically save cardiac arrhythmias that match a specific pattern. Some external devices only save the heart’s actions at the push of a button when the person concerned notices any abnormalities themselves.

Doctors use stress tests to check how cardiac arrhythmias behave during physical exertion. A bicycle ergometer is usually used for this purpose. In addition to the stress ECG , this examination also includes blood pressure measurement.

Under certain circumstances, the doctor supplements the examinations with a heart ultrasound (echocardiography), with which the underlying heart diseases can often be identified. An MRI (magnetic resonance imaging) is also helpful in some cases to detect diseases and structural changes in the heart.

In some cases, the doctor performs an electrophysiological study (EPU) . Using a cardiac catheter, he introduces thin electrodes to the heart via the groin vein, with which he derives an ECG directly from certain sections of the heart. In this way, the cardiac arrhythmia can not only be assessed well, but also treated directly if necessary (catheter ablation).

How dangerous are cardiac arrhythmias?

Some arrhythmias are harmless, while others are life-threatening. Arrhythmias that occur in what is known as the atrium of the heart are unpleasant, but usually not acutely life-threatening. However, some arrhythmias originate in the chambers of the heart (ventricular arrhythmia). Ventricular fibrillation or ventricular tachycardia are examples. They are life-threatening because the heart is no longer able to pump blood efficiently around the body.

In the case of ventricular arrhythmias, those affected often suffer from shortness of breath, chest pain, dizziness and paleness, but the symptoms sometimes worsen within a few minutes. In ventricular fibrillation, the body’s circulatory system quickly breaks down. It is therefore the most dangerous type of cardiac arrhythmia. It leads to a lack of pulse, fainting and respiratory failure. In the case of ventricular fibrillation, immediate resuscitation with a defibrillator is required, otherwise death will occur in a short time.

Cardiac arrhythmias in the atrium (supraventricular arrhythmias) usually do not have such a dramatic course. The cardiac skeleton acts as an electrical insulator between the atria and ventricles. If the atrial rhythm is too fast, not all beats are transmitted to the ventricles. Atrial fibrillation does not lead to rapid death, but causes tachycardia and palpitations.

Basically, cardiac arrhythmias generally have a favorable prognosis in people with a healthy heart.

Consequences of cardiac arrhythmias

If a cardiac arrhythmia persists for a long time, this may have consequences for the person affected. For example, the heart becomes weaker and weaker (heart failure). The risk of heart attacks also increases. For example, there is a risk of a heart attack because fast-beating hearts consume more oxygen. The heart muscle gets this from the coronary arteries. If these or the heart muscle itself are pathologically changed, the oxygen supply is no longer sufficient over time and there is a risk of undersupply (ischemia).

In the case of irregular and rapid cardiac arrhythmias, the blood swirls around in some places in the heart. If this condition persists, the blood clots and forms a blood clot (thrombus). If it escapes from the heart, it travels through the bloodstream to other parts of the body.

There, the vessels become narrower and narrower, so that the blood clot gets stuck and blocks the artery. As a result, the affected organ, or at least parts of it, are no longer supplied with sufficient oxygen and perish. The consequences are a stroke in the brain, a pulmonary embolism in the lungs or a kidney infarction with subsequent renal insufficiency.

prevent cardiac arrhythmia

Cardiac arrhythmias can sometimes be prevented by preventing or treating the diseases that cause them. Those who eat healthily, exercise and avoid stimulants usually automatically regulate their weight and blood sugar levels and thus prevent coronary heart disease, for example.

Those affected do not always notice cardiac arrhythmias. However, causes such as an overactive thyroid gland or altered potassium levels are easily treatable. It is advisable that people who have frequent heart palpitations or palpitations see a doctor. He not only checks the heart function, but also the blood values ​​in order to find the causes of cardiac arrhythmias.

Sexuality in cardiac arrhythmias

Many people with heart disease wonder if they can still have a normal sex life. However, these worries are usually unfounded. There are usually no medical concerns, especially in people with a well-controlled arrhythmia who can tolerate moderate exercise.

Caution is advised with certain forms of cardiac arrhythmias as long as they are not well controlled by the therapy. This applies, for example, to ventricular tachycardia triggered by physical activity. If in doubt, it is advisable for those affected to ask their doctor for an assessment in advance.

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