Heart Arrhythmia

The following are the most common arrhythmia symptoms. However, you may experience symptoms differently – and these symptoms may resemble other conditions or medical problems, so it's always best to talk with your doctor if you experience:

• Palpitations (a sensation of fluttering or irregularity of the heartbeat)
• Weakness
• Fatigue
• Low blood pressure
• Dizziness
• Fainting
• Heart failure
• Collapse
• Cardiac arrest
• Difficulty feeding (in babies)

At INTEGRIS we use the most advanced imaging methods and diagnostic tools to determine the cause, severity and prognosis of your arrhythmia. Some of these diagnostic tests may include:

• Electrocardiogram (ECG): An electrocardiogram measures your heart's electrical activity. By placing electrodes at specific locations on your body (chest, arms and legs), a graphic representation, or tracing, can be made as the electrical activity is received and interpreted by an ECG machine. An ECG can show the presence of arrhythmias, damage to your heart caused by ischemia (lack of oxygen to the heart muscle), or myocardial infarction (MI, or heart attack), a problem with one or more of the heart valves or other types of heart conditions.

There are several variations of the ECG test:

• Resting ECG: An ECG done while you are lying down.
Exercise ECG, or Stress Test: You are attached to the ECG machine as described above. However, rather than lying down, you exercise by walking on a treadmill or pedaling a stationary bike while the ECG is recorded. This test is done to assess changes in the ECG during stress, such as exercise.
• Signal-Averaged ECG: This procedure is done in the same manner as a resting ECG, except your heart's electrical activity is recorded for a longer period of time, usually 15 to 20 minutes. Signal-averaged ECGs are done when arrhythmia is suspected, but not seen on a resting ECG. The signal-averaged ECG has increased sensitivity to abnormal ventricular activity called late potentials.
• Electrophysiologic Studies (EPS): A nonsurgical but invasive test in which a small, thin tube (catheter) is inserted into a large blood vessel in your leg or arm and advanced to your heart. This lets your doctor find the site of the arrhythmia's origin within your heart tissue to determine how to best treat it. Sometimes your doctor can treat the arrhythmia by doing an ablation at the time of the study.
• Holter Monitor: Arrhythmias may be transient in nature and not seen during the shorter recording times of a resting ECG. A Holter Monitor is a continuous ECG recording done during a period of 24 or more hours. Electrodes are attached to your chest and connected to a small portable ECG recorder by lead wires. You go about your daily activities, except those that cause an excessive amount of sweating. This could cause the electrodes to become loose or fall off during the procedure. These activities include taking a shower or swimming.
• Event Monitor: This is similar to a Holter monitor, except you start the ECG recording only when you feel symptoms. Event monitors are worn for a longer time period than Holter monitors. You can remove the monitor to shower or bathe.
• Mobile Cardiac Monitoring: This is similar to both Holter and event monitors. The ECG is monitored constantly to allow for detection of arrhythmias, which are recorded and sent to your doctor regardless of whether you have symptoms. You can also start recordings yourself when you have symptoms. These monitors can be worn up to 30 days.
• Implantable Loop Recorder: This miniature heart recording device is implanted under the skin overlying your heart. It can record the heart rhythm for up to two years and is useful in diagnosing intermittent or rarely occurring arrhythmias.

Some arrhythmias may cause few, if any, problems. In this case, you may not need treatment. When arrhythmia does cause problems, we're here to help solve them, with INTEGRIS electrophysiologists who specialize in heart rate and rhythm conditions. Your treatment plan will be determined the type of arrhythmia you have, how severe your symptoms are, and whether you have other conditions such as diabetes, kidney failure, or heart failure. Some treatments for arrhythmias include:

• Lifestyle Changes: Stress, caffeine and alcohol can cause arrhythmias. Your doctor may recommend you avoid these or any other things that may cause the problem. If your provider thinks stress is a cause, he or she may recommend meditation, stress-management classes, an exercise program or psychotherapy to ease stress.
• Medicine: Your doctor will recommend a medicine based on the type of arrhythmia you have, whether you have other health conditions and other medications you take.
• Cardioversion: The health care provider sends an electrical shock to your heart through the chest. This will stop certain very fast arrhythmias such as atrial fibrillation, supraventricular tachycardia or atrial flutter. You are connected to an ECG monitor which is also connected to the defibrillator.
• Ablation: An invasive but nonsurgical procedure done in the electrophysiology lab. The health care provider puts a thin, flexible tube (catheter) into your heart through a vessel in your groin or arm. The provider uses a method such as radio frequency ablation (which heats the tissue) or cryoablation (which freezes the tissue) to destroy the site of the arrhythmia.
• Pacemaker: A permanent pacemaker is a small device that is put under the skin, often in the chest region just under the collarbone. It sends electrical signals to start or regulate a slow heartbeat. Pacemakers are often used for slow arrhythmias such as sinus bradycardia, sick sinus syndrome or heart block.
• Implantable Cardioverter Defibrillator (ICD): Similar to a pacemaker, the small ICD is put under the skin, often just under the collarbone. An ICD senses the heartbeat rate; if your heart rate goes higher than the level entered into the device, it sends an electrical shock to the heart, correcting the rhythm to a slower, more normal one. ICDs are used with a pacemaker to send an electrical signal to regulate a slow heart rate. ICDs are used for life-threatening fast arrhythmias such as ventricular tachycardia or ventricular fibrillation.
• Surgery: Surgery is usually done only when all other treatments have failed. Surgical ablation is a major surgery in which the surgeon opens your chest to reach your heart to destroy or removes the tissue causing the arrhythmia. This requires general anesthesia.

Part of heart and vascular care includes managing heart disease and preventing further deterioration to help you live the fullest life possible. To accomplish that, we'll provide you with education, continued care options and programs even after you are discharged including:

• Cardiac Rehabilitation
• Heart Education
• Anticoagulation Management Clinic
• Heart Care Program
• Integrative Medicine
• Palliative Care