rhythm of my heart: heart rhythm disorders
DESCRIPTION
The heart is like an intricate machine—controlled by electrical impulses that must occur at regular intervals to work properly. When that doesn’t happen, the result is a rhythm disorder, also known as an arrhythmia. These abnormalities can range from common and harmless rhythms to serious and potentially life-threatening rhythms. Dr. Eric Mak, specialist in cardiac electrophysiology, discusses these conditions and their treatment methods.TRANSCRIPT
CardiacElectrophysiologyEric C. Mak, MD
Cardiology
www.SpringfieldClinic.comwww.SpringfieldClinic.com
Heart Rhythm Disorders
• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm
• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A
Heart Rhythm Disorders
• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm
• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A
Sinus Rhythm
Sinus Rhythm
Heart Rhythm Disorders
• Arrhythmias are abnormal heart rhythms, i.e. rhythms that are not sinus– They can be fast or slow– They can be symptomatic or asymptomatic– They can benign or serious
Heart Rhythm Disorders
• Common Questions– Are arrhythmias bad?– What can I do if I have an arrhythmia?– Do I have to do anything if I have an
arrhythmia?– How do I know if I have an arrhythmia?
Heart Rhythm Disorders
• Common Questions– Are arrhythmias bad?– What can I do if I have an arrhythmia?– Do I have to do anything if I have an
arrhythmia?– How do I know if I have an arrhythmia?
Heart Rhythm Disorders
• Not all arrhythmias cause palpitations
• Not all palpitations are caused by arrhythmias
How do I know if I have an arrhythmia?
Heart Rhythm Disorders
• EKG: 10 sec “snapshot”• Holter monitor: 24-48 hr• Event monitor: 1-4 weeks
• Implantable loop recorder: 3 years
Heart Rhythm Disorders
• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm
• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A
Ectopy, aka extra beats
PACs / APDsPVCs / VPDs
Ectopy, aka extra beats
• Symptoms• Prognosis• Treatment
Ectopy, aka extra beats
• Symptoms– “skipped beats”– Tired / fatigue
Ectopy, aka extra beats
• Prognosis– VERY common; everyone has a few PACs
and PVCs– Generally benign, though very frequent
PVCs (when PVCs are over 20-25% of total beats) can cause weakening of the heart
Ectopy, aka extra beats
• Treatment– Do nothing– Medicines– Procedures
Ectopy, aka extra beats
• Treatment– Do nothing– Medicines: beta blockers and calcium
channel blockers, though the side effects can sometimes be as bad or worse than the ectopy
– Procedures: very effective if the ectopic beats can be located; the more ectopic beats, the easier to locate them
Heart Rhythm Disorders
• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm
• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A
Bradycardia, aka slow heart rhythms
Sinus node dysfunctionSick sinus
Heart block
Bradycardia, aka slow heart rhythms
• Symptoms• Prognosis• Treatment
Bradycardia, aka slow heart rhythms
• Symptoms– Tired / fatigue (worse with exercise)– Shortness of breath (worse with exercise)– Fainting / passing out
Bradycardia, aka slow heart rhythms
• Prognosis• Treatment
– Do nothing– Medicines– Procedures
Bradycardia, aka slow heart rhythms
• Treatment– Do nothing– Medicines: stop medications that slow the
heart rate– Procedures: pacemaker
Bradycardia, aka slow heart rhythms
• Prognosis– Sinus node dysfunction: pacing improves
symptoms, but does not prolong life– Heart block: pacing improves symptoms
and prolongs life
Bradycardia, aka slow heart rhythms
Heart Rhythm Disorders
• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm
• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A
Tachycardia, aka fast heart rhythms
Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia
Ventricular TachycardiaVentricular Fibrillation
SVTs (Supraventricular Tachycardias)Atrial FibrillationAtrial Flutter
AVNRTAVRTAtrial Tachycardia
Ventricular TachycardiaVentricular Fibrillation
SVTs (Supraventricular Tachycardias)
• Symptoms• Prognosis• Treatment
SVTs (Supraventricular Tachycardias)
• Symptoms– Palpitations, usually starts and stops
abruptly– Sometimes with chest pain, shortness of
breath, and lightheadedness– Fainting and passing out is rare
SVTs (Supraventricular Tachycardias)
• Prognosis– Generally very symptomatic, but benign
SVTs (Supraventricular Tachycardias)
• Treatment– Do nothing: sometimes coughing, Valsalva
maneuvers can stop episodes– Medicines: adenosine given in the hospital
can often stop episodes; beta blockers and calcium channel blockers to prevent episodes at home
– Procedures: EP study and ablation
Tachycardia, aka fast heart rhythms
Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia
Ventricular TachycardiaVentricular Fibrillation
Tachycardia, aka fast heart rhythms
Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia
Ventricular TachycardiaVentricular Fibrillation
Atrial Fibrillation and Flutter
• Symptoms• Prognosis• Treatment
Atrial Fibrillation and Flutter
• Symptoms– Palpitations– Tired / fatigue– Shortness of breath
Atrial Fibrillation and Flutter
• Prognosis– Increased risk of stroke in patients with
other medical problems• Congestive heart failure• High blood pressure• Older patients• Diabetes• Prior strokes• Patients with previous heart stents• Women
Atrial Fibrillation and Flutter
• Treatment– Blood thinners / aspirin to reduce risk of
stroke– Rate Control
• Beta blockers and calcium channel blockers to control heart rate
• Ablate AV node and implant pacemaker
– Rhythm Control• Antiarrhythmic drugs• Catheter Ablation
Atrial Fibrillation and Flutter
• Catheter ablation success rates– Atrial flutter: 90%– Paroxysmal atrial fibrillation: 70-80%– Long persistent atrial fibrillation: <50% with
most patients requiring multiple procedures
• Ablation of atrial fibrillation has not been proven to reduce stroke risk, so generally need to continue blood thinners
Tachycardia, aka fast heart rhythms
Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia
Ventricular TachycardiaVentricular Fibrillation
Sudden Cardiac DeathAtrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia
Ventricular TachycardiaVentricular Fibrillation
Sudden Cardiac Death
• Symptoms• Prognosis• Treatment
Sudden Cardiac Death
• Symptoms– Cardiac arrest– Passing out without warning– But most people have no symptoms
Sudden Cardiac Death
• Symptoms• Risk Factors• Prognosis• Treatment
Sudden Cardiac Death
• Risk Factors– Cardiomyopathy– Ejection Fraction of 35% or less
Sudden Cardiac Death
• Treatment– Do nothing– Medicines: heart failure medicines (beta
blockers, ace inhibitors, statins)– Procedures: implantable defibrillator
Sudden Cardiac Death
Sudden Cardiac Death
• Symptoms• Risk Factors• Prognosis• Treatment
Sudden Cardiac Death
• Prognosis– One third of patients that meet criteria for
ICD will die within 5 years– ICDs reduce the risk of death by over half
Hearth Rhythm Disorders
• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm
• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A
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