The Argentine footballer from Barcelona, Sergio Aguero, he was terrified last Saturday when he collapsed during the league match between his team and Alava. The ‘Kun’, who suffered from dizziness, withdrew from the pitch on his own foot and subsequently underwent a medical examination which has pointed to a cardiac arrhythmia as the cause of the mishap.
The name arrhythmia, which literally means loss of rhythm, refers to any abnormality in the frequency of the heartbeat.
What is this disease?
The normal heartbeat is regular (rhythmic) and at rest its frequency fluctuates between 60 and 100 times per minute. If it goes too slow, (less than 60 beats per minute), we call it bradycardia. If it beats too fast (more than 100 beats per minute) we call it tachycardia. A normal heart can beat faster with exercise or emotions and can beat slower with sleep or training. The maximum heart rate a person can reach is calculated with the formula 220 minus their age in years. Therefore, the older a person is, the lower the maximum frequency his heart can reach in conditions of exertion or emotions.
The heart rate is controlled by autonomous cells that produce and transmit electrical impulses within our heart. The electrical impulse is born of the “nodosinusal”. From there starts an electrical impulse that stimulates the contraction of the atria. This electrical impulse then reaches the nodoauricular-ventricular (which acts as a safety node) and spreads to the ventricles. When electricity reaches him, the heart muscle contracts and thus pumps blood. That the transmission of this electrical impulse follows the correct sequence is essential for cardiac contraction to be effective.
Classification of arrhythmias
By the place of origin the problem:
In les aurícules: Supraventriculars
In the ventricles: Ventricular
For heart rate:
Tachycardia (frequency greater than 100 beats per minute): flutter (250-350 lpm) and fibrillation (faster than 350 beats per minute)
Bradycardia (frequency less than 60 beats per minute)
For the “rhythmicity” of the heartbeat:
Regular: The heart beats regularly (rhythmically) with a frequency that can be normal, fast or slow.
Irregular: The heart beats irregularly (arrhythmically) with a frequency that can be normal, fast, or slow.
For the cause of the arrhythmia:
Physiological normal tachycardias, associated with exercise or emotions)
Pathological (abnormal, will probably need treatment)
By the form of appearance of the arrhythmia:
Acute: of recent appearance
Chronicles: months or years
Paroxysmal (appear and disappear spontaneously and suddenly)
Most common symptoms. Although no symptoms may occur and only arrhythmias may be detected due to pulse alterations, the most common symptoms are usually as follows:
Feeling the heartbeat (this is called palpitations): the most common is to feel them in the chest or neck. You may notice fast or slow throbbing, or just a feeling of “tipping” inside your chest.
Chest pain, usually in the center of the chest, with or without palpitations.
Dizziness, as if losing consciousness, with or without palpitations.
Syncope (transient loss of consciousness).
Tiredness, especially when exercising or physical exertion.
Difficulty breathing (this symptom is called dyspnea).
Sometimes arrhythmias cause the heart to activate so fast that it completely loses its effectiveness and it’s like it stops. This happens with some ventricular tachycardias and ventricular fibrillation. It loses consciousness a few seconds after its onset and if left unresolved produces what is known as sudden death.
What is the treatment of arrhythmias?
Arrhythmias are treated only when they produce symptoms or when they are dangerous (when they can alter the patient’s prognosis). The treatments are:
Control triggers, if known. For example alcohol or other toxins.
Treat the disease that promotes arrhythmia. For example, high blood pressure or hyperthyroidism.
Administer drugs that act directly or indirectly on arrhythmias. Indirect treatment is to treat for example high blood pressure that sometimes causes arrhythmias or hyperthyroidism. Direct treatment with drugs, is to use antiarrhythmic drugs. Care must be taken that, in some cases, when the heart has an abnormality other than electrical, antiarrhythmic drugs can be dangerous. At other times, treatment is aimed at preventing consequences of arrhythmias, such as embolism. That is why we use anticoagulant drugs in some patients with arrhythmias.
In many patients, rapid arrhythmias can be cured. For this a technique called ablation is performed. It consists in the fact that with small catheters that are introduced through veins or arteries to the heart, the areas of tissue where the electrical problem that causes the arrhythmia are destroyed. Most cases of accessory pathways, intranodal tachycardia, atrial tachycardia, can be cured. flutter atrial and ventricular without associated heart disease. In addition, many cases of patients with atrial fibrillation (the most common sustained arrhythmia) and other ventricular tachycardias are cured.
The arrhythmies glasses, bradyarrhythmias, are usually treated with pacemaker unless there is a correctable cause (e.g., some prescription medications for something else, which slow down the heart). Pacemakers are mini-computers the size of a matchbox, which are implanted under the skin and are connected to the heart by one, two or three wires. In this way they regulate the heart rate at all times.
Finally, when arrhythmias can endanger the patient’s life and we cannot cure them, Implantable Automatic Defibrillatorss (DAI). These devices (their size is half a mobile phone), are placed by a small intervention under the skin, connected with one or more cables that monitor the heart. Unlike pacemakers, DAIs are not only able to speed up the heart if it goes too slowly, but they can also apply electric shocks. This treatment is indicated in most patients who have fortunately been able to survive a severe ventricular arrhythmia or cardiac arrest. But there are also patients in whom this treatment is indicated even though they have not yet undergone arrhythmias.
For example, patients who have severely damaged heart as a result of previous heart attacks, even if they have never had an arrhythmia, may live longer if they have one of these devices implanted.
Causes of arrests
Congenital or hereditary: it is born with alterations in the formation of the cardiac impulse or in its transmission, either by problems in the generating cells of the cardiac electricity or by the existence of cables of more or less, within the heart.
Cardiovascular diseases: hypertension, myocardial infarction, or any disease that alters the structure of the heart. By dilating, thickening, or destroying walls and heart cavities, electrical cables are also indirectly affected.
Thyroid disorders, diabetes, hormonal changes in women.
As a side effect of medications:
Emotional stress: fear, anxiety, stress, grief.
Physical stress: Excessive work or exercise.
Toxic habits: drugs (especially cocaine and amphetamines), excesses with alcohol, coffee, tobacco.
How much should I go to the doctor?
In the event of any of the symptoms described above, it is advisable to go to the doctor to rule out an arrhythmia.
The ideal for diagnosing arrhythmias is to perform a electrocardiogram (ECG) coinciding with symptoms. Asymptomatic ECG sometimes also provides important clues. Many times this is not possible because the symptoms last a short time and occur from time to time. To try to know what happens in the heart when you have the symptoms that appear from time to time, we use devices that monitor our heartbeat and can be placed in the body from 24 hours even 2 years. Are called Holter. In addition to knowing what the arrhythmias are, it is essential to also know how the heart is. For it it is realized:
A medical history (to know a family history, personal history such as high blood pressure or other diseases that can promote arrhythmias).
Physical exploration.
Almost always a chest x-ray
Echocardiogram to see what the structure of the heart is like.
If it is necessary to delve further into the anatomy of the heart, an MRI (RSMN) or a computed tomography (CT) scan is performed.
If it is necessary to know how the coronary arteries are, a coronary angiography will be performed. It should be remembered that any heart disease can affect the electrical system and promote the appearance of arrhythmias.
Finally, to know for sure how the electrical system is, an electrophysiological study is performed. To do this, small electrodes are inserted through the femoral vein, which reach the heart and analyze its electrical activity. If electrical alterations are found in the electrophysiological study that can be resolved, destroying a minimal part of cardiac tissue, the catheter ablation procedure will then be performed using radiofrequency, cold (cryoablation) or other energy sources.
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