What exactly is an arrhythmia? And an electrical storm? Ventricular tachycardia, defibrillation? The Heart Rhythm Section of the Polish Cardiac Society presents the "Arrhythmia Alphabet" - a handy glossary of the most important terms in the field of cardiac rhythm disorders. It is well worth getting to know them!
Arrhythmia
i.e. heart rhythm disturbances, are either too fast (tachycardia), too slow (bradycardia) or irregular heartbeats. There are two main types of cardiac arrhythmias: supraventricular (these include atrial flutter, atrial fibrillation, atrial tachycardia, atrioventricular nodal tachycardia, atrioventricular tachyarrhythmia, sinus tachycardia) and ventricular (these include ventricular tachycardia, ventricular fibrillation, additional ventricular excitation).
Electrical storm
are at least three episodes of sustained ventricular arrhythmia occurring within 24 hours or sustained ventricular tachycardia. During an electrical storm, the patient's heart most often develops reentrant arrhythmias, or recurrent tachycardias. They can be likened to a motorboat spinning around an island in a lake. The electrical stimuli revolve around some anatomical barrier, such as a scar. Ventricular tachycardia is then produced. A rarer phenomenon is focal tachycardias - those where arrhythmias excite from only one point in the heart.
An electrical storm is a life-threatening condition. In patients who have an implantable cardioverter-defibrillator (ICD), the device usually first attempts to terminate the arrhythmia with rapid pacing of the heart (antiarrhythmic pacing). If this fails and the sustained arrhythmia still persists, high-energy discharges are applied. An ICD can successfully terminate a ventricular arrhythmia, but this is not the case in 100% cases. In the therapeutic management of electrical storm, prompt hospitalisation, precise diagnosis of the cause of the storm and the correct selection of an effective treatment method are of paramount importance.
Tachycardia
Tachycardia, also known as tachycardia, is one type of heart rhythm disturbance. In a healthy person at rest, the heart performs between 60 and 100 beats per minute. We speak of tachycardia when the heart muscle rate is accelerated to more than 100 beats per minute.
It is worth remembering that a faster heartbeat is not always a reason to panic - it may simply be a physiological reaction to strong emotions, physical activity, dehydration or the ingestion of certain substances. A cardiologist should be consulted if episodes of tachycardia recur without any identifiable cause. A visit to a specialist is also necessary if the accelerated heart rhythm persists for more than a few minutes and is accompanied by shortness of breath and chest pain.
Defibrillation
'heart reset'. Defibrillation is a medical procedure that is used as part of cardiopulmonary resuscitation. Defibrillation saves lives in situations of cardiac arrest in the course of a cardiac arrhythmia known as ventricular fibrillation. It is also performed in cases of certain ventricular tachyarrhythmias. Ventricular tachyarrhythmias: ventricular fibrillation and ventricular tachycardia are the most common causes of cardiac arrest.
Defibrillation involves passing a current through the patient's body to 'reset' the heart to restore its normal function.
A special apparatus (defibrillator), which generates electrical discharges, is used to carry out defibrillation. This equipment is available to emergency medical teams, hospital wards and emergency rooms. The defibrillator is equipped with two electrodes called "spoons", which are held by the rescuer or doctor by pressing them with sufficient force onto the patient's chest. The electrodes can also be taped to the chest in appropriate places. After analysing the heart rhythm on the device's monitor, the doctor or paramedic decides whether defibrillation should be performed.
The AED defibrillators available in public places make it possible to help anyone. The defibrillator guides the person operating it step-by-step, who only has to follow the directions - stick the resuscitated person's chest electrodes, charge the defibrillator and trigger the discharge when the AED communicates that it is indicated.
Electrophysiology and electrotherapy
fields of medicine including: diagnosis, therapy and care of patients with heart rhythm disorders. A cardiologist who specialises in the diagnosis and treatment of arrhythmias is an electrophysiological specialist.
In daily clinical practice, the electrophysiologist investigates and treats cardiac arrhythmias with: drugs, treatments (primarily ablation of the underlying arrhythmia) and therapy using implantable devices: pacemakers, cardioverter-defibrillators or resynchronisation therapy systems.
Ejection fraction
The ejection fraction (EF - ejection fraction, LVEF - left ventricle ejection fraction) is a basic parameter assessed in cardiology. It measures the efficiency of the heart and determines the volume of blood that is ejected from the left ventricle during each contraction of the heart muscle. This parameter is expressed as a percentage. Normal values are above 50%, and in most cases 60% is considered the norm. Evaluation of ejection fraction is crucial in most cardiac conditions - both for diagnostic purposes and to control disease progression and plan treatment.
Google, Doctor Google. And if not Doctor Google, then what?
What does my illness actually entail? What does it mean for me? Where can I find reliable information about it? How can I actually help rather than harm myself by finding out about diagnosis and treatment? These are questions that virtually every patient asks themselves. It is really worth trying to find reliable answers, as they can have a significant impact on the effectiveness of the treatment provided.
First and foremost, it is worth taking an interest in the studies of medical scientific societies and the content verified and authorised by their experts. For example, the Polish Society of Cardiology conducts a number of educational activities aimed at doctors and researchers, but an important area of the society's activities is also education aimed at the general public, including cardiac patients. At: https://ptkardio.pl/edukacja You will find a number of portals prepared, reviewed and, importantly, continuously updated under the guidance of cardiology specialists. Patients with a history of myocardial infarction, cardiac arrhythmia, heart failure, pulmonary embolism and familial hypercholesterolaemia, among others, will find relevant, reliable and accessible information here. This is a very important support in therapy.
Holistic treatment of arrhythmias
Cardiac arrhythmias can accompany various cardiovascular diseases, but they can also be a symptom of diseases of other systems, such as hyperthyroidism, anaemia or psychiatric disorders. Why are arrhythmias diagnosed and treated holistically? We invite you to read an interview with a specialist electrophysiologist:
https://rytmserca.ptkardio.pl/news/236-prof_rafal_baranowski_arytmie_leczymy_holistycznie
Implantation of the implantable system - and what next?
Implantation of a cardiac device is an important moment in the lives of patients with heart rhythm disorders. How do you function on a day-to-day basis with an implanted device: what is allowed and what is better avoided with an implanted cardioverter-defibrillator (ICD), pacemaker (IPG), cardiac resynchronisation therapy (CRT) device used to treat different types of arrhythmia? We recommend an article by the Heart Rhythm Section of the Polish Society of Cardiology:
How do I prepare for a teleportation? My e-visit" template
Experts from the Heart Rhythm Section of the Polish Society of Cardiology have developed a checklist for patients using e-health visits. The one-page free template will help to save the patient and doctor time and not forget anything important:
https://rytmserca.ptkardio.pl/news/213-moja_ewizyta_lista_kontrolna_dla_pacjenta_juz_do_pobrania
Cardioverter-defibrillator
(and. ICD - implantable cardioverter defibrillator) is a fully automatic device whose task is to detect life-threatening ventricular arrhythmias and terminate them. The implantable cardioverter defibrillator constantly "watches" the heart rhythm. When the heart rate is higher than the pre-set and programmed by the doctor (higher than the 'detection threshold'), the device begins to analyse the ECG features in an attempt to determine whether it is in fact dealing with a life-threatening ventricular arrhythmia. Various algorithms are used for this purpose. Their purpose is to distinguish between dangerous ventricular arrhythmias and physiological acceleration of the heart rate or less dangerous supraventricular arrhythmias. "Detection threshold" can be individually programmed for each patient. If the ICD classifies an arrhythmia as life-threatening, it begins to prepare to terminate it, i.e. to deliver therapy.
The therapy can take the form of an electrical shock (cardioversion and defibrillation) or so-called antitachyarrhythmic pacing (ATP), which involves briefly stimulating the heart chamber at a rate slightly higher than that of the arrhythmia. Which type of therapy is delivered is programmed by the doctor each time, depending on the individual needs of the patient.
Improved quality of life for "cardiac patients"
Patients diagnosed with cardiovascular conditions can live longer and enjoy a better quality of life. The prescription is a healthy lifestyle, responsibility and following doctors' recommendations. These five principles are worth keeping in mind every day:
https://rytmserca.ptkardio.pl/news/179-zyc_dluzej_i_lepiej__5_zalecen_dla_sercowcow
Atrial fibrillation
Atrial fibrillation is the most common heart rhythm disorder (arrhythmia). It is characterised by a fast, irregular heartbeat, often causing a palpitating sensation in the chest.
Atrial fibrillation affects about 1-2% of the general population, more often men, and even more than 10% in people over 80 years of age.
Typically, atrial fibrillation occurs in people who have suffered myocardial damage from chronic diseases such as hypertension, ischaemic heart disease, heart failure, diabetes, valvular defects or obesity. All of these diseases, over the years, damage the cells responsible for generating and conducting electrical impulses in the heart, which promotes the development of arrhythmias.
An attack of atrial fibrillation can be caused by electrolyte disturbances (a decrease in the concentration of potassium and/or magnesium in the blood), an episode of myocardial ischaemia (e.g. an exacerbation of coronary artery disease), as well as disorders not directly related to the cardiovascular system, such as hyperthyroidism.
Atrial fibrillation can be:
- paroxysmal, when it occurs suddenly and lasts less than 7 days (often less than 48 h) and resolves spontaneously or after treatment with cardioversion,
- persistent, when it lasts more than 7 days and resolves after treatment with cardioversion,
- persistent, when it recurs despite treatment, occurs continuously, is well tolerated by the patient and accepted by the treating physician, and the patient is taking permanent medication to prevent AF complications.
Sudden cardiac arrest
Sudden cardiac arrest (SCA) is a condition in which mechanical heart function ceases. This can be caused by an arrhythmia, which causes the electrical impulse in the heart to spread so rapidly and/or chaotically that the individual cells of the heart muscle contract and diastole at different times, with the result that the body's "pump" is unable to do its job properly and distribute the blood properly. There is virtually a cessation of the heart from the point of view of its 'hydraulics', despite the sometimes preserved electrical function. This is an immediate life-threatening condition requiring immediate intervention.
Sudden cardiac arrest can occur, among other things, as a result of ischaemia during a myocardial infarction. The deterioration or stoppage of the blood supply to the heart muscle leads to a lack of energy to work the 'pump' and to a disruption of the mechanical function of the heart, but can also affect the electrical 'control system' of the heart and lead to life-threatening cardiac arrhythmias.
Sometimes SCA occurs as a result of other abnormalities or diseases. These include, for example, genetic heart diseases that, due to ionic disorders, disorganise the electrical function of the heart and contribute to arrhythmias. Sometimes, signs of this type of disease are diagnosed in a follow-up ECG, but this is not always the case. A history of various cardiac conditions present in the patient's immediate family may be helpful. If someone close to the patient has been resuscitated or has had an implantable cardioverter-defibrillator (ICD), this is an important diagnostic clue.
Sudden cardiac arrest can also occur as a result of heart failure due to dilated cardiomyopathy. In this case, the heart is severely damaged and impaired as a result of the disease. However, SCA can also occur in an organically healthy heart - in young people, including athletes. Each case requires a detailed diagnosis aimed at eliminating the cause of SCA and preventing possible future incidents.
Syncope
Fainting, often mistaken for fainting, can be a harmless incident but also a symptom of a serious medical condition.
From a medical point of view, fainting is a transient loss of consciousness, caused by a decrease in the blood supply to the brain - also transient. A fainting spell without complete loss of consciousness is professionally referred to as a pre-fainting state. Conversely, when there is a brief but complete loss of consciousness, it is fainting.
Loss of consciousness can have various causes. They are divided into traumatic, associated, for example, with a head injury, and non-traumatic, when the loss of consciousness is not caused by any injury. In the second group, a distinction is made between syncope and other entities, such as epilepsy, epileptic seizures, so-called pseudo or psychogenic syncope, associated with psychological disorders, or rare disease entities associated with impaired blood supply to the brain due to other causes. Most commonly, however, syncope is associated with transient cerebral ischaemia.
Cardiogenic syncope is directly related to heart disease or arrhythmia. In this case, treatment will depend on the diagnosed underlying disease - we will treat the cause (the cardiac condition) rather than the symptom (which will be eliminated or significantly reduced following effective therapy for the arrhythmia or heart disease). It is worth remembering that some diseases leading to syncope can also be life-threatening, so this symptom should not be underestimated before the underlying cause is recognised.
When suspecting cardiogenic syncope, the doctor will ask the patient whether, before losing consciousness, he/she experienced a very fast or very slow heart rate, chest pain, shortness of breath. To ascertain the cause of the syncope, the doctor will recommend tests: laboratory blood tests and ECG and, in selected patients, ECHO of the heart. If necessary, further specialised diagnostics will be recommended.
Pulse
Otherwise known as the heart rate, it determines the number of heartbeats per minute, i.e. the frequency of the heartbeat. Its value is strictly defined for a healthy person and should be neither too low nor too high. Any deviation from the norm requires diagnosis, as abnormal heart rates can be a symptom of cardiovascular disease and should not be underestimated. The pulse rate depends on many factors, above all age.
How to measure the pulse correctly and what are the average indicative normal pulse values for different age groups? We recommend an article by the Heart Rhythm Section of the Polish Society of Cardiology: https://rytmserca.ptkardio.pl/dla_pacjenta/37-zmierz_rodzicom_puls
Cardiac resynchronisation
Resynchronisation, in a nutshell, involves simultaneous pacing of the right and left ventricles. This is especially important for patients with so-called left bundle branch block, a condition characteristic of patients with advanced heart failure. Left bundle branch block impairs the arrival of excitation (electrical impulses) from the atria to the ventricles. As a result, the heart chambers contract non-simultaneously, which impairs the emptying of blood from the left ventricle and also impairs valve function. As a result, heart contraction is less effective. Resynchronisation through simultaneous stimulation of both chambers corrects this defect and improves the patient's wellbeing.
In Poland, approximately 5 000 CRT devices are implanted annually. cardiac resynchronisation therapy). These are mainly cardioverter-defibrillators with resynchronisation function.
Cardiac pacemaker
The purpose of a pacemaker is to stimulate and therefore accelerate the heart rhythm, thus ensuring that the right conditions are in place to supply the body with blood. The main tasks of the pacemaker are to continuously monitor the heart and to stimulate it to work if the heart rhythm is not sufficient. The pacemaker senses the patient's rhythm and produces its electrical signals, but adapts them to the patient's heartbeat. In addition, it switches into action when the patient's heart beats abnormally (too slowly).
A pacemaker is an automatic device powered by a battery with a lifespan of about five to several years. It consists of an electrical pulse generator and wires called electrodes. The number of electrodes depends on the type of arrhythmia and disease the patient has.
Telemonitoring
Telemonitoring of implantable devices used in cardiac therapy involves the full control of the pacemaker based on modern, but widely available technology. Depending on the function of the implantable system telemonitoring device, information from the patient to the doctor is transmitted via GSM or the Internet. Some technologies even allow pacemaker control via a smartwatch.
Telemonitoring makes it possible to control not only the implanted system, but also the patient's condition. Based on the reports automatically generated by the device, the telemonitoring centre monitors the patient's condition in real time. If the patient has any doubts about his or her wellbeing, he or she can send an additional (supernumerary) report to the centre. This function is available on some systems. Staff at the telemonitoring centre can then reassure the patient that there is nothing wrong or, if necessary, instruct them to report to the hospital immediately. With telemonitoring, patient safety increases and centres can better manage their workload and resources, optimising cardiac care.
Ischaemic stroke
Stroke is a serious threat to health and life. Ischaemic strokes are the most common (85%). The risk of such a stroke increases up to fivefold in patients with atrial fibrillation, an arrhythmia characteristic of old age.
A stroke is damage to brain tissue as a result of blockage of a brain artery (ischaemic stroke) or rupture of a blood vessel (haemorrhagic stroke). As many as 85% of all stroke cases have an ischaemic background. Every second, more brain cells die, deprived of blood supply. If no treatment is given, the changes become increasingly advanced and irreversible - the stroke risks disability (paresis, paralysis) or even death.
Stroke is often referred to as the insidious - because silent - killer. Stroke can be treated effectively, but time is crucial to successful treatment. It is estimated that treatment, administered within 90 minutes of stroke onset, allows one out of four patients to return to full function. Stroke statistics are alarming. 60 000 new cases are registered annually in Poland. All scientific guidelines place great emphasis on prevention. It is worth knowing that strokes can be effectively prevented and remembering how to do it every day.
The first step in stroke prevention is to take care of your general health. Eating healthily and moving more - sounds trivial, but it's really important. It is advisable to control your weight (obesity is an important risk factor for stroke), reduce or eliminate alcohol consumption, stop smoking, avoid stress and have good dental and gum hygiene. It is a good idea to have regular checkups and monitor your own health - take your blood pressure and heart rate regularly and make sure you are not suffering from cardiovascular disease.
Wearables
small electronic body-worn devices: wristbands, watches and apps that record ECG and other vital functions and monitor physical activity. These devices can have an assistive diagnostic value, but when choosing the right model, it is worth making sure that the system has medical device status and relevant certifications.
Surgical treatment of arrhythmias
which is primarily ablation. Ablation is a cardiac procedure performed to treat arrhythmias. The purpose of ablation is to create tiny scars in the heart to stop the conduction of abnormal electrical signals in the heart. These signals cause an irregular heartbeat - an arrhythmia. There are mainly two types of these procedures in use today: RF ablation, which uses heat energy (radiofrequency current), and cryoablation - the cooling (freezing) of tissue. Other methods, such as non-thermal electroporation, are also being developed.
Substantive consultation:
Source: rytmserca.ptkardio.pl