A human heart beats 80 times per minute, on average — that can be more than 100,000 beats per day. And it all happens quietly and in a way you wouldn’t notice if your heart rhythm is normal. “Anytime someone has an awareness of their heart beating irregularly or is aware of extra beats or skipped beats — particularly if they feel their heart racing or beating very fast — it’s not normal,” says Dr. Conor D. Barrett, Cardiac Electrophysiologist and Director of the Al-Sabah Arrhythmia Institute at St. Luke’s and Roosevelt Hospitals. Basically, awareness of an irregular heartbeat could signal a heart rhythm disorder.
When the heart’s electrical system malfunctions
There are many different types of heart rhythm disorders, also called arrhythmias. When the heart’s electrical system is working properly, it produces a regular heartbeat of 60 to 100 beats per minute, which is known as normal sinus rhythm. But when the electrical system isn’t working properly, it can create chaos in the heart, sending electrical impulses in a disorganized manner and creating an irregular rapid or slow heartbeat. Atrial fibrillation (or AFib), the most common type of arrhythmia, can cause the heart rate to jump to more than 200 beats per minute.
“AFib has a spectrum of severity, with some people feeling their hearts beat abnormally for just a few seconds or a few hours, while people with longstanding persistent atrial fibrillation may experience abnormal rhythm for years,” Dr. Barrett says. “Others have no symptoms at all.”
Additional symptoms of atrial fibrillation include heart palpitations, lack of energy, shortness of breath, lightheadedness and, in rare circumstances, fainting. Anyone who has these symptoms should not attribute them to aging, Dr. Barrett stresses. “Listen to your body. If one day you can walk up the stairs with no problems and another day you are short of breath after one flight of stairs, that’s not normal,” he says. Anyone who has chest pain or shortness of breath should call 9-1-1 or go to the emergency department, he adds.
People should regularly see their primary care doctors and discuss any symptoms they have. They may then be referred to a cardiologist or a cardiac electrophysiologist for non-invasive tests that include electrocardiograms, or ECGs, which are snapshots of the electrical impulses traveling through the heart. Patients who have intermittent episodes of irregular heartbeats may take home a device called a Holter monitor that can be worn for days or weeks to record any heart rhythm disturbances and allow the doctor to evaluate them.
Determining treatment plans
“People with atrial fibrillation are more likely to develop blood clots in the heart, and therefore are at a higher risk for stroke, so we have to assess their stroke risk once they are diagnosed,” Dr. Barrett says. Many patients, especially if they are over age 75, have diabetes, high blood pressure, have had a stroke or have other types of heart or valve disease, are put on blood thinners to decrease stroke risk.
There are many medications that can help control heart rhythm, and treatment plans are individualized for each patient, depending on other complications they may have. For people who have ongoing symptoms, a minimally invasive catheter-based procedure, called catheter ablation, can eliminate the cause of atrial fibrillation. “There’s been quite a rapid evolution in the understanding of atrial fibrillation and therapies for patients,” says Dr. Barrett. “The catheter ablation procedure has revolutionized our approach to atrial fibrillation in many of our patients.” Patients should talk to their doctors to see if they are candidates for this procedure.
Causes can remain a “mystery”
AFib may have many contributing factors. A complete patient history will look at factors such as high blood pressure, coronary artery disease, heart valve disease, cardiomyopathy (a weakening of the heart muscle), pulmonary embolism, and congenital heart disease. Some people have AFib but have none of these contributing factors, often called “lone AFib.” Atrial fibrillation can affect patients of any age, but the risk for developing the condition increases with age, Dr. Barrett says.
“I see patients from their teenage years all the way up to their 90s, and one thing they always ask me is, ‘What did I do to bring this on myself?’ Oftentimes, there really is no reason for the patient to blame themselves,” Dr. Barrett says. However, anyone can benefit from leading a lifestyle that includes a heart-healthy diet with low consumption of saturated fat, exercising regularly, not smoking and managing stress.
For more information about atrial fibrillation treatment, call 1-855-411-LWNY (5969) or visit the Al-Sabah Arrhythmia Institute website.