Although mostly arrhythmias are symptomatic, sometimes they may not produce any symptoms. Some serious arrhythmias like atrial fibrillation can be asymptomatic, while not so harmless arrhythmias like premature betas can be very symptomatic. So when we are deciding about severity of any arrhythmias, asymptomatic status may not imply severity of disease process.
- Palpitations or feeling of your own heartbeat, people can feel this as if heart is skipping a beat, fluttering, or beating too hard or fast)
- A slow heartbeat, which can be felt as slow pulses
- An irregular pulse or heart beat
- Significant pauses in between the pulses
Some of the symptoms may be more serious and life threatening like,
- Weakness, dizziness, and light-headedness
- Fainting or nearly fainting
- Shortness of breath
- Chest pain
- Sudden cardiac arrest
- How To Diagnose Cardiac Arrhythmias?
- Diagnosing cardiac arrhythmias can be difficult, because of the infrequent episodes, and by the time patient reaches the doctor, arrhythmia may subside, making it difficult to identify exact nature of arrhythmia. So if the patient doesn’t have documented arrhythmia, then history, physical examination and when required various investigations may be required to diagnose the arrhythmia.
- History Taking:
- In history taking the exact nature of arrhythmia is assessed by asking the patient to describe the exact mode of onset of symptoms, ask them to explain how they feel the palpitations, any precipitating or relieving factors. Some patients may develop arrhythmias during particular time of the day, sometimes during the exercise, which may help in diagnose the exact nature of arrhythmia. Some arrhythmias are relieved by pressure over the neck,eyeballs,these may help the doctor to clinch the diagnosis.
Presence of other health problems, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems may also be important to know to diagnose and to decide on further management. It is also important to know about the family’s medical history, including whether anyone in the family:
History previous medications and current medications are also important. History of smoking, physical exercise and intake of drugs like cocaine or amphetamine will also be enquired.
- History of arrhythmias in the family
- Any history of heart disease or high blood pressure in the family
- History of sudden death in the family
- The following things will be assessed during the physical examination
- To assess the rate and rhythm of the heartbeat
- To the heart for any extra or unusual sound heard during the heartbeat
- To assess the pulse for counting the heart beat
- To look for swelling in the legs or feet, which could be a sign of an enlarged heart or heart failure
- To Look for signs of other diseases, such as thyroid disease, that could be causing the problem
- Diagnostic Tests And Procedures
An arrhythmia is considered documented if it can be recorded on an electrocardiogram(ECG ). This is the standard clinical tool for diagnosing arrhythmias. It records the relative timing of atrial and ventricular electrical events. It can be used to measure how long it takes for impulses to travel through the atria (the heart’s upper chambers), the atrioventricular (AV) conduction system and the ventricles (the heart’s two lower, pumping chambers). Because of the fleeting nature of arrhythmias, a person who complains of symptoms that suggest arrhythmia may often have an ECG that appears normal.
To do an ECG, the healthcare professional places small patches or stickers called electrodes on different parts of the body. One is put on each arm and leg and several across the chest. They don’t hurt. With various combinations of these electrodes, different tracings of the heart’s electrical activity can be made and permanently recorded on paper or in a computer.
Holter and Event Monitors
Suspected arrhythmias sometimes may be documented by using a small, portable ECG recorder, called a Holter monitor (or continuous ambulatory electrocardiographic monitor). This can record 24 hours of continuous electrocardiographic signals. While an ECG is sort of a 12-second “snapshot” of the heart’s electrical activity, the Holter monitor is more like a “movie.”
As with an ECG, electrodes are taped to the chest. The wires are connected to a portable, battery-operated recorder that can run for 24 to 48 hours. The patient can do most normal activities while being tested. The patient may need to keep a diary or log of your activities and symptoms.
At the end of the measurement period, the recorder’s tape or memory is analyzed on a computer that rapidly identifies rhythm disturbances that occurred while you were wearing the monitor. The diary helps the healthcare professional see how the activities or symptoms correspond to recorded events in the heart. For suspected arrhythmias that occur less frequently than every day, an event monitor may be of help.
An event monitor is similar to a Holter monitor. The patient has to wear an event monitor while doing the normal activities. However, an event monitor only records the heart’s electrical activity at certain times while patient is wearing it. For many event monitors, the patient will push a button to start the monitor when patient feels symptoms. Other event monitors start automatically when they sense abnormal heart rhythms.Patient can wear an event monitor for weeks or until symptoms occur.
Other tests also are used to help diagnose arrhythmias.
Blood tests. Blood tests check the level of substances in the blood, such as potassium and thyroid hormone. Abnormal levels of these substances can increase your chances of having an arrhythmia.
Chest x ray. A chest x ray is a painless test that creates pictures of the structures in your chest, such as your heart and lungs. This test can show whether your heart is enlarged.
Echocardiography. This test uses sound waves to create a moving picture of the heart. Echocardiography (echo) provides information about the size and shape of the heart and how well the heart chambers and valves are working.
The test also can identify areas of poor blood flow to the heart, areas of heart muscle that aren’t contracting normally, and previous injury to the heart muscle caused by poor blood flow.
A transesophageal echo, or TEE, is a special type of echo that takes pictures of the heart through the oesophagus. The oesophagus is the passage leading from the mouth to your stomach. This test is very useful particularly in patients with AF to identify blood clots inside the body.
Stress test. This is an option that provokes arrhythmias and makes their diagnosis (and thus their proper treatment) easier. A treadmill test may be used for people whose suspected arrhythmias are clearly exercise-related. It is important to know if exercise makes an arrhythmia worse. To test this, the patient will walk and run on a treadmill — or ride a stationary bicycle — while the heart rate and rhythm are monitored.
Electrophysiology study (EPS). This test is used to assess serious arrhythmias. During an EPS, a thin, flexible wire is passed through a vein in the groin (upper thigh) or arm to the heart. The wire records the heart’s electrical signals.
The doctor can use the wire to electrically stimulate the heart and trigger an arrhythmia. This allows the doctor to see whether an ant arrhythmia medicine can stop the problem.
Tilt table testing. A tilt test may be advised for some people who’ve had recurrent fainting spells. This test shows how the heart rate and blood pressure respond to a change in position from lying down to standing up. In this test, an intravenous line (a small plastic tube in a vein) is usually started in case medications need to be given during the test. If a cause of the fainting spells is found, medications can be given through the intravenous line to help prevent the episodes.
Coronary angiography. Coronary angiography uses dye and special x rays to show the inside of the blood vessels of the heart. To get the dye into your coronary arteries, the doctor will use a procedure called cardiac catheterization.
A thin, flexible tube called a catheter is put into a blood vessel in the arm, groin (upper thigh), or neck. The tube is threaded into the coronary arteries, and the dye is released into the bloodstream.
Special x rays are taken while the dye is flowing through the blood vessels. This helps the doctor find blockages that can cause a heart attack.
Implantable loop recorder. This device detects abnormal heart rhythms. Minor surgery is used to place this device under the skin in the chest area.
An implantable loop recorder helps doctors figure out why a person may be having palpitations or fainting spells, especially if these symptoms don’t happen very often. The device can be used for as long as 12 to 24 months.