Arrhythmia

Arrhythmias are defined as an abnormal condition characterized by the heart having an irregular muscle contraction. Heart rhythm problems arise when the electrical impulses that normally stimulate the heart in a coordinated fashion malfunction. Consequently, the heart can be described as beating too fast, too slow, or in an irregular rhythm when arrhythmic. While most people will experience an arrhythmia at least once in their life, the consequences and underlying pathology vary greatly in severity. They can be present in the healthy heart with minimal consequences for the life of the individual or they can be an extremely serious problem that can threaten the individual, often leading to heart disease, stroke, or a sudden death.

Diagnosis of arrhythmias is often suggested from the use of a stethoscope to auscultate the heart or feeling the peripheral pulses for any deviation from normality. When an irregular heart rate is suspected from these general methods, more specific methods such as an electrocardiogram (ECG or EKG) are employed. ECGs are more specific and can also detect arrhythmias that are inaudible or impalpable in nature. For those individuals in which an unpredictable arrhythmia is suspected, a Holter monitor, or ECG used for 24-hour periods, is recommended.

[Page 160]Emergency treatment of cardiac arrhythmias is dependent on the hemodynamic status of the patient, which in turn determines the urgency of action needed. Indications of extremely urgent care include shock, hypotension, congestive heart failure, severe shortness of breath, altered level of consciousness, and chest pain. With other patients presenting with less serious symptoms, the proper management often means taking time to employ more diagnostic tests, taking a thorough medical history and performing a complete physical exam.

Arrhythmias can be caused by a variety of underlying pathologies. These include atrial fibrillation, premature atrial contraction, sinus sickness syndrome, ventricular fibrillation, premature ventricular contraction, asystole, ventricular tachycardia, junctional tachycardia, and first-, second-, and third-degree heart blocks. Depending on the cause, several routes of treatment can be undertaken from a medical and surgical perspective.

On an international scale, arrhythmias are often undiagnosed or unreported due to a lack of health-care access and the necessary technological tools for treating troublesome arrhythmias. While industrialized countries with modern healthcare technology like the United States may have the tools to treat arrhythmias and prevent adverse events, countries on the other end of the economic scale are not as fortunate. Dealing with arrhythmias, regardless of country, will require strong tools for diagnosis and an equally strong integration of the patient into the healthcare system in order to achieve behavioral changes.