Missed beats and wayward heart rhythms

Throbbing with wonderful precision and amazing rhythm, with its each part functioning like a well-orchestrated unit, the human heart is truly an ingenious piece of nature's creation. Contracting and relaxing to a plan from the time we are in the mother's womb to all through our life, and capable of altering its pace at a moment's notice to suit our requirements, its each beat is a symphony of sorts. But there are times when the rate and rhythm of the heart go awry, or its parts (chambers) fall out of tune. Such disorderliness of the heart-beat, rhythm or con­duction can at times upset the very rhythm of life. Yet timely therapy can often immediately set it right.

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What is the mystique of the heart's normal heart rhythm? How do its chambers co-ordinate so wonderfully?
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What is the normal rate at which a healthy heart beats?

What conditions can make the heart beat faster than normal?

Does this lead to any problem?

When is it said that the heart has slowed down? In which situation can this occur?

What abnormalities can occur in the rhythm of the heart?

What kind of ectopic rhythms affect the atria? Why do they occur? What treatment do they need?

What are the different ventricular ectopic rhythms?

What are the different forms of heart block? Why do they occur?

What conditions can lead to a heart block?

Are there any symptoms indicative of heart block?

What is the treatment?

What is the mystique of the heart's normal heart rhythm? How do its chambers co-ordinate so wonderfully?   Top  

The very basis of it all lies in the amazing ability of the heart muscles to contract rhythmically and the unique natural pacemaker system it has been endowed with.

The heart's movement is governed by special impulses originating from within this sytem.

A cardiac impulse is born in the upper part of the heart in the right atrium in an area called the sino-atrial node. From here it rapidly traverses the entire heart system. First, the wave of contraction passes through the muscle fibres of the upper chambers (atria), until it comes to a midway junction between the atria and the lower chambers (ventricles).

It then quickly spreads down a bundle of specialized heart tissues (named the bundle of His) into the ventricular tissue. The bundle splits into two parts, and ramifies the muscles of both ventricles. Following thus, the cardiac wave of contraction spreads thoughout the ventricles producing their contraction.

As long as these electrical impulses originate and travel in the ordained fashion, the heart will beat at a steady, rhythmic pace. First its upper chambers would contract, pushing blood into the lower chambers, and then the lower chambers would send the blood flowing throughout the rest of the body.

Even though at times influences from the nervous system transmitted through nerves to the S.A. node would push up or bring down the heart rate, this synchronocity would normally be maintained.

What is the normal rate at which a healthy heart beats?   Top  

For a normal person, in normal circumstances, the heart rate lies between 60 and 90 beats per minute. But frequently it varies with cardiac and body requirements, depending on the degree of activity. For instance, increased activity pushes up the demand for supplies of oxygen and nutrients and the heart has to quicken its pace to provide it. Conversely, at rest with everything having slowed down, the heart too slackens its pace.

What conditions can make the heart beat faster than normal?   Top  

This can occur in all forms of heart failure and in condi­tions with a high metabolic rate, such as fever and an over functioning thyroid.

But this may also happen in situations with no underlying cardiac or bodily disease. An excessive use of tea, coffee, alcohol, and some drugs can greatly push up the heart rate. Physical activity, anxiety, stress, and emotional upsets can do the same. So can excitement.

Does this lead to any problem?   Top  

No, if the heart rhythm does not go astray, there is usually no big worry. The treatment that is needed is of the underlying disease only, if such is present.

When is it said that the heart has slowed down? In which situation can this occur?   Top  

A heart-beat of less than 60 per minute indicates a slow heart rate. This can be a normal finding in many athletes and suggests a good cardiac reserve. But sometimes there are other causes, such as jaundice, a low-functioning thyroid (in a dis­ease named myxoedema), a build-up of increased pressure within the cranium, a recent heart attack, or an effect of a heart rate slowing medication, such as digitalis. Rarely it can occur as part of sinoatrial disease and can be so severe as to cause spells of fainting and dizziness. With it, there may be disturbances of atrial rhythm. This serious condition may require an artificial pacemaker implant (see next chapter) and anti-arrhythmic medications.

What abnormalities can occur in the rhythm of the heart?   Top  

There can be many kinds of abnormalities, or arrhyth­mias. But most result because of abnormal cardiac impulses that get triggerred ectopically, that is, from points anywhere within the heart other than its natural pacemaker. This could take place in the upper cardiac chambers, when they are named atrial ectopic rhythms or within the lower chambers, when. they are called ventricular ectopic rhythms. Each is a large group with many varying degrees of abnormalities, ranging from simple, missed, or dropped beats to life-threatening situations.

Other than these two large groups of ectopic rhythms, dis­turbances also occur along the pathway of cardiac impulses from varying degrees of blockades, resulting in a group of conditions called heart blocks.

What kind of ectopic rhythms affect the atria? Why do they occur? What treatment do they need?   Top  

There could be ectopic beats, atrial paroxysmal tachycardia, atrial flutter and atrial fibrillation. Each needs to be considered separately. Ectopic beats often cause no symptoms but can give the sensation of an extra or thumping beat. Their presence can usually be detected by a stethoscope. They can occur at any age, in either sex, and quite normally. Over-indulgence in tea, coffee, alcohol, or tobacco and mental and physical fatigue can be at the root of them. They may also occur with attacks of migraine and digestive upsets.

No treatment is necessary, other than simply reassuring oneself that all is well.

In atrial paroxysmal tachycardia the heart rate is very rapid, and it comes on in sudden bouts (paroxysms). It may last from a few seconds up to days, with the heart racing at a rate of 140 to 220 beats a minute. Although there is often no organic cause for the disorder, it is common in certain diseased states of the heart, particularly in the valve disease called mitral stenosis.

Attacks come suddenly, and may disappear quickly. The sufferer feels anxious as he realizes that his heart has suddenly started racing. He may feel faint or breathless. With prolonged attacks, increased urination may occur.

The treatment is usually simple, if no underlying organic cause exists. Many persons learn to control the attacks them­selves. Simple measures such as holding the breath, drinking iced water, or a self-induced vomiting can successfully termi­nate the attack.

Doctors often try carotid sinus massage, over one side of the neck, for a few seconds. If this does not work, a sedative and retiring to bed is all that is necessary.

If attacks are frequent or disabling, beta blocker medication and digoxin may be prescribed. They reduce the frequency of attacks or abolish them.

Atrial flutter is a condition where the atria start beating at a very rapid rate of about 300 beats a minute. Not all beats reach the ventricles, as a result of an accompanying heart block of varying degrees. The ECG is diagnostic. The treatment relies on digitalis, which is given to slow the ventricular rate. This either abolishes the attack or changes the rhythm to that of atrial fibrillation.

Atrial fibrillation is one of the commonest kinds of persistent arrhythmia in which the atria beat chaotically and ineffectively. Rheumatic mitral valve disease (see Chapter 9) is its common­est cause in young and middle-aged patients. In older patients, CAD is the usual cause. A hyperactive thyroid, a recent heart attack, and pericarditis are the other causes. Alcohol and infec­tions can provoke attacks in predisposed individuals. The condition may cause or aggravate heart failure and may end up throwing blood clots (emboli) into the circulation. Again the ECG is diagnostic. The pulse is totally irregular.

The treatment consists in treating. the cause. Digitalis comes in useful to treat the failure and slow the ventricular rate. Anticoagulant therapy is given to patients in danger of emboli. In some cases, Direct Current (DC) shock administered to the external chest wall under light anaesthetic can help restore I normal rhythm.

What are the different ventricular ectopic rhythms?   Top  

Just the same as in the atria, ectopic beats can emanate from a ventricle. Ventricular tachycardia, fibrillation, and asystole also occur.

Ectopic beats are fairly frequent in normal people, but commoner after a heart attack and in patients on digitalis. Indistinguishable from atrial ectopic beats, other than by ECG, they are usually of little importance. In patients on digitalis, their occurrence should suggest the need for a reduction in dosage. If occurring in a. patient of myocardial infarction, they need to be carefully watched.

Ventricular tachycardia generally occurs in patients with serious heart disease and may constitute a clinical emergency. The ventricles, spurred into a rapid, regular rhythm initiated by an ectopic focus, begin to beat at a rate of140 to 220 a minute. Untreated, this situation may last from seconds to days, and may cause heart failure or acute circulatory failure, particularly in patients with myocardial infarction. Generally the symp­toms in evidence are those of the infarct and a sudden rapid deterioration in the patient's condition may bring the condition to notice. A sudden drop in blood pressure, shock, fainting, breathlessness, and sweating may occur. Immediate treatment needs to be started. Lignocaine, given intravenously, proves beneficial in many cases. If it fails, a direct Current counter shock is given, using a defibrillator. A further preventive use of procainamide medication can reduce the risk of recurrent episodes.

Ventricular fibrillation is the commonest immediate cause of sudden death. It occurs commonly as a result of a heart attack, but may result from accidents such as drowning or electrocu­tion. The ventricles have a rapid, ineffective, uncoordinated movement, which causes cessation of circulation. Within seconds, the patient loses consciousness, his breathing stops and no pulse is palpable. Without treatment, death occurs shortly. When this occurs in a coronary care unit, the immediate application of DC shock can prove to be life-saving. Under other circumstances, the circulation has to be maintained by giving the victim cardio-pulmonary resuscitation.

Ventricular asystole is an even more sinister condition. It usually ends in a sudden and quick death. In patients with spontaneously terminated attacks, an artificial pacemaker may help prevent recurrences.

What are the different forms of heart block? Why do they occur?   Top  

Heart blocks are broadly categorized into three kinds: (1) Sino-atrial block, (2) Atrio-ventricular block, and (3) Bundle branch block.

In general, they occur when the normal cardiac impulses (which cause excitation of the heart tissue) fail to travel or get delayed along their pathway. Thus, a block at the sino-atrial node itself leads to a complete cardiac cycle being missed. If the delay or block is at the midway junction between the atria and ventricles, it results in varying degrees of atrio-ventricular block. Only some, or sometimes none/ of the a trial contractions find their way into the ventricles. When the conduction delay occurs at the left or right branch of bundle of His, it is called bundle branch block and produces a delay in contraction of the ventricle on the affected side.

What conditions can lead to a heart block?   Top  

There are many causes of a heart block. Most are associ­ated with a serious heart disease, myocardial infarction being the commonest. Carditis, rheumatic fever, a scar in the heart muscles, diphtheria, and an overdose of digitalis are some of the other known causes. A stimulation of the vagus nerve from stimuli such as fright, unpleasant sight, or bad news can act likewise.

Are there any symptoms indicative of heart block?

In mild, partial degrees of heart block, the symptoms may be non-existent or transient. Dropped beats may occur and unpleasant sensations in the chest reported.

But in a complete block, faintness is common, and sudden. bouts of loss of consciousness may occur, which could be serious.

What is the treatment?   Top  

A complete heart block in acute infarction requires treat­ment with medication such as isoprenaline or electrical pacing. 

In chronic heart block, the solution lies in an implantation of an artificial permanent pacemaker.

Herbal Cure for Heart - Complete Pack
Total Heart Support	Arjuna	Arjun Tea	Arjun Saar	Kumari Saar	Total Price
					Free Shipping and Handling Worldwide! No Side Effects!
2 Bottles	1 Bottle	1 Pack	4 Bottles	4 Bottles
$47.90	$ 31.00	$ 14.95	$ 75.80	$ 75.80	$ 274.55
Price after Discount 20%					$ 220.00
Buy This Pack for Just $ 220.00
Free Shipping and Handling Worldwide! No Side Effects!

Click here to buy Individual herbal products for heart care, heart herbal cure, herbs for heart