How to treat arrhythmia?

Written by Chen Ya
Geriatrics
Updated on September 25, 2024
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The treatment of arrhythmias should be based on the symptoms of the patients with arrhythmias, the type of arrhythmias, and their impact on hemodynamics. Control of arrhythmias during episodes involves removing the cause and focus of the disease and preventing recurrence, which can be divided into non-pharmacological and pharmacological treatments. Non-pharmacological treatments include methods such as eyeball compression, carotid sinus massage, pinching the nose to exhale forcefully and hold breath to reflexively excite the vagus nerve, along with electrical treatments like electrical cardioversion, defibrillation, pacemaker implantation, and ablation surgery. There are mainly four types of drugs used: sodium channel blockers; beta-adrenergic blockers; drugs selectively prolonging the repolarization process, such as amiodarone; and calcium channel blockers. However, long-term use of these antiarrhythmic drugs can have varying degrees of side effects, and severe cases can cause ventricular arrhythmias or cardiac conduction block which can be fatal. Therefore, in clinical application, it is essential to strictly control the indications, monitor for adverse reactions, and rigorously follow the doctor's orders.

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Written by Chen Ya
Geriatrics
1min 28sec home-news-image

Arrhythmia is caused by what?

Arrhythmia is caused by abnormal excitation of the sinoatrial node or excitation originating outside the sinoatrial node, with slow conduction, blockage, or conduction through abnormal pathways. This results in the frequency and (or) rhythm abnormalities of heartbeats, which are collectively referred to as arrhythmias. Most of the causes include the following: one is genetic arrhythmias, often due to gene channel mutations, such as the commonly seen long QT syndrome, short QT syndrome, Brugada syndrome, etc. There are also acquired arrhythmias, seen in various organic heart diseases, including coronary atherosclerotic heart disease, commonly referred to as coronary heart disease, cardiomyopathy, myocarditis, and rheumatic heart disease, particularly prevalent during heart failure or acute myocardial infarction. Arrhythmias are also not uncommon in basically healthy individuals or patients with autonomic dysfunction. Other causes include electrolyte imbalance or endocrine disorders, and sometimes anesthesia, hypothermia, or surgery, such as thoracic or cardiac surgery, or medications, central nervous system diseases may also cause arrhythmias, but the specific reasons are not very clear.

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Written by Wang Li Bing
Intensive Care Medicine Department
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Is ventricular arrhythmia serious?

Arrhythmias are primarily divided into sinus arrhythmias, atrial arrhythmias, and ventricular arrhythmias. Among these, ventricular arrhythmias are further categorized into ventricular premature contractions, ventricular tachycardia, ventricular flutter, and ventricular fibrillation. Ventricular flutter and ventricular fibrillation are fatal types of arrhythmias. Patients generally experience loss of consciousness, generalized convulsions, and even cessation of breathing and death. If ventricular fibrillation occurs, it is imperative to immediately perform defibrillation and cardiopulmonary resuscitation, among other emergency interventions.

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Written by Chen Ya
Geriatrics
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Why does arrhythmia cause chest pain?

The causes of chest pain due to arrhythmias primarily involve all kinds of arrhythmias reducing the blood flow in the coronary arteries. Although various arrhythmias can decrease coronary blood flow, they rarely cause myocardial ischemia. However, severe arrhythmias that cause significant myocardial ischemia can result in chest pain. For patients with coronary heart disease, various arrhythmias can induce or exacerbate myocardial ischemia, which may also manifest as chest pain and shortness of breath, and in severe cases, lead to acute heart failure, acute myocardial infarction, and persistent, unbearable chest pain and tightness.

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Written by Xie Zhi Hong
Cardiology
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Is atrial fibrillation a serious arrhythmia?

Atrial fibrillation is a type of cardiac arrhythmia, primarily feared for its potential to form blood clots within the heart. These clots can travel to other organs via the bloodstream, most commonly to the brain. Additionally, pieces of these clots can also travel to coronary arteries causing myocardial infarction, leading to organ embolism wherever they lodge. Generally, if no blood clots are formed, many individuals with atrial fibrillation may not experience symptoms. However, if combined with other cardiac conditions such as heart failure or coronary artery disease, atrial fibrillation can exacerbate the risk of developing these heart diseases. Thus, atrial fibrillation on its own is not severe but becomes concerning when associated with other cardiac conditions, increasing the risk of other heart diseases. If atrial fibrillation occurs with left or right accessory pathways, it may also lead to ventricular fibrillation, resulting in sudden death of the patient. Moreover, if the atrial fibrillation has no apparent cause, and the heart structure is normal with no symptoms, then such isolated atrial fibrillation does not typically form blood clots and is considered relatively mild.

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Written by Chen Ya
Geriatrics
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Does arrhythmia require hospitalization?

Arrhythmia treatment should be determined based on the patient's symptoms, type of arrhythmia, and its impact on hemodynamics. For instance, minor conditions like slight sinus bradycardia, irregular sinus rhythm, occasional atrial premature contractions, and first-degree atrioventricular block, which have minimal impact on hemodynamics and no significant clinical manifestation or structural heart disease, do not necessitate hospitalization. However, more severe arrhythmias such as sick sinus syndrome, rapid atrial fibrillation, paroxysmal supraventricular tachycardia, and sustained ventricular tachycardia, which can cause symptoms like palpitations, chest tightness, dizziness, low blood pressure, sweating, and in severe cases, fainting, Adam-Stokes syndrome, and even sudden cardiac death, require prompt medical attention and hospitalization for treatment.