What is Dysrhythmia?

Cardiac dysrhythmias are a problem with the rate or rhythm of your heartbeat caused by changes in your heart’s normal sequence of electrical impulses. Your heart may beat too quickly, called tachycardia; too slowly, bradycardia; or with an irregular pattern. Dysrhythmias can range from completely harmless to life-threatening (without proper treatment).

Minor dysrhythmias can occur in a perfectly healthy heart. Other causes of dysrhythmia include:

• Heart disease
• An electrolyte imbalance (such as sodium and potassium)
• Changes to the heart muscle
• Injury from a heart attack
• Healing after heart surgery

There are many dysrhythmia types –with different causes, symptoms and treatment needs. The most common is atrial fibrillation (AF), which occurs when the upper chambers of the heart, or atria, fibrillate. This means that they beat very rapidly and irregularly. Therefore, blood is not pumped efficiently to the rest of the body.

Others include:

• Accessory pathway tachycardia
• Atrial flutter 
• AV nodal reentrant tachycardia 
• Brady-dysrhythmias 
• Heart block 
• Long QT syndrome 
• Paroxysmal supraventricular tachycardia (PSVT)
• Premature atrial contractions 
• Premature ventricular contractions (PVCs) 
• Sinus node dysfunction 
• Ventricular fibrillation 
• Ventricular tachycardia 

Baptist Health is known for advanced, superior care for patients with heart disease and the diagnosis, management and treatment of dysrhythmia. You will appreciate timely appointments and respectful attention to your concerns, all in a positive and friendly atmosphere. At Baptist Health, you have access to the region’s most comprehensive, multidisciplinary team of specialists and innovative therapies, including many available only through specialized clinical trials. In every way, we work to demonstrate the utmost in excellent care to those who trust us with their health.

The Difference Between Arrhythmia vs. Dysrhythmia

Both arrhythmia and dysrhythmia refer to an abnormal rhythm of your heartbeat. If you experience an arrhythmia, the rhythm of your heartbeat is too fast or too slow. If you experience dysrhythmia, the rate of your heartbeat is irregular, but it's still within a normal range. Both conditions require treatment to prevent complications that can become severe if left untreated.

Heart Arrhythmia (Dysrhythmia) Signs and Symptoms

Dysrhythmia symptoms can vary from silent to severe. That’s why regular checkups are so important. Symptoms like these may be noticed on a regular basis or every once in a while:

• Chest pain or tightness
• Dizziness or lightheadedness
• Fainting
• Palpitations – a feeling of skipped heartbeats or fluttering
• Pounding in the chest
• Shortness of breath
• Weakness or fatigue

Heart Arrhythmia (Dysrhythmia) Diagnosis

Early diagnosis is critical for more severe dysrhythmias, such as atrial fibrillation or Long QT syndrome. To determine if a patient has dysrhythmia, and identify the type, we use advanced technology to effectively diagnose, inform treatment and carefully monitor the condition. Diagnostic procedures and technologies can include:

Echocardiogram: This ultrasound exam uses soundwaves to take moving pictures of the heart’s chambers and valves.

Electrocardiogram (EKG): This test measures the electrical activity of the heart and can help determine if parts of the heart are enlarged, overworked or damaged. The heart’s electrical currents are detected by 12 to 15 electrodes that are attached to the arms, legs and chest via sticky tape.

Electrophysiology study: This test records the heart’s electrical activities and pathways. It can help find what’s causing heart rhythm problems and identify the best treatment. 

Event monitor: This portable EKG device records the heart rate when a button is pressed. It can be worn for weeks or until symptoms occur.

Holter monitor: This portable EKG device continuously records the heart’s rhythms and is worn for 24 to 48 hours during normal activity.

Stress testing: This test is conducted during exercise. If a person can't exercise, medicine is given to increase heart rate. Used along with an EKG, the test can show changes to the heart’s rate, rhythm or electrical activity as well as blood pressure. Exercise makes the heart work hard and beat fast while heart tests are administered.

Tilt table test: This test helps determine what’s causing fainting spells. It measures the difference in heart rate and blood pressure when someone is standing up or lying down. The patient lies on a stretcher, tilted at different angles while getting an EKG and blood pressure and oxygen level monitoring.

Heart Arrhythmia (Dysrhythmia) Causes

The following can lead to dysrhythmia development:

• A high-fat diet
• Certain OTC and prescription drugs or supplements
• Coronary artery disease (blockage in the arteries)
• Diabetes
• Drug abuse
• Excessive use of alcohol (more than two drinks per day)
• High blood pressure
• High cholesterol
• Obesity
• Sleep apnea
• Smoking
• Stress

Risk Factors

Risk factors that could contribute to dysrhythmia include:

Advancing age: People over the age of 60 are more likely to develop dysrhythmia.

Congenital heart defects: Certain structural or functional heart problems may be present at birth.

Family history: Some cases of heart disease or conditions like Long QT syndrome can run in families.

Previous heart attacks or surgeries: Damage to the heart can weaken the muscle and affect its electrical system.

Prevention

While some risk factors like age and heredity cannot be controlled, there are ways you can help to prevent certain dysrhythmias or risks associated with those dysrhythmias:

Avoid triggers: If you have dysrhythmia, avoid caffeine, alcohol, certain cold and cough medications, appetite suppressants, beta blockers and psychotropic drugs. Ask your physician for a list of these triggers.

Be careful with supplements: Tell your physician about any vitamins or supplements you’re taking to be sure they don’t interact with treatment medications. 

Get regular checkups: And, if you experience new or changing symptoms or side effects from medications, see your physician.

Monitor your pulse: Put the second and third fingers of one hand on the inside of the wrist of the other hand, just below the thumb or on the side of your neck, just below the corner of your jaw. Count the number of beats you feel in one full minute. Keep a record of this to share with your physician so you can determine if you’re experiencing a fast or slow heart rate.

Practice good heart health: Watch what you eat, exercise and avoid smoking.

Take your medications as prescribed:  If you’ve been prescribed a medication to control your dysrhythmia, be sure to take it as prescribed. if you have high blood pressure, high cholesterol or diabetes, check with your physician to ensure you’re taking the best medications to manage each condition.

Heart Arrhythmia (Dysrhythmia) Prognosis

Prognosis varies depending on the type of dysrhythmia and if coronary artery disease, valvular heart disease or heart failure are present.

Many dysrhythmias are considered harmless and are left untreated. The availability of permanent pacemakers, implanted cardioversion/defibrillation devices and effective medications has improved the prognosis for many people with serious cardiac dysrhythmias.

Treatment and Recovery

Treatment for dysrhythmia depends on its type, cause, the presence of heart disease and your overall health. It can include:

Procedures

• Vagal maneuvers: You may be able to stop certain dysrhythmias, like supraventricular tachycardia, by using maneuvers that include holding your breath and straining, dunking your face in ice water or coughing. These actions affect the vagus nerves that control your heartbeat, often causing your heart rate to slow.
• Cardioversion: For certain dysrhythmias – like atrial fibrillation – your physician may treat you with this procedure, during which a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses and can restore a normal rhythm.
• Catheter ablation: For this procedure, your doctor will thread one or more catheters through your blood vessels to your heart. Electrodes at the catheter tips use heat, extreme cold or radiofrequency energy to damage (ablate) a small spot of heart tissue and create an electrical block along the pathway that’s causing your dysrhythmia.
• Device implantation: You may be a candidate for a pacemaker or implantable cardioverter-defibrillator (ICD). A pacemaker is a small device placed under the skin near the collarbone in a minor surgical procedure. A wire extends from the device to the heart. If a pacemaker detects an abnormal heart rate, it emits electrical impulses that stimulate your heart to beat at a normal rate.

An ICD is a battery-powered unit implanted under the skin near the collarbone, like a pacemaker. One or more electrode-tipped wires from the ICD run through veins to the heart. If it detects an abnormal heart rhythm, it sends out low- or high-energy shocks to reset the heart rhythm. Your physician may recommend this device if you have a high-risk dysrhythmia like ventricular tachycardia or ventricular fibrillation or if you’ve had sudden cardiac arrest.

Medication 

For many types of tachycardia, you may be prescribed medication to control your heart rate or restore a normal heart rhythm.

If you have atrial fibrillation, your physician may prescribe blood-thinning medications to help keep dangerous blood clots from forming, putting you at risk for a stroke.

Surgery 

• Maze procedure: During this procedure, a surgeon makes a series of incisions in the upper half of your heart (atria) to create a pattern (or maze) of scar tissue to interfere with stray electrical impulses that cause some types of dysrhythmia. The procedure is very effective, but it is usually reserved for people who don’t respond to other treatments or for those who are having heart surgery for other reasons.
• Coronary artery bypass grafting (CABG): This surgery improves blood flow to your heart by creating a bypass around your narrowed coronary arteries using arteries or veins taken from other parts of your body.

Recovery After Surgery

For the maze procedure, recovery takes about four weeks and most patients take a blood-thinning medication for about 12 weeks after surgery.

For coronary bypass surgery, you will recover first in the intensive care unit and then the hospital for three to five days. Recovery at home then takes an additional six weeks or more. 

Complications

Many dysrhythmias are mild and don’t cause complications. However, more serious arrhythmias can raise the risk of severe, and even life-threatening, complications, such as:

Congestive heart failure: If the heart rhythm is abnormal for an extended period of time, the heart muscle may become weak and fail to pump blood efficiently throughout the body.

Fainting (syncope): A heart that’s out of rhythm may not be able to pump blood efficiently to the brain. If this occurs, a person may faint and sustain injuries during the fall.

Stroke: Certain dysrhythmias, like atrial fibrillation, can cause small blood clots to form in the heart. If these clots break loose and move through the bloodstream to the brain, they could cause a stroke. Risk of stroke depends on age, type of dysrhythmia and whether any other cardiovascular risk factors for stroke, such as high blood pressure, are present.

Sudden death: Ventricular dysrhythmia in people with structural heart disease — such as a weakened heart muscle from a previous heart attack — or undetected Long QT syndrome can lead to sudden cardiac arrest and death.