Heart Rhythm Disorders

Prof. Dr. Remzi Karaoguz

Koc University Hospital - Department of Cardiology 

Heart has a special working rule that works naturally. Some external factors like the medicines we use, the hormones in our bodies, or the sympathetic nervous system affect the speed of the heart. In an adult person 60-100 heartbeat per minute are accepted as normal. Heart rate disorders are caused by changes in the number of sinus joints or the signals that are caused in different parts of the body. Rhythm disorders are divided into two types, one being tachycardia (when the heartbeats are over 100 per minute), and the second is bradycardia (when the heart rate is below 60 per minute). Some rash disorders may occur to people with normal heart function but without any significant determination can be adjusted itsealf or with short-term treatment. As an example of these cases we can show excessive tachycardia. While some rash disorders are also symptoms of heart disease which give rise to symptoms such as strong heartbeats, decreased tension, difficulty breathing, or fainting. These types of rhythm disorders, with proper diagnose and treatment, can prevent complications, and increase the quality and longevity of the person.

Heart rate slowdown (Bradycardi)

In all of us, a heart with normal function of the sinus joints naturally beats around 60-100 times per minute. If the sinus joints signal less than 60 beats per minute, this is known as a bradycardia. For Sportsmen who do exercise consistently and also while we are asleep is normal that heartbeats are slower. They are not caused by a certain symptom. In other cases, the sinus velocity is very slender and causes symptoms such as dizziness, powerlessness or quick fatigue while walking. Sometimes faint may also occur. When the slowdown of the sinus is large, the reason is that there is a disorder of this sinus called sinus syndrome. Another reason for critically low heartbeats are the articulatory blocks. Especially in the second or third rank of these artioventricular blocks, can cause noninterpretation of the signals to the sinus joints in the ventricul. If the signal does not reach the ventricul from any other way, the heartbeats fall dangerously. Patients who suffer from atrioventricular blocks often face a fictitious condition.

If in both heart rate slowdowns there is a problem that can’t be treated, it can be corrected with a heart rate monitor. The insertion of the battery is done by a cardiologist under local anesthesia. The battery is placed underneath the skin by connecting electrodes placed in the right ventricule or in other cases may be placed near the atrium of the heart. Other parameters can be programmed on the battery except the speed. Thus, at a time when heartbeat is slow, the energy coming out of the battery through the electrodes is transmitted to the heart muscle and according to programming it turns it into normal beating.

Fast Heartbeats (Tachycardia)

Takikardi is divided into the atrium and ventricule tachycardia. Tachycardia that has its source from the atrium comes in a form of crisis and is a rhythm disorder that varies from 130 to 250 heartbeats per minute. These cases can be seen at approximately 2 people per 1000 people. These strong heart attacks include symptoms such as dizziness, difficulty in breathing, chest tightness, and sometimes faintiness. These types of shocks do not arise from total heart failure and therefore have a successful outcome from treatment. During stroke times, carotid massaging can reduce these strokes. If there is no improvement the patient can take anti-arrhythmic medicines. These strokes are usually repeatable. To stop these repetitions, the patient has to leave the factors causing them and should take medication for a long time. Another way of treatment is catheter ablation. Cataclysm ablation is a very effective treatment. In specialized centers this process is done without complications and there is great success. After the process the chance of repeated shocks is only 1-2%.

Tachycardia that stem from the ventricule are very dangerous to human life. In adults the main reasons are coronary artery disease, myocardial infarction, and heart muscle dysfunction. This rhythm disorder causes immediate stopping of the heartbeat, dysfunction of the respiratory tract and bloodstream and also loss of consciousness. In this condition, a heart and respiratory massage and also electric shock with defibrillator should be performed as soon as possible. The rhythm disorder that stems from the ventricule and causes the immediate stopping of the heart usually happens out of the hospital environment. If in places where there are many people like airports, libraries or stadiums, would be places defibrillator devices and trained teams for patients with heart rate disorders, treating these patients instantly, the death rate would decrease.

Since 1980 there are devices that are apt to treat this group of patients. Devices placed on the body resemble to heart battery. These devices after determining rhythm disorders regulate it by electrical treatment. The treatments that can be applied to this group of patients are medication and catheter ablation. From experience, this treatment decreases the factors that cause coronary artery disease, heart attacks, and dangerous ventricule rhythm disorders.

Protection from atrial fibrillation and paralyzing shocks

Atrial fibrillation is the most important atrial fibrillation. In general, it is an arithmy that affects 1 to 2% of the population. Atrial fibrillation due to chaotic electrical signals disturbs normal atrium shrinkage and creates vibration. Even though it comes in an attack mode, it can be seen frequently. During atrial fibrillation, the blood at the atrium may create clot. The clots that are created here and the circulation of these clots can lead to dangerous strokes. For this reason, the treatment of atrial fibrillation as a prevent from strokes is the foundation of this problem. The first solution is the use of anticoagulant medication (blood thinner). Vitamin K antagonist is used for many years as a blood thinner. Vitamin K antagonist stops some of the factors that cause blood clots. Koumadin is a type of vitamin K that has been used since 1954. Using together some foods and medicines, can make the effects of coumadin to be increased or decreased. The dose of the drug varies according to the patients and this dose is determined by the doctor by constantly doing blood tests. In recent years new drugs that have entered the market and dilute blood like thrombin which inhibits blood clots. Pradaxa (Dabigratan) are also other clotting inhibitor. The Xa inhibitory factors prevent certain Xa enzymes and thus prevent blood clots. Xarelto (Rovaroxaban), Eliquis (Apiksaban) and Lixiana (Edoxaban) are also inhibitory Xa factors. In patients with atrial fibrillation and blood clots at risk, all anticoagulants reduce this risk. On the other hand, especially on vulnerable groups, can also cause bleeding. That is why patients who use this medicines should be constantly checked. Changing the dose of medication or discontinuing it should be done under the doctor's knowledge.

People suffering from atrial fibrillation have symptoms such as stroke, powerlessness, fatigue, and breathing difficulties. According to the patient's condition, treatments that can be applied to reduce and regulate heartbeats include antiarrhythmic drugs, controlled cardiac output (kardioversion), catheter ablation (stopping factors that cause disorders by cooling or heating methods), heart rate and surgical interventions. In addition, patients suffering from atrial fibrillation should be checked if they suffer from excessive cholesterol, high cholesterol, thyroid, diabetes mellitus and sleep apnea, and if these factors have to be corrected.