What is AFib or AF? Atrial Fibrillation and it is the most common abnormal heart rhythm that we see. In a normal heart, the heart beats in a steady pattern, with all four chambers of the heart beating in a rhythmic pattern. In AFib, the upper chambers of the heart “fibrillate” or quiver, causing an irregular rhythm.
In a normal heart, the heartbeat is a single electrical impulse from the atria, causing the atria to contract or squeeze, moving the blood into the lower ventricles. When AFib occurs, the electrical impulse does not follow the proper order, causing many impulses from the atria and trying to get through the AV node. This can happen because:
- The heart structure and its electrical impulse pathways may change as we get older; or
- A type of trigger may develop that is an electrical circuit sending out extra impulses at a faster rate
- As the extra impulses try to push through the AV node it causes the atria to fibrillate or quiver.
Is this life threatening?
No. It can lead to symptoms that have a negative impact on quality of life, however left untreated the side effects can be life threatening, leading to stroke or heart failure.
Atrial flutter or AFL is a common abnormal heart rhythm that is a type of rapid heart beat or tachycardia which occurs above the ventricles. In this condition, the upper chambers of the heart or the atria beat too fast, resulting in muscle contractions that are out of sync with the lower chambers of the heart.
The heart has it’s own “electrical system” which is the power source that will make the heart beat. This power source consists of electrical impulses that travel through the heart making the heart pump. In atrial flutter, the power source or electrical impulse travels in a circle within the right atrium of the heart, causing the atria to beat faster than the ventricles. The heart beats fast similar to AFib, but in AFL or atrial flutter the heart beats too fast but in a regular rhythm.
Some medical conditions increase the risk for developing AFL, including:
- Heart failure
- Previous heart attack
- Valve abnormalities or congenital heart defects
- High Blood Pressure
- Recent surgery
- Thyroid problems
- Alcoholism, including binge drinking
- Chronic lung disease
- Acute (serious) illness
Without treatment, AFL can also cause a fast pulse rate for long periods of time. This means that the ventricles are beating too fast and if this occurs over long periods of time the heart muscle can become weakened. This is called cardiomyopathy. Without treatment, AFL can also cause another type of arrhythmia called atrial fibrillation or AFib which is the most common abnormal heart rhythm.
AFL in and of itself is not life threatening, however if it is not treated the side effects can potentially be life threatening as it makes it harder for the heart to effectively pump blood. With the blood moving more slowly, it is more likely to form clots, which has a chance of traveling to the brain and lead to a stroke or heart attack.
Cardiomyopathy is a condition in which the muscle of the heart becomes enlarged, thick or rigid and in rare cases the muscle tissue may have been replaced with scar tissue. Because of the thickening of the muscle it makes it harder for the heart to effectively pump blood. The heart becomes weaker and therefore it is harder to maintain a normal electrical rhythm.
This condition can result in heart failure or in irregular heartbeats or arrhythmias and can also cause other complications such as heart valve problems.
The main types of cardiomyopathy are:
- Dilated cardiomyopathy
- Hpertrophic cardiomyopathy
- Restrictive cardiomyopathy
- Arrhythmogenic right ventricular dysplasia
- Unclassified cardiomyopathy
- Stress-induced cardiomyopathy, also known as “broken heart syndrome”
Cardiomyopathy is something that can be acquired in that it can develop as the result of another disease or condition, or can have genetic predisposition and be inherited from a parent. Many times the actual cause may be unknown and it can affect all age groups.
Cardiomyopathy may exhibit no signs or symptoms and in many patients may not need treatment. But in certain cases, it develops quickly with severe symptoms and serious complications. Treatments include lifestyle changes, surgery, devices that are implanted to help control the condition, specific medicines and other nonsurgical procedures to control symptoms and prevent it from worsening.
When arteries become so clogged that the flow of blood to the heart is reduced or stopped, the lack of oxygen can damage or kill the heart muscle, causing a heart attack. Knowing the symptoms of a heart attack and getting immediate emergency treatment can limit or prevent heart muscle damage because without blood, tissue will lose oxygen and die.
Heart attacks most often occur as a result of coronary artery disease, a condition in which plaque, a waxy substance, builds up inside the coronary arteries. These arteries are responsible for carrying oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque may occur over a period of many years.
Eventually, an area of plaque can rupture inside of an artery, causing a clot to form on the plaque’s surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery. If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die and that tissue is replaced with scar tissue.
Another cause of a heart attack which is less common is a severe spasm or tightening of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren’t affected by atherosclerosis.
Taking action quickly at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment works best when it’s given right after symptoms occur. Many people aren’t sure what’s wrong when they are having symptoms of a heart attack. Some of the most common warning symptoms of a heart attack for both men and women are:
- Chest pain or discomfort. This can occur in the center or left side of the chest, last more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain and also may feel like heartburn or indigestion.
- Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach above the belly button.
- Shortness of breath. In some this could be the only symptom that they have or may coincide with other symptoms. It can occur when you are resting or doing a little bit of physical activity.
Other symptoms may include:
- Breaking out in a cold sweat
- Feeling unusually tired
- Nausea and vomiting
- Light-headedness or sudden dizziness
- Symptoms for women can vary greatly from symptoms that men may experience
Not all heart attacks begin with the sudden, crushing chest pain and symptoms may vary from person to person. If you’ve already had a heart attack, your symptoms may not be the same for another one. If you think you or someone else may be having heart attack symptoms or a heart attack, don’t ignore it or feel embarrassed to call for help. The key is acting fast in this situation.
Heart block is a condition where the heart experiences an abnormal heart rhythm where instead of it beating too rapidly it actually beats too slowly known as bradycardia. In this condition, the electrical signals that tell the heart to contract are partially or totally blocked between the upper chambers, the atria, and the lower chambers or ventricles. For this reason, this condition is also known as an AV block or atrioventricular block AV block.
There are several types of heart block:
- First-degree heart block: This is where electrical impulses slow as they pass through the conduction system, but they all successfully reach the ventricles, rarely causing symptoms or problems. No treatment is generally needed.
- Second-degree heart block (Type I) – In Type I, electrical impulses delay further and further with each heartbeat until a heart beat fails to reach to the ventricles entirely. It can cause dizziness or other symptoms and some people may only experience this during sleep.
- Second-degree heart block (Type II) – In Type II, some of the electrical impulses actually never reach the ventricles. This is more serious than Type I and can be less common. In patients with Type II your doctor will most likely recommend a pacemaker to treat type II second degree heart block, as it frequently will become a third degree heart block.
- Third-degree heart block – In third-degree heart block it is considered a complete heart block. In this condition none of the electrical impulses from the atria reach the ventricles, causing the ventricles or lower chambers of your heart to generate some impulses on their own. These impulses or junctional or ventricular escape beats are usually very slow. Symptoms may include general malaise with lightheadedness and fatigue.
- Bundle Branch Block – In Bundle Branch, the impulses slow or are “blocked” as they travel through the conducting tissue in one of the two ventricles
Some people with heart block will not experience any symptoms. Others will have symptoms that may include the following:
- Fainting (
- Dizziness or lightheadedness
- Chest pain
- Shortness of breath
For some patients with certain medical conditions, they have an increased risk of developing one of the types of heart block. These conditions includes Some medical conditions increase the risk for developing heart block. These medical conditions include:
- Heart failure or prior heart attack
- Heart valve abnormalities
- Heart valve surgery
- Certain medications
- Lyme disease
- Toxic substances – exposure
The term heart failure does not actually mean your heart has stopped. Heart failure is when your heart muscles have become too weak to effectively pump blood through the body. The chambers of your heart may be stretching more in order to try and pump blood and the kidneys may be affected by reacting to this and retaining fluid and salt. As a result, one may experience swelling in the arms, legs and feet, lungs and other organs. Early diagnosis and treatment are crucial as it can stop or slow down the worsening of heart failure.
What causes heart failure
Heart failure can be brought on by many conditions that damage the heart, including:
- Coronary artery disease. This is a disease of the arteries that supply blood and oxygen to your heart. If the arteries narrow or get blocked, your heart becomes starved for oxygen and nutrients and can’t pump as well.
- Heart attack.
- Cardiomyopathy. Damage to your heart muscle caused by artery or blood flow problems, infections, and alcohol and drug abuse. Other diseases or genetic issues can also bring it on.
- Conditions that overwork the heart. These include high blood pressure, heart valve disease, thyroid disease, kidney disease, diabetes, or heart defects you’ve had since you were born.
Types of Heart Failure
- Systolic heart failure – a condition where the muscle doesn’t squeeze with enough force leading to less oxygen in the blood.
- Diastolic heart failure – where the ventricle or main heart chamber doesn’t relax properly, lowering the amount of blood in the heart and raising the blood pressure in your lungs.
Heart valve problems can be inherited or develop on their own, affecting the heart’s ability to push blood from chamber to chamber.
Heart valves control the flow of blood into the ventricles of the heart. In healthy valves, the mitral and tricuspid valves should close when the ventricles are full to prevent blood from flowing back into the atria as the ventricles contract. As the ventricles contract, the aortic and pulmonic valves are forced open and blood is pumped out of the heart, toward the lungs, the aorta and the body. When the ventricles finish contracting and begin the relax, the aortic and pulmonic valves close shut. This process continues over and over to allow blood to be pumped throughout the body.
Two types of valve disease
- Valvular Stenosis occurs when the valve opening is smaller than normal causing the heart to overwork in order to pump blood through it. This occurs because the valve has hardened and we can see this occur in all four valves of the heart.
- Valvular Insufficiency or regurgitation, is caused by a leaky valve or one not closing properly. This causes the heart to have to work extra hard to make up for the leaky valve and results in less blood flow throughout the body. You can see the valve insufficiency in any of the four valves of the heart.
Causes of valve disease
Problems and valvular disease can be congenital and even develop before birth or may occur over time. Sometimes the actual cause is unknown.
Congenital valve disease we usually see only in the pulmonic or aortic valve, resulting in valves that have malformed leaflets or valves that are the wrong size.
Bicuspid aortic valve disease is a congenital valve disease that affects the aortic valve. Instead of the normal three leaflets or cusps, the bicuspid aortic valve has only two making the valve either stiff or leaky.
Acquired valve disease.
- Rheumatic fever may cause heart problems that appear 20 – 40 years after the infection. The infection is usually seen in children, but later in life the heart valves can become inflamed causing the leaflets to stick together or become rigid. It can also lead to mitral regurgitation.
- Endocarditis is a condition where bacteria or other germs have traveled in the blood stream and attack the heart valves, leading to leaky valves. This is a life threatening infection and people with valve disease, especially mitral valve prolapse are at increased risk especially during dental procedures, surgery or those with severe infections.
There are many other changes that can occur to the valves of the heart leading to stiff or leaky valves.
Mitral valve prolapse (MVP) is a very common condition, affecting 1 to 2 percent of the population where the mitral valve does not close completely during contraction. The condition rarely causes symptoms and usually doesn’t require treatment.
Other causes of valve disease include: coronary artery disease, heart attack, cardiomyopathy, hypertension, syphilis, aortic aneurysms, and connective tissue diseases
Hypertension, also known as High Blood Pressure, is a long term medical condition where the blood pressure in the arteries is elevated on a persistent basis. It is caused by a mix of genetic factors or family history and environmental factors.
Many patients may have had it for years without any symptoms which is why it can be referred to at times as the silent killer because it is damaging to the heart and organs but there may be no noticeable symptoms. It is the long term high blood pressure that is so dangerous to patients. It can be a major risk factor in the development of stroke, heart attack, kidney disease, peripheral artery disease, coronary artery disease and even vision loss.
Rarely will patients experience symptoms so annual physicals and check ups are crucial as blood pressure monitoring will reveal changes in a patients’ blood pressure and can allow for the monitoring of any increases. There are two readings in blood pressure, diastolic and systolic. This reading you are familiar with hearing 120/80 which is diastolic over systolic. The normal range for diastolic is between 100 and 140 and the normal range for systolic is between 60 and 90. When the numbers exceed these ranges it is considered high blood pressure.
- Secondary Hypertension – this is hypertension which occurs secondary to other conditions or disease such as hyperthyroidism or coarctation of the aorta which causes decreased blood pressure in the lower extremities.
- Hypertensive Crisis – this is when the top number is 180 or over and the lower number is 110 or over. This can be lowered with medications but if it lasts over a certain amount of time it can lead to organ damage.
- Pregnancy – some pregnant women develop pre-eclampsia or gestational hypertension and can occur in 8 to 10% of pregnancies. In these pregnancies, health of the mother and baby are crucial and monitoring and careful management are very important.
Regular monitoring of a patients blood pressure along with life style changes and/or medication can lead to the control of high blood pressure and reducing the risks associated with high blood pressure and long term high blood pressure. These life style changes may include: weight loss, changes in diet, reduction of salt intake, increase in fresh vegetables and fruits, exercise, stress reduction and limited alcohol intake.
Premature ventricular contractions (PVC) are abnormal or extra heart contractions or heartbeats that occur in the lower pumping chambers of the heart or ventricles. Extra, early, or “skipped” beats are the most common cause of irregular heart rhythms and feel like a flip flop or skipped beat. These are very common and can occur at some point in ones lifetime. Premature ventricular contractions may also be referred to as:
- Premature ventricular complexes
- Ventricular premature beats
In a patient that is generally healthy and not experiencing any symptoms or fatigue, with occasional premature ventricular contractions there is generally no cause for concern and no treatment is necessary. However, if a patient is experiencing these on a frequent basis, it is usually recommended investigation into the underlying cause of the PVCs and treatment to make the patient feel better.
Symptoms of this condition include:
- Heart “flip flops”
- Pounding or jumping
- Skipped beats
- Increased awareness of your heart beat
The reasons aren’t always clear why this condition occurs or begins to accelerate. Risk factors may include:
- Physical changes in the body due to genetics or aging
- Increased adrenaline through consumption of caffeine, other stimulants, nicotine, exercise or anxiety
- Drugs and alcohol
- Congential heart defects or heart conditions/diseases such as high blood pressure, etc.
- Certain medications
A treatment plan will be set forth with your doctor and their recommendations. This may include:
- Lifestyle changes
- Ablation therapy
Sick sinus syndrome SSS is not a disease but is a group of symptoms indicating that the sinus node or the heart’s natural pacemaker is not functioning properly. It is a relatively uncommon heart rhythm disorder where someone has a slow heart rhythm, one that is too fast, or one that alternates between the two. Patients with a slow heart rhythm have what is called bradycardia and those with a heart rhythm that is too fast have what is called tachycardia.
The sinus node is a specialized group of cells in the upper chamber of the heart, the atria, that creates electrical signals that regulate the pace and rhythm of the heartbeat. Normally, the signals occur in a regular, steady pattern but with SSS the pattern is irregular. Sometimes it may be caused by a defect in the heart or other factors.
In most patients, there are no symptoms but in others they may experience:
- Slower than normal pulse
- Fainting (syncope)
- Shortness of breath
- Chest pain
- Sleep problems and confusion
- Heart racing, pounding, or fluttering
While the exact cause of SSS is unknown, there are some contributing factors:
- Previous heart attack
- Medications – high blood pressure or other heart diseases
- Hyperkalemia (too much potassium in the blood)
- Heart surgery
- Sleep apnea
- Thyroid disease
In rare cases, SSS may be associated with conditions such as:
- Diphtheria – can damage the heart muscle
- Muscular dystrophy
A harmless faster rhythm, sinus tachycardia is a normal increase in heart rate that happens with fever, excitement, and exercise. There is no need for treatment, except in rare cases when it is caused by an underlying problem, such as anemia (low blood count) or hyperthyroidism (overactive thyroid gland).
Strokes (brain attacks), although not true heart disorders, are caused by blockage or reduced blood flow to the brain. While some strokes occur when a blood vessel bursts, most happen due to clogged or blocked vessels to the brain, in the same way clogged vessels in the heart can cause a heart attack. Abnormal heart rhythms such as atrial fibrillation and atrial flutter can lead to the formation of blood clots in the heart. When dislodged, a blood clot can travel to the brain, block a vessel and cause a stroke. All strokes pose serious health threats and immediate emergency medical attention should be sought.
There are three types of strokes:
- Ischemic strokes
- Hemorrhagic strokes
- Transient ischemic attacks (TIAs), or mini-strokes
- Ischemic stroke: this is the most common, occuring in aroundn 85 percent of strokes. It is caused by blockages or narrowing of the arteries that provide blood to the brain, resulting in reduced blood flow that damages brain cells. Many times caused by clots forming in the arteries int he brain or other blood vessels before dislodging and moving through the blood into the narrower arteries in the brain causing the blood flow to reduce dramatically to the brain. We also see plaque from fatty deposits in the arteries causing clots.
- Hemorrhagic stroke: is bleeding in the brain and the stroke is caused by arteries in the brain leaking or bursting open, with the leaking blook putting pressure on brain cells and damaging them. These ruptures can be caused by hypertension, trauma to the brain, blood thinning medications and aneurysms.
- Transient ischemic attack or TIA: are different than 1 and 2 because in a TIA or mini stroke the blood to the brain is only interrupted briefly. They are often caused by clots and should still be regarded as an immediate medical emergency as with all other types of strokes. Patients who experience a mini stroke or TIA will have a greater chance of experiencing a full blown stroke at a later date.
- Numbness in the body, particularly one side
- Inability to move limbs or slurred speech
- Trouble seeing or trouble walking
- Difficulty speaking
- Face drooping, especially on one side
Treatment depends on the particular type of stroke that occured. Treatment protocols may include surgery, medications, therapy, lifestyle changes, physical therapy, rehab and more. Support groups and therapy are important in managing the affects of a stroke in patients
Because a stroke can cause so much damage, prevention can be a key in reducing your risks:
- Don’t smoke
- Maintain a healthy weight
- Monitor and control blood pressure and hypertension
- Avoid alcohol or drink in moderation
- Exercise regularly
- Watch stress levels
- Consume a diet full of fresh fruits and vegetables, whole grains, nuts and seeds and healthy fish oils and olive oils. Consume healthy, lean proteins and dairy and watch salt intake and consume adequate amounts of water daily. Avoid or greatly limit fast food, fried foods, snack foods and highly processed luncheon meats.
Syncope or fainting is a temporary loss of consciousness as a result of lack of blood flow to the brain. It typically occurs as a result of low blood pressure and the brain is not getting enough oxygen.
It can be caused by very benign conditions to those that are life threatening.
Non-threatening conditions that cause Syncope:
- Being overheated
- Heavy sweating as a result of hard work outdoors or strenuous exercise
- Blood pooling in lower extremities due to a certain sitting position and faint upon standing
Serious conditions that may cause Syncope as a symptom of the disease:
- Fast or slow heart palpitations – bradycardia or tachycardia
Neurally mediated syncope is the most common form of fainting and a frequent reason for emergency department visits. It’s also called reflex, neurocardiogenic, vasovagal (VVS) or vasodepressor syncope. It’s benign and rarely requires medical treatment. It is typically seen in children and young adults. It is caused by the nervous system that regulates blood pressure reacting to pain or emotional stress. NMS typically happens while standing and is often preceded by a sensation of warmth, nausea, lightheadedness, tunnel vision or visual “grayout.” Placing someone in a reclining position restores blood flow and consciousness, and ends the seizure.
Cardiac or cardiovascular syncope is caused by various heart conditions, such as bradycardia, tachycardia or certain types of hypotension. It can increase the risk of sudden cardiac death. People suspected of having cardiac syncope but who don’t have serious medical conditions may be managed as outpatients. Further inpatient evaluation is needed if serious medical conditions are present.
Sudden cardiac arrest caused by ventricular fibrillation is the cause of half of all cardiac deaths. In VF, the heartbeat is fast and chaotic, causing the lower heart chambers, or ventricles, to spasm. Sometimes, a heart attack (blockage of the heart pipes/arteries) can lead to VF. VF is sudden, happens without warning, and stops the heart from working. The lack of oxygen to the body, especially to the brain, is deadly.
Sudden cardiac arrest is caused by an electrical problem. It is not the same as a heart attack (myocardial infarction), which is a circulatory (plumbing) problem caused by clogged blood vessels that cut off the supply of blood to the heart. Though CPR may help, the only truly effective VF treatment is defibrillation, which uses paddles or electrodes to “shock” the heart back to normal rhythm. Without treatment, the person with VF will pass out suddenly and die.
The most common signs of ventricular fibrillation are sudden collapse or fainting, because the muscles and brain have stopped receiving blood from the heart. About an hour before VF a person may experience:
- Tachycardia, heart palpitations
- Pain in the chest
VFib vs AFib
Ventricular fibrillation is more serious than atrial fibrillation. VF results in loss of consciousness and death, because ventricular arrhythmias are more likely to interrupt the pumping of blood, or undermine the heart’s ability to supply the body with oxygen-rich blood. VFib can cause sudden cardiac death which can kill a victim in minutes, and it can occur even in people who seem healthy.
- Previous VF
- Previous heart attack
- Cocaine or methamphetamine use
- Congenital heart disease, or being born with a heart defect
- Electrocution or other injuries causing heart muscle damage
Heart attack is the most common cause of ventricular fibrillation.
This usually occurs in emergency situation as the patient has lost consciousness. Tests include:
- Heart monitor
- Electrocardiogram (EKG)
- Cardiac enzyme test
- Chest x-ray
- Nuclear scan
- Angiogram or coronary catherization
- MRI or CT scan
Immediate focus on restoring blood flow to the brain through:
- Preventing recurrence
- Implantable cardioverter defribillator
- Bypass surgery
- Ventricular tachycardia ablation
A life-threatening arrhythmia, ventricular tachycardia is usually seen along with other serious heart disease but sometimes happens in people with normal hearts. Because VT can lead to ventricular fibrillation (a dangerously fast and disorganized heartbeat), it is a serious condition that needs aggressive treatment and follow up. VFib is a leading cause of sudden cardiac death.
The cause is sometimes not known in VT, especially in young people. In most cases, it is caused by previous heart attack, myocarditis, congenital heart defect, cardiomyopathy or may occur after heart surgery. There are rare cases where it is caused by genetic inherited problems, such as long QT syndrome. It may also be cause by low potassium levels or electrolyte imbalance, or medicines and certain nonprescription medicines including over the counter decongestants, diet pills, herbal (ma huang or ephedra) or illegal drugs like cocaine that are stimulants.
Symptoms include a rapid heart beat resulting in not enough oxygen rich blood reaching the rest of the body. Because of this VT can be life threatening.
- Sense of rapid heart beat
- Shortness of breath
- Chest pain
- Pressure in the chest
- Near-fainting or fainting (syncope)
- Weak pulse
- No pulse
VT is dangerous if it last more than a few seconds as it can turn into VF or ventricular fibrillation, which causes sudden death.
- Implantable defibrillator