Rhythm of My Heart: Heart Rhythm Disorders

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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.

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Rhythm of My Heart: Heart Rhythm Disorders

  1. 1. CardiacElectrophysiologyEric C. Mak, MDCardiology
  2. 2. www.SpringfieldClinic.com
  3. 3. 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
  4. 4. 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
  5. 5. Sinus Rhythm
  6. 6. Sinus Rhythm
  7. 7. 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
  8. 8. 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?
  9. 9. 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?
  10. 10. Heart Rhythm Disorders • Not all arrhythmias cause palpitations • Not all palpitations are caused by arrhythmias
  11. 11. How do I know if I have anarrhythmia?
  12. 12. Heart Rhythm Disorders • EKG: 10 sec “snapshot” • Holter monitor: 24-48 hr • Event monitor: 1-4 weeks • Implantable loop recorder: 3 years
  13. 13. 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
  14. 14. Ectopy, aka extra beats PVCs / VPDs PACs / APDs
  15. 15. Ectopy, aka extra beats • Symptoms • Prognosis • Treatment
  16. 16. Ectopy, aka extra beats • Symptoms – “skipped beats” – Tired / fatigue
  17. 17. 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
  18. 18. Ectopy, aka extra beats • Treatment – Do nothing – Medicines – Procedures
  19. 19. 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
  20. 20. 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
  21. 21. Bradycardia, aka slow heartrhythms Sinus node dysfunction Sick sinus Heart block
  22. 22. Bradycardia, aka slow heartrhythms • Symptoms • Prognosis • Treatment
  23. 23. Bradycardia, aka slow heartrhythms • Symptoms – Tired / fatigue (worse with exercise) – Shortness of breath (worse with exercise) – Fainting / passing out
  24. 24. Bradycardia, aka slow heartrhythms • Prognosis • Treatment – Do nothing – Medicines – Procedures
  25. 25. Bradycardia, aka slow heartrhythms • Treatment – Do nothing – Medicines: stop medications that slow the heart rate – Procedures: pacemaker
  26. 26. Bradycardia, aka slow heartrhythms • Prognosis – Sinus node dysfunction: pacing improves symptoms, but does not prolong life – Heart block: pacing improves symptoms and prolongs life
  27. 27. Bradycardia, aka slow heartrhythms
  28. 28. 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
  29. 29. Tachycardia, aka fast heartrhythmsAtrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia Ventricular Tachycardia Ventricular Fibrillation
  30. 30. SVTs (SupraventricularTachycardias)Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia Ventricular Tachycardia Ventricular Fibrillation
  31. 31. SVTs (SupraventricularTachycardias) • Symptoms • Prognosis • Treatment
  32. 32. SVTs (SupraventricularTachycardias) • Symptoms – Palpitations, usually starts and stops abruptly – Sometimes with chest pain, shortness of breath, and lightheadedness – Fainting and passing out is rare
  33. 33. SVTs (SupraventricularTachycardias) • Prognosis – Generally very symptomatic, but benign
  34. 34. SVTs (SupraventricularTachycardias) • 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
  35. 35. Tachycardia, aka fast heartrhythmsAtrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia Ventricular Tachycardia Ventricular Fibrillation
  36. 36. Tachycardia, aka fast heartrhythmsAtrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia Ventricular Tachycardia Ventricular Fibrillation
  37. 37. Atrial Fibrillation and Flutter • Symptoms • Prognosis • Treatment
  38. 38. Atrial Fibrillation and Flutter • Symptoms – Palpitations – Tired / fatigue – Shortness of breath
  39. 39. 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
  40. 40. 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
  41. 41. 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
  42. 42. Tachycardia, aka fast heartrhythmsAtrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia Ventricular Tachycardia Ventricular Fibrillation
  43. 43. Sudden Cardiac DeathAtrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia Ventricular Tachycardia Ventricular Fibrillation
  44. 44. Sudden Cardiac Death • Symptoms • Prognosis • Treatment
  45. 45. Sudden Cardiac Death • Symptoms – Cardiac arrest – Passing out without warning – But most people have no symptoms
  46. 46. Sudden Cardiac Death • Symptoms • Risk Factors • Prognosis • Treatment
  47. 47. Sudden Cardiac Death • Risk Factors – Cardiomyopathy – Ejection Fraction of 35% or less
  48. 48. Sudden Cardiac Death • Treatment – Do nothing – Medicines: heart failure medicines (beta blockers, ace inhibitors, statins) – Procedures: implantable defibrillator
  49. 49. Sudden Cardiac Death
  50. 50. Sudden Cardiac Death • Symptoms • Risk Factors • Prognosis • Treatment
  51. 51. 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
  52. 52. 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
  53. 53. More Resources Find videos, handouts and more resources atwww.SpringfieldClinic.com/DoctorIsIn

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