Here we explain how patients with suspected arrhythmias may show various symptoms and how these symptoms can help determine the severity, diagnosis, and treatment.
Patients with Suspected Arrhythmias May Show Different Symptoms:
•Common symptoms include palpitations (feeling irregular heartbeats), syncope (fainting), and feeling like they might faint (presyncope).
•Sometimes, arrhythmias can cause subtler signs like feeling tired, having less stamina, or vague discomfort, and occasionally, patients may have no symptoms at all.
•In rare cases, arrhythmias can lead to sudden cardiac arrest.
Severity and Underlying Heart Condition Matter:
•The seriousness of symptoms, especially if they cause fainting, and whether the patient has underlying heart problems determine the diagnosis and outlook.
•Patients with structural heart issues have a higher risk of life-threatening arrhythmias like ventricular tachycardia or ventricular fibrillation.
•Detecting whether there’s structural heart disease is crucial in diagnosing and predicting the outcome for those with suspected arrhythmias.
Exception for Family History:
•In cases where patients have a strong family history suggesting an inherited arrhythmia disorder (like long QT syndrome or Brugada syndrome), a family history of fainting or sudden death should prompt referral to a heart rhythm specialist, even if there’s no structural heart disease.
In summary, diagnosing and managing arrhythmias depends on the symptoms’ severity and the presence of underlying heart issues, but a family history of specific arrhythmia disorders can also be important.
Palpitations are feelings of irregular or fast heartbeats. They're often caused by abnormal beats called premature atrial contractions (PACs) and premature ventricular contractions (PVCs) or by rapid heart rhythms known as tachyarrhythmias. To figure out if palpitations need further evaluation, doctors consider the patient's description.
When patients have an irregular, unpredictable pattern of palpitations, it could be due to atrial fibrillation. A regular, fast pattern may suggest a sustained fast heart rate. Feeling a strong, regular pounding sensation in the neck may indicate palpitations from a fast heart rhythm.
In contrast, those who feel symptoms from PACs or PVCs are often more aware of the pause or the strong beat that follows the premature beat than the early beat itself. If these symptoms only occur occasionally and the patient has no other problems or heart disease, they usually don't need further checks.
However, if the symptoms happen more often, are severe, or come with near-fainting or fainting, they need further assessment. Antiarrhythmic medications are usually not needed for treating PACs or PVCs unless the symptoms are bothersome. β-Blockers, like metoprolol or atenolol, are often used to treat highly symptomatic patients with documented PACs or PVCs. Recent research suggests that patients with PVCs making up more than 24% of their heartbeats during 24-hour monitoring might have a higher risk of developing PVC-related heart problems.
Palpitations are most often linked to fast heart rhythms (tachyarrhythmias), while slow heart rhythms (bradyarrhythmias) rarely cause palpitations. Most fast heart rhythms in patients without heart disease are due to supraventricular tachycardias, which often resolve on their own within seconds. If a fast heart rhythm lasts longer, it can often be stopped with simple actions. Patients can cough, do the Valsalva maneuver, forcefully exhale with a closed throat, or gently rub their eyes to stop the rhythm. Doctors can also perform carotid sinus massage, but this should be avoided in elderly patients and those with certain medical conditions.
In patients with heart disease, palpitations might signal ventricular tachycardia, especially if accompanied by fainting or near-fainting. Occasionally, someone without heart disease might have idiopathic ventricular tachycardia, typically arising from specific heart areas. These cases often have a good outcome with ablation.
Syncope, which is a sudden loss of consciousness, and presyncope, a feeling of lightheadedness, happen when blood flow to the brain is temporarily reduced. This can be due to various reasons, including heart rhythm issues like tachyarrhythmias, bradyarrhythmias, or neurocardiogenic syncope. But sometimes, it can occur without any heart rhythm problems. To understand the cause, doctors need to carefully examine the patient's medical history and perform a physical examination to rule out other heart or neurological problems.
Certain aspects of the patient's history can point to heart rhythm issues as the cause. For instance, if syncope is linked to palpitations and there are no neurological issues before or after the episode, it might be due to a heart rhythm problem. Syncope can also be caused by conditions like aortic stenosis or left ventricular outflow obstruction.
Distinguishing between syncope and other conditions like vertigo, ataxia, or seizures is important. While syncope involves a loss of consciousness, vertigo feels like the room is spinning, ataxia results in a lack of balance, and seizures involve uncontrolled body movements. Postictal symptoms, which occur after seizures, are absent in syncope cases.
To diagnose the cause of syncope, it's crucial to gather detailed information about each episode, including what happened before, during, and after. Knowing the patient's activities, position, and symptoms when the episode started can provide valuable clues. For instance, if the loss of consciousness happens rapidly without warning, it could be due to seizures or certain arrhythmias. Palpitations during the warning signs may indicate a tachyarrhythmia.
Additionally, descriptions of what occurred during the loss of consciousness from witnesses can help. Muscle movements during the event can sometimes be similar to seizures, so understanding the nature of these movements is important. The duration of confusion and disorientation after regaining consciousness is another key factor. In neurocardiogenic syncope, orientation is regained within seconds, while seizures typically have a longer period of confusion and agitation after regaining consciousness.
In summary, syncope and presyncope are episodes of temporary loss of consciousness or lightheadedness, and they can be caused by various factors, including heart rhythm problems. Gathering detailed information about the events and symptoms, along with careful examination, is essential to determine the cause and appropriate treatment.