Arrhythmias - Common Forms

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Arrhythmias - Common Forms
Arrhythmias - Common Forms
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Video: Cardiac Arrhythmias 2023, February
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Arrhythmias: Common forms

Arrhythmias can be harmless or a sign of another disease. If left untreated, severe forms can lead to the development or worsening of heart failure in the long term or increase the risk of stroke and cardiovascular arrest. There are very different types of cardiac arrhythmias and numerous possibilities of classification.

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  • ">What types of cardiac arrhythmias are there?

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  • Extrasystoles
  • Atrial fibrillation and atrial flutter
  • Conduction disorders
  • Tachycardias
  • Ventricular flutter, ventricular fibrillation and cardiovascular arrest
  • Special forms

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Arrhythmias can affect different areas of the heart, make the heart rate faster or slower, and have a variety of causes. They are therefore characterized according to the following criteria:

Place of origin

  • ventricular arrhythmia: in the ventricle,
  • supraventricular arrhythmia: in the atria or in the AV node.

Effects on the heart rhythm

  • Acceleration of the heart rhythm (tachycardia): The pulse is over 100 beats per minute. Tachycardia can also occur in healthy people who are very agitated or exerted.
  • Slowing of the heart rhythm (bradycardia): The pulse is less than 60 beats per minute. Bradycardia also often occurs in healthy competitive athletes.

Cause of the arrhythmia

  • Irritation disorder: The problem lies in the sinus or AV node.
  • Conduction disorder: The problem lies in the transmission of impulses.

What types of cardiac arrhythmias are there?

The most common cardiac arrhythmias are extrasystoles, atrial fibrillation, certain conduction disorders, supraventricular tachycardias, much less often ventricular fibrillation and cardiovascular arrest.

Extrasystoles

Extrasystoles are heartbeats that occur prematurely and are not caused by impulses from the sinus node but from the atrium (supraventricular extrasystoles, SVES) or the ventricle (ventricular extrasystoles, VES). These heartbeats disrupt the normal sinus rhythm and are noticeable as "heart stumbling" or "dropouts" in the heartbeat. Extrasystoles also occur in people with healthy hearts as an unpleasant but basically harmless phenomenon. Occasionally, temporary extrasystoles are triggered by stress, excitement, consumption of alcohol or coffee, fever or disturbances in mineral concentration. Usually no treatment is required.

On the other hand, extrasystoles that arise as a result of cardiovascular disease (e.g. coronary artery disease, cardiac muscle disease or heart failure) must be taken seriously. The exact cause should be identified and the underlying condition treated. Therapy of the extrasystoles themselves is usually not necessary.

Atrial fibrillation and atrial flutter

Tissue damage in the heart can disrupt the conduction. The excitation wave emanating from the sinus node only affects part of the atrial muscles, while other areas are not yet excited. The excitation wave then not only travels via the AV node in the direction of the heart chamber, but also to the not yet excited atrial muscle cells. This can create a circular wave of excitation within the atrial muscles.

In the case of atrial flutter, this circular excitation also leads to pumping actions of the atrial muscles. In atrial fibrillation, various waves of excitation circle chaotically within the atria, beating too quickly, irregularly and in an uncoordinated manner. Sufficient blood can no longer be pumped into the circulation. This is often not completely ejected from the heart, so that blood clots (thrombosis) and, as a result, embolisms or strokes can form. The ventricles can only compensate for this decline in performance for a short time. Over time, prolonged overload can lead to cardiac insufficiency (heart failure).

Atrial fibrillation is one of the most common persistent cardiac arrhythmias, especially in older people. Around four percent of those over 60 and ten percent of those over 80 are affected. Atrial fibrillation is usually not an acute danger, but it is a progressive, ie worsening, and potentially dangerous disease that sometimes causes massive discomfort: Those affected have an increased risk of death because they are more likely to have a stroke, heart failure or cardiovascular arrest suffer.

Depending on the duration, a distinction is made between different forms of atrial fibrillation, which can merge into one another in the course of the disease:

  • Paroxysmal atrial fibrillation: occurs repeatedly and repeatedly, lasts a maximum of seven days and stops on its own.
  • Persistent atrial fibrillation: lasts more than seven days and doesn't stop on its own.
  • Permanent atrial fibrillation: lasts more than six months.

Conduction disorders

The normal course of excitation from the sinus node via the atria to the AV node and from there via the two Tawara legs to the muscles of the heart chambers can be delayed in different places (first degree block), temporarily interrupted (second degree block) or completely blocked (block III degree). Depending on the location of the disorder, different forms of conduction disorders are distinguished.

  • Sinus atrial block (SA block): The electrical impulses are not properly directed from the sinus node to the atrial muscles.
  • Atrioventricular block (AV block): The electrical impulses from the atria do not reach the ventricles properly.
  • Thigh block (intraventricular block): The disturbance of the impulse conduction lies in the Tawara thighs within the heart chambers.

Tachycardias

Tachycardias are arrhythmias with a rapidly accelerated heartbeat (over 100 beats per minute). A distinction is made between two main forms:

  • Supraventricular tachycardias: The impulse for the accelerated heartbeat arises in the area of ​​the sinus node, the atria or the so-called AV node. The heart suddenly starts beating very quickly, 150 to 220 times per minute. Such an attack of palpitations can last a few seconds or several hours and then sometimes disappear suddenly.

    Paroxysmal, ie tachycardias that occur in attacks, often occur in young, healthy people, can recur throughout their lives, and are rarely dangerous, but unpleasant. In people who already have heart disease, the supraventricular tachycardia can lead to angina pectoris, dizziness or loss of consciousness - treatment is therefore necessary.

  • Chamber tachycardia (ventricular tachycardia): The impulse for the accelerated heartbeat arises in the area of ​​the heart chambers. The most common cause is a serious heart disease, such as a heart attack. There are rapid, uncoordinated pumping movements of the ventricles and atria. The arterial blood pressure drops, and adequate blood flow in the body is no longer guaranteed. The situation can become life-threatening and requires immediate medical care, if possible in hospital.

Ventricular flutter, ventricular fibrillation and cardiovascular arrest

The transitions from ventricular tachycardia to ventricular flutter and fibrillation are fluid. With ventricular flutter the heart beats about 250 times per minute, with ventricular fibrillation more than 320 times per minute. The heart can then no longer pump blood into the circulation - for the body this is like a cardiovascular arrest. The patient becomes unconscious. Resuscitation measures must be initiated immediately to save his / her life. For more detailed information, see Emergency: Cardiac Arrest. The emergency doctor must be called immediately. Ventricular fibrillation is the leading cause of sudden cardiac death. Survivors are implanted with a defibrillator to deliver an electric shock if ventricular fibrillation recurs.

Special forms

  • Sick sinus syndrome: Alternating rhythm disturbances (irritation and conduction disorders of the sinus node), with occasional occurrence of atrial fibrillation and an irregular heartbeat that is generally too slow or does not increase under stress (bradycardia) with too high heart rates (tachycardia).
  • Carotid sinus syndrome: Certain sensory cells (receptors) check the blood pressure in many parts of the body and ensure that the heart rate and blood pressure are flexibly adapted to the respective needs. In the carotid sinus syndrome, the blood pressure receptors at the dividing points of the carotid artery (on both sides of the neck at about collar height) are overexcitable. This hypersensitivity of the carotid sinus is congenital in rare cases, but usually only occurs in old age (especially in men over 50 years of age). External pressure is interpreted as too high blood pressure and leads to a sudden drop in heart rate up to temporary cardiac arrest or blood pressure with dizziness and unconsciousness. Often these reactions are triggered by shaving, extreme turning movements of the neck or tight collars.

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