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Cardiac Electrophysiolo gy Eric C. Mak, MD Cardiology

Rhythm of My Heart: Heart Rhythm Disorders

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The heart is like an intricate machine—controlled by electrical impulses that must occur at regular intervals to work properly. When that doesn’t happen, the result is a rhythm disorder, also known as an arrhythmia. These abnormalities can range from common and harmless rhythms to serious and potentially life-threatening rhythms. Dr. Eric Mak, specialist in cardiac electrophysiology, discusses these conditions and their treatment methods.

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Page 1: Rhythm of My Heart: Heart Rhythm Disorders

CardiacElectrophysiologyEric C. Mak, MD

Cardiology

Page 2: Rhythm of My Heart: Heart Rhythm Disorders

www.SpringfieldClinic.comwww.SpringfieldClinic.com

Page 3: Rhythm of My Heart: Heart Rhythm Disorders

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Page 4: Rhythm of My Heart: Heart Rhythm Disorders

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Page 5: Rhythm of My Heart: Heart Rhythm Disorders

Sinus Rhythm

Page 6: Rhythm of My Heart: Heart Rhythm Disorders

Sinus Rhythm

Page 7: Rhythm of My Heart: Heart Rhythm Disorders

Heart Rhythm Disorders

• Arrhythmias are abnormal heart rhythms, i.e. rhythms that are not sinus– They can be fast or slow– They can be symptomatic or asymptomatic– They can benign or serious

Page 8: Rhythm of My Heart: Heart Rhythm Disorders

Heart Rhythm Disorders

• Common Questions– Are arrhythmias bad?– What can I do if I have an arrhythmia?– Do I have to do anything if I have an

arrhythmia?– How do I know if I have an arrhythmia?

Page 9: Rhythm of My Heart: Heart Rhythm Disorders

Heart Rhythm Disorders

• Common Questions– Are arrhythmias bad?– What can I do if I have an arrhythmia?– Do I have to do anything if I have an

arrhythmia?– How do I know if I have an arrhythmia?

Page 10: Rhythm of My Heart: Heart Rhythm Disorders

Heart Rhythm Disorders

• Not all arrhythmias cause palpitations

• Not all palpitations are caused by arrhythmias

Page 11: Rhythm of My Heart: Heart Rhythm Disorders

How do I know if I have an arrhythmia?

Page 12: Rhythm of My Heart: Heart Rhythm Disorders

Heart Rhythm Disorders

• EKG: 10 sec “snapshot”• Holter monitor: 24-48 hr• Event monitor: 1-4 weeks

• Implantable loop recorder: 3 years

Page 13: Rhythm of My Heart: Heart Rhythm Disorders

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Page 14: Rhythm of My Heart: Heart Rhythm Disorders

Ectopy, aka extra beats

PACs / APDsPVCs / VPDs

Page 15: Rhythm of My Heart: Heart Rhythm Disorders

Ectopy, aka extra beats

• Symptoms• Prognosis• Treatment

Page 16: Rhythm of My Heart: Heart Rhythm Disorders

Ectopy, aka extra beats

• Symptoms– “skipped beats”– Tired / fatigue

Page 17: Rhythm of My Heart: Heart Rhythm Disorders

Ectopy, aka extra beats

• Prognosis– VERY common; everyone has a few PACs

and PVCs– Generally benign, though very frequent

PVCs (when PVCs are over 20-25% of total beats) can cause weakening of the heart

Page 18: Rhythm of My Heart: Heart Rhythm Disorders

Ectopy, aka extra beats

• Treatment– Do nothing– Medicines– Procedures

Page 19: Rhythm of My Heart: Heart Rhythm Disorders

Ectopy, aka extra beats

• Treatment– Do nothing– Medicines: beta blockers and calcium

channel blockers, though the side effects can sometimes be as bad or worse than the ectopy

– Procedures: very effective if the ectopic beats can be located; the more ectopic beats, the easier to locate them

Page 20: Rhythm of My Heart: Heart Rhythm Disorders

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Page 21: Rhythm of My Heart: Heart Rhythm Disorders

Bradycardia, aka slow heart rhythms

Sinus node dysfunctionSick sinus

Heart block

Page 22: Rhythm of My Heart: Heart Rhythm Disorders

Bradycardia, aka slow heart rhythms

• Symptoms• Prognosis• Treatment

Page 23: Rhythm of My Heart: Heart Rhythm Disorders

Bradycardia, aka slow heart rhythms

• Symptoms– Tired / fatigue (worse with exercise)– Shortness of breath (worse with exercise)– Fainting / passing out

Page 24: Rhythm of My Heart: Heart Rhythm Disorders

Bradycardia, aka slow heart rhythms

• Prognosis• Treatment

– Do nothing– Medicines– Procedures

Page 25: Rhythm of My Heart: Heart Rhythm Disorders

Bradycardia, aka slow heart rhythms

• Treatment– Do nothing– Medicines: stop medications that slow the

heart rate– Procedures: pacemaker

Page 26: Rhythm of My Heart: Heart Rhythm Disorders

Bradycardia, aka slow heart rhythms

• Prognosis– Sinus node dysfunction: pacing improves

symptoms, but does not prolong life– Heart block: pacing improves symptoms

and prolongs life

Page 27: Rhythm of My Heart: Heart Rhythm Disorders

Bradycardia, aka slow heart rhythms

Page 28: Rhythm of My Heart: Heart Rhythm Disorders

Heart Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Page 29: Rhythm of My Heart: Heart Rhythm Disorders

Tachycardia, aka fast heart rhythms

Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

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SVTs (Supraventricular Tachycardias)Atrial FibrillationAtrial Flutter

AVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

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SVTs (Supraventricular Tachycardias)

• Symptoms• Prognosis• Treatment

Page 32: Rhythm of My Heart: Heart Rhythm Disorders

SVTs (Supraventricular Tachycardias)

• Symptoms– Palpitations, usually starts and stops

abruptly– Sometimes with chest pain, shortness of

breath, and lightheadedness– Fainting and passing out is rare

Page 33: Rhythm of My Heart: Heart Rhythm Disorders

SVTs (Supraventricular Tachycardias)

• Prognosis– Generally very symptomatic, but benign

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SVTs (Supraventricular Tachycardias)

• Treatment– Do nothing: sometimes coughing, Valsalva

maneuvers can stop episodes– Medicines: adenosine given in the hospital

can often stop episodes; beta blockers and calcium channel blockers to prevent episodes at home

– Procedures: EP study and ablation

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Tachycardia, aka fast heart rhythms

Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

Page 36: Rhythm of My Heart: Heart Rhythm Disorders

Tachycardia, aka fast heart rhythms

Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

Page 37: Rhythm of My Heart: Heart Rhythm Disorders

Atrial Fibrillation and Flutter

• Symptoms• Prognosis• Treatment

Page 38: Rhythm of My Heart: Heart Rhythm Disorders

Atrial Fibrillation and Flutter

• Symptoms– Palpitations– Tired / fatigue– Shortness of breath

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Atrial Fibrillation and Flutter

• Prognosis– Increased risk of stroke in patients with

other medical problems• Congestive heart failure• High blood pressure• Older patients• Diabetes• Prior strokes• Patients with previous heart stents• Women

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Atrial Fibrillation and Flutter

• Treatment– Blood thinners / aspirin to reduce risk of

stroke– Rate Control

• Beta blockers and calcium channel blockers to control heart rate

• Ablate AV node and implant pacemaker

– Rhythm Control• Antiarrhythmic drugs• Catheter Ablation

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Atrial Fibrillation and Flutter

• Catheter ablation success rates– Atrial flutter: 90%– Paroxysmal atrial fibrillation: 70-80%– Long persistent atrial fibrillation: <50% with

most patients requiring multiple procedures

• Ablation of atrial fibrillation has not been proven to reduce stroke risk, so generally need to continue blood thinners

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Tachycardia, aka fast heart rhythms

Atrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

Page 43: Rhythm of My Heart: Heart Rhythm Disorders

Sudden Cardiac DeathAtrial FibrillationAtrial FlutterAVNRTAVRTAtrial Tachycardia

Ventricular TachycardiaVentricular Fibrillation

Page 44: Rhythm of My Heart: Heart Rhythm Disorders

Sudden Cardiac Death

• Symptoms• Prognosis• Treatment

Page 45: Rhythm of My Heart: Heart Rhythm Disorders

Sudden Cardiac Death

• Symptoms– Cardiac arrest– Passing out without warning– But most people have no symptoms

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Sudden Cardiac Death

• Symptoms• Risk Factors• Prognosis• Treatment

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Sudden Cardiac Death

• Risk Factors– Cardiomyopathy– Ejection Fraction of 35% or less

Page 48: Rhythm of My Heart: Heart Rhythm Disorders

Sudden Cardiac Death

• Treatment– Do nothing– Medicines: heart failure medicines (beta

blockers, ace inhibitors, statins)– Procedures: implantable defibrillator

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Sudden Cardiac Death

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Sudden Cardiac Death

• Symptoms• Risk Factors• Prognosis• Treatment

Page 51: Rhythm of My Heart: Heart Rhythm Disorders

Sudden Cardiac Death

• Prognosis– One third of patients that meet criteria for

ICD will die within 5 years– ICDs reduce the risk of death by over half

Page 52: Rhythm of My Heart: Heart Rhythm Disorders

Hearth Rhythm Disorders

• An introduction to the normal electrical system of the heart, i.e. Sinus Rhythm

• Ectopy (extra beats)• Bradycardias (slow heart rhythms)• Tachycardias (fast heart rhythms)• Q/A

Page 53: Rhythm of My Heart: Heart Rhythm Disorders

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