Irregular heartbeat (arrhythmias)

Cardiac arrhythmias are irregular heartbeats that deviate from the normal. Affected people sometimes perceive this as stumbling or racing of the heart or as unwelcome pauses in the heartbeat sequence

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Much too fast: tachycardia can manifest itself as a racing heart

© W & B / Jörg Neisel

Cardiac arrhythmias - in short

When the heart deviates from its normal sinus rhythm, it is called an arrhythmia. There are many different types of cardiac arrhythmias, from harmless to life-threatening. Cardiac arrhythmias should therefore always be clarified by a doctor. An electrocardiogram (EKG) or a 24-hour long-term EKG helps to track down the arrhythmia. Further examinations may also be necessary. If treatment is necessary, it will depend on the type of arrhythmia.

What are arrhythmias?

The heart normally beats about 60 to 80 times per minute when the body is at rest. The electrical activity that triggers the contraction of the heart muscle is generated in the heart itself: the clock is the so-called sinus node, which is located in the upper area of ​​the right atrium. From here, the impulses pass through the walls of the atria to the AV node (atrio-ventricular node) and then via specific conduction pathways (bundles of His, fascicles in the right and left ventricles and Purkinje fibers) into the muscles of the heart.

When you get excited or do physical exertion, your pulse accelerates, while it slows down during sleep, for example. These changes are caused by the so-called autonomic nervous system, which influences the sinus node.

An irregular heartbeat sequence is called arrhythmias. Mild or occasional cardiac arrhythmias are often not noticed at all. The irregular heartbeat can also be felt as a "heart stumble" or a racing heart. It can lead to dizziness, fainting, unconsciousness, seizures as well as chest pain and tightness, in some cases even shock.

Using the cardiac current curve in the electrocardiogram (EKG), the doctor can recognize whether the heart has changed its normal, so-called sinus rhythm, into an irregular (arrhythmic) and / or too fast (tachycardia) or too slow (bradycardia) rhythm. It is important to find out the probable cause of the arrhythmia and, if possible, to correct it.

One of the most common cardiac arrhythmias: atrial fibrillation

© W & B / Jörg Neisel

causes

External causes of cardiac arrhythmias can be, for example:

• Nervousness, excitement, and fear
• Excessive consumption of caffeine (for example in the form of coffee or cola)
• Excessive consumption of alcohol
• Use of drugs and poisons
• Side effects of some medications (for example thyroid hormones or certain psychotropic drugs)
• Severe bloating (meteorism)
• Febrile infections
• Irritation of the so-called carotid sinus node: This is a receptor on the main artery in the neck, which can be irritated, for example, by a tight scarf or collar, overstretching the head or blow / pressure. The result is a sharp slowdown in the heartbeat, leading to fainting. If the carotid sinus is oversensitive, it is called the carotid sinus syndrome.

Organic causes of arrhythmias include:
• Coronary artery disease (CHD)
• Heart attack
• heart muscle diseases (cardiomyopathies)
• Inflammation of the heart muscle (myocarditis)
• Valvular heart disease
• Congenital diseases that lead to arrhythmias (for example Brugada syndrome, arrhythmogenic right ventricular disease, Wolff-Parkinson-White syndrome, WPW syndrome)
• high blood pressure (hypertension)
• Electrolyte disorders (for example, potassium deficiency)
• Overactive or underactive thyroid gland (hyperthyroidism, hypothyroidism)

Forms of arrhythmia

There are many forms of cardiac arrhythmias: A distinction is made on the one hand with irritation disturbances (disturbed formation of electrical impulses) and disturbances with faulty transmission of the cardiac excitation (impulse conduction disturbances). Arrhythmias are also divided according to their place of origin (atrium or ventricle).
Furthermore, doctors differentiate between arrhythmias with a heartbeat that is too slow (bradycardias and bradyarrhythmias, for example with atrial fibrillation with heart rates below 60 beats per minute) from those with an excessively fast heartbeat (tachycardia or tachyarrhythmia with simultaneous irregularity of the heart rhythm, for example as a result of atrial fibrillation with a heart rate of over 100 Beats per minute). Heartbeats that occur outside of the normal heart rhythm are called extrasystoles by doctors.

Examples of cardiac arrhythmias are:
• Atrial fibrillation, atrial flutter: Rapid, irregular excitation in the atrium, which leads to an irregular pulse. The result is that the atrium no longer contracts evenly. This affects the blood transport to the heart chambers, the pumping capacity of the heart decreases. In some corners, the blood flow may even stall so much that clots can form. If these leave the heart via the artery, they can migrate to the brain and trigger a stroke there.