Cardiac arrhythmias

Introduction

Cardiac arrhythmias refer to all heart rhythm disorders, that is to say, any irregularity in the frequency or regularity of heartbeats. The heart may then beat too quickly (tachycardia), too slowly (bradycardia), irregularly, or experience extra beats (extrasystoles). These disorders result from a disruption of the electrical activity of the heart, which normally controls the harmonious contraction of the atria and ventricles. Mostly benign, some arrhythmias are vital emergencies and can cause serious complications such as stroke or heart failure.

If you feel unusual palpitations, a new shortness of breath, or a feeling of faintness, contact your primary care physician first. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: call 021 845 45 45 or use our application available on the App Store and Google Play.

Who is at risk of suffering from it?

Anyone can develop an arrhythmia, but certain profiles are more exposed. The elderly, patients suffering from high blood pressure, diabetes, sleep apnea, coronary artery disease, heart failure, or thyroid disorders are particularly vulnerable. High-level athletes may present physiological bradycardias. Atrial fibrillation is more common after age 65, while ventricular tachycardias occur mainly in the context of underlying heart disease. Stress, alcohol, tobacco, caffeine, and certain medications can also promote their occurrence.

Symptoms of Arrhythmias

Arrhythmias manifest through signs that mainly affect the cardiovascular system but can impact the entire body. Some arrhythmias are completely asymptomatic and discovered during a routine examination, while others cause marked discomfort or serious episodes.

Main symptoms

• Palpitations: conscious perception of heartbeats, which feel fast, strong, irregular, or skipped.

• Shortness of breath: feeling of lack of air during exertion or at rest, linked to a decrease in cardiac output.

• Chest tightness or pain: sometimes signals associated suffering of the heart muscle.

• Dizziness and vertigo: linked to a transient reduction in cerebral blood flow.

• Syncope: brief loss of consciousness, a warning sign requiring prompt consultation.

• Fatigue and anxiety, sometimes swelling of the lower limbs when heart failure sets in.

When to consult in an emergency?

An emergency consultation is necessary in the following situations:

• Prolonged palpitations (more than a few minutes) or particularly poorly tolerated.

• Palpitations associated with chest pain, shortness of breath, dizziness, lightheadedness, or loss of consciousness — call 144 immediately.

• Occurrence of an arrhythmia in an elderly person, a pregnant woman, a patient with a known heart disease, diabetes, or hypertension.

• Onset after a new medication or excessive alcohol consumption.

• Family history of sudden death or hereditary rhythm disorders.

What to do before calling Docadom? Contact your primary care physician first, who knows your cardiovascular history and your usual treatment. If they are unreachable or if you need a home doctor outside of opening hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of serious signs (intense chest pain, lightheadedness, loss of consciousness), dial 144 immediately.

Causes of Arrhythmias

Arrhythmias result from a disruption of the heart's electrical system. Causes can be cardiac, non-cardiac, or genetic.

Cardiac causes

These are the most common among severe arrhythmias: coronary artery disease (and myocardial infarction), heart failure, valvular heart disease, cardiomyopathies, congenital malformations, and follow-ups after heart surgery.

Non-cardiac causes

Hyperthyroidism, electrolyte imbalances (potassium, magnesium, calcium), sleep apnea, high blood pressure, diabetes, obesity, certain infections such as viral myocarditis, as well as toxic substances (alcohol, tobacco, stimulant drugs), excess caffeine, and certain medications can trigger or worsen an arrhythmia.

Arrhythmias of genetic origin

Some arrhythmias are linked to genetic abnormalities called channelopathies: long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia. Often familial, they can manifest as syncope or, in severe forms, as sudden death, sometimes in apparently healthy young individuals.

Main Types of Arrhythmias

Atrial fibrillation

This is the most common sustained arrhythmia, affecting 1 to 2% of the population and up to 10% of those over 80. The atria contract in a chaotic and rapid manner. Its main complication is the formation of clots in the left atrium, which cause strokes.

Flutter and supraventricular tachycardias

Atrial flutter shares the same risk factors and complications as fibrillation. Supraventricular tachycardias (nodal reentry, Wolff-Parkinson-White syndrome) cause episodes of palpitations with abrupt onset and offset, generally benign but often disabling.

Ventricular tachycardia and fibrillation

Ventricular tachycardia is often associated with underlying heart disease. Ventricular fibrillation prevents any effective contraction and causes cardiovascular arrest. These two arrhythmias are absolute emergencies requiring immediate defibrillation.

Bradycardias and extrasystoles

Bradycardias correspond to a rhythm lower than 60 beats per minute. When pathological, they may require the implantation of a pacemaker. Extrasystoles are extra beats, felt as a skipped beat or a flutter in the chest, most of the time benign.

Diagnosis of Arrhythmias

The diagnosis combines history taking, clinical examination, and targeted additional tests.

Diagnostic methods

• Electrocardiogram (ECG): reference examination, which identifies most rhythm disorders.

• Holter ECG: recording over 24 to 72 hours, useful for detecting paroxysmal arrhythmias.

• Event recorders and implantable monitors: for rare symptoms or unexplained syncope.

• Echocardiography: evaluates the structure of the heart and the ejection fraction.

• Stress test: useful for arrhythmias triggered by exertion.

• Electrophysiological study: invasive examination that maps electrical activity and can treat the arrhythmia through ablation.

• Laboratory workup: electrolytes, renal function, TSH, sometimes troponin and NT-proBNP.

Alternative diagnoses

Several pathologies can mimic an arrhythmia:

• Angina pectoris or myocardial infarction.

• Pulmonary embolism, which can cause sudden tachycardia and shortness of breath.

• Anxiety disorders and panic attacks, to be differentiated after a normal ECG.

• Hyperthyroidism, anemia, hypoglycemia.

Treatment of Arrhythmias

Treatment aims to relieve symptoms, restore a normal rhythm, prevent complications (notably stroke and sudden death), and treat the underlying cause.

Drug treatment

• Beta-blockers (bisoprolol, metoprolol): first choice in many tachycardias.

• Heart rate-lowering calcium channel blockers (verapamil, diltiazem).

• Amiodarone (Cordarone®): powerful antiarrhythmic for severe arrhythmias, requiring close monitoring.

• Flecainide (Flécaïne®): in atrial fibrillation without structural heart disease.

• Anticoagulants (apixaban, rivaroxaban, dabigatran, edoxaban, warfarin): essential in atrial fibrillation to prevent stroke.

Interventional procedures

• Radiofrequency ablation or cryoablation: highly effective in supraventricular tachycardias, atrial flutter, and a large proportion of atrial fibrillations.

• Electrical cardioversion: synchronized electrical shock to restore sinus rhythm.

• Emergency defibrillation to treat ventricular fibrillation.

Implantable devices and lifestyle

The pacemaker is indicated in symptomatic bradycardias and atrioventricular blocks. The implantable cardioverter-defibrillator (ICD) is placed in patients at high risk of sudden death. Lifestyle is essential: limiting alcohol, tobacco, caffeine, controlling weight, diabetes, hypertension, and sleep apnea, adapted physical activity, stress management.

Prevention of Arrhythmias

Lifestyle

• Balanced diet, rich in fruits, vegetables, and oily fish.

• Regular physical activity, at least 30 minutes a day.

• Maintaining a healthy weight; obesity is a major risk factor for atrial fibrillation.

• Smoking cessation and limiting alcohol (responsible for holiday heart syndrome).

• Limiting stimulants (coffee, strong tea, energy drinks).

• Monitoring blood pressure, blood sugar, and cholesterol.

• Screening and treatment for sleep apnea.

Medical follow-up and self-monitoring

• Annual consultation with the primary care physician, with pulse check and heart auscultation.

• Baseline electrocardiogram, especially after age 50 or in case of family history.

• Self-monitoring of the pulse for a few minutes daily, after age 65.

• Use of smartwatches and connected bands capable of detecting arrhythmias, as a complement to medical follow-up.

• Specialized cardiological assessment in case of unexplained symptoms or family history of sudden death.

Possible Complications

Stroke is the most feared complication of untreated atrial fibrillation. It manifests as sudden paralysis on one side of the body, speech difficulties, visual disturbances, or loss of consciousness, and constitutes an absolute emergency.

Other complications include heart failure linked to prolonged tachycardia (tachycardia-induced cardiomyopathy), sudden cardiac death due to ventricular fibrillation, traumatic syncopes with falls or accidents, impaired quality of life, as well as complications related to treatments (pro-arrhythmic effect, bleeding under anticoagulants).

When to Contact a Doctor for Your Arrhythmia

Any new or poorly tolerated arrhythmia requires medical advice. Here is the procedure to follow:

• As a first resort: contact your primary care physician. They alone know your treatment, your cardiological history, and your eventual anticoagulant treatment.

• If your primary care physician is unavailable (evenings, weekends, holidays), Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request via our mobile application, available for free on the App Store and Google Play.

• In case of serious signs (intense chest pain, faintness, loss of consciousness, signs of stroke), dial 144 without delay.

Conclusion: A Controlled Heart Rhythm is a Saved Life

Cardiac arrhythmias group a wide variety of rhythm disorders, from simple benign extrasystoles to vital emergencies such as ventricular fibrillation. They are characterized by palpitations, shortness of breath, faintness, or chest pain, which can lead to complications such as stroke, heart failure, or sudden death. Appropriate management — antiarrhythmic drugs, anticoagulants, ablation, pacemaker, implantable defibrillator — allows the vast majority of patients to lead a normal life.

If in doubt, consult your primary care physician first. If they are not available, Docadom provides you with an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile application (App Store, Google Play) to request an emergency consultation.

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