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Heart Attack and Cardiac Disorders

(30) Heart Attack and Cardiac Disorders

Symptoms of a Heart Attack

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What are the characteristic features of chest pain or other forms of chest discomfort felt by heart attack victims?

For one thing, you would feel any form of chest pain or chest discomfort deeply rather than feeling it on the surface. Physical exercise, stress, or anger often trigger chest pain, but heart attack pain does not clear up by resting or taking even three or more tablets of nitroglycerin.

Heart attack victims often describe such chest pain as crushing, heavy, oppressive, or constricting, or as a sensation of severe pressure in the chest. Chest pain frequently occurs behind the breastbone. As has been pointed out, it may spread to the left arm, left shoulder, jaw, teeth, or neck or to the center portion of the upper back. Occasionally, it may radiate to the right arm or right shoulder as numbness or a tingling sensation instead of as outright pain. Sometimes, such discomfort may be felt in much lower locations than usual, so it may be pronounced in the upper abdomen. In 10 to 15% of heart attack victims, a typical silent heart attack might not produce any pain at all.

Do women’s and men’s heart attack symptoms differ?

Women often experience nausea and vomiting. Pain or severe discomfort is frequently felt in the upper abdomen. Sometimes women notice only marked fatigue after everyday physical activity, rather than chest pain. Women’s symptoms of angina or heart attack are not typical, so they often delay medical attention and necessary diagnostic tests.

Many women misinterpret their heart attack symptoms as other illnesses, and they have a tendency to regard their symptoms very lightly. For this reason, many physicians tend to manage this disorder less aggressively in women patients.

Which heart attack victims are at highest risk of death?

The outcome of a heart attack depends on the conditions that surround the event. Outcome is more serious in some people than in others. For example, elderly people (particularly those with poor general health conditions) react more intensely to heart attack. People with diabetes and diseases of other organs (e.g., kidneys, liver, and lungs) also are less able to endure a heart attack. This holds true also for people recovering from cardiac arrest; those having had a massive heart attack or blockage of multiple heart arteries; and those with multiple coronary risk factors. People having varied complications (e.g., congestive heart failure, serious heart rhythm abnormalities) also suffer the results of heart attack much more severely.

What is a silent heart attack and whom will it strike?

The term silent heart attack describes an attack that produces little or no chest pain. In place of chest pain, silent heart attack makes itself known by rather uncommon symptoms: marked dyspnea (shortness of breath), extreme fatigue, and life-threatening cardiac arrhythmias (abnormal heart rhythms). A silent heart attack may occur in 10 to 15% of heart attack cases (up to 25–30% according to some medical reports). It’s relatively common among elderly people and diabetic patients. It’s also more common in undereducated people and in chronic alcoholics. Such heart attacks are commonly misdiagnosed or their diagnosis is delayed because of their unusual symptoms.

Thus, risk of death in a silent heart attack is higher.

What is cardiac arrest?

Cardiac arrest means that the heart is not able to pump the blood at all as a result of ineffective, abnormal heart rhythms: too fast, too slow, or lack of heartbeat. When cardiac arrest strikes, your lungs also fail to function, leading to cardiopulmonary arrest. (Cardio means heart, and pulmonary means lungs). Because blood circulation to the entire body, including the brain, is stopped, you become unconscious (enter a coma or a semicomatose state).

By and large, the underlying cause of cardiac arrest in the majority of the cases is ventricular fibrillation (as mentioned, a very rapid, irregular, chaotic, and ineffective heart rhythm arising from the ventricles). On the other hand, an AV block (heart block, slower or nonexistent conduction of the cardiac impulse from the atria to the ventricles) usually causes a very slow heart rhythm. This is a condition in which the electrical conduction of heart impulses to the ventricles is slowed or interrupted.

Terms:

Cardiopulmonary arrest - cessation of heart and lung functions.

Heart block - slower-than-usual or absent conduction of the cardiac impulse from the atria to the ventricles.

What are the direct causes of sudden cardiac death?

In the majority of the cases, sudden cardiac death occurs as a result of ventricular fibrillation, the chaotic heart rhythm arising from the ventricles. You can use the terms sudden cardiac death and cardiac arrest interchangeably, but the underlying problem is ventricular fibrillation.

CONDITIONS THAT MIMIC HEART ATTACKS

Can other ailments cause me to think I’m having a heart attack?

Many disorders, both cardiac and noncardiac, may closely mimic a heart attack. For example, the symptoms of cardiac diseases or disorders, such as myocarditis (inflammation of the heart muscle), pericarditis (inflammation of the sac surrounding the heart), and aortic dissection or rupture (tear of the main artery leading from the heart), can cause you to think you’re going through a heart attack. Certain disorders or diseases of the lungs can also fool you. Some of them include pulmonary embolism (blood clots in the lung arteries), a pneumothorax (a collapsed lung), and pneumonia (infection and inflammation of the lungs). Then, too, you could be experiencing severe asthma, pulmonary hypertension (elevated BP in the arteries carrying blood to the lungs), or pleurisy (inflammation of the membrane that lines the chest cavity and covers the lungs).

Gastrointestinal diseases and disorders that might fool you would be gallstone, cholecystitis (inflammation of the gallbladder), peptic ulcer, heartburn, and disorders of your esophagus. As if that isn’t confusing enough, you could be having a panic attack (an anxiety attack) or Tietze’s syndrome. Possibly you might have fractured a rib or be having pain in bones in that area due to other causes, such as sore muscles in the chest.

Other disorders with similar symptoms that might not be very familiar to you are shingles, cancer, anemia, and vasculitis (a group of disorders that inflame the blood vessels). Even exposure to high altitudes could produce discomfort resembling that of a heart attack.

Because there are so many potential reasons for your symptoms-including the possibilities that you really are having a heart attack-you should not attempt to decide the cause for yourself. Even when it’s not a heart attack, some of the other possible causes are dangerous or life-threatening conditions, so you should get treatment regardless.

Terms:

Myocarditis - inflammation of the heart muscle.

Pericarditis - infection or inflammation of the pericardium.

Aortic dissection - a tear of main artery leading from the left ventricle.

Pulmonary – embolism blood clots in the lung arteries.

Pneumothorax - collapse of part or all of a lung as a result of accumulation of air in the chest cavity.

Asthma - recurrent sudden shortness of breath, with wheezing cough and sensation of constriction.

Pulmonary hypertension - elevated blood pressure in the arteries carrying blood to the lungs. Pleurisy inflammation of the membrane that lines the chest cavity and covers the lungs.

Cholecystitis - inflammation of the gallbladder causing abdominal pain.

Esophagus - feeding tube connecting the mouth and stomach.

Shingles - disorder caused by the herpes zoster virus (chicken pox) that can cause intense pain along the nerve distribution.

Anemia - a decrease in the red blood cells and/or hemoglobin content of the blood.

Vasculitis - group of disorders that cause inflammation of the blood vessels.

 

 

 

 

 

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(31) Heart Attack and Cardiac Disorders

DVT -Pulmonary Embolism

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What is pulmonary embolism?

A blood clot in one or more of the arteries in the lungs causes pulmonary embolism. Its clinical picture closely resembles that of a heart attack. However, various diagnostic tests, particularly a lung scan (a special x-rayexamination) confirm the diagnosis. If you had this type of embolism, you might cough up blood.

On an ECG, the typical abnormalities brought about by pulmonary embolism (beyond the scope of this book) differ markedly from those of a heart attack. In most cases, the blood clots usually arise from your leg veins, and you would feel a very rapid heart rate. Of course, pulmonary embolism does not damage your heart muscle. This can be checked by blood enzyme tests and ECG analysis.

What is a pneumothorax?

Pneumothorax in nonmedical terms means collapse of the lungs. Pneumothorax produces a sudden and severe shortness of breath (dyspnea) that comes with significant chest pain and profuse sweating. At first glance, the clinical picture of pneumothorax mimics that of a heart attack, but x-ray pictures can point out the differences between the two disorders. Of course, no evidence can prove that pneumothorax would damage your heart muscle. Pneumothorax can occur spontaneously, for no obvious reason, but it may be caused by trauma or certain lung diseases as well.

What is dissection or rupture of the aorta?

Dissection of the aorta takes place in the main artery leading from the heart.When the inner layers of the aorta separate, thereby forcing blood flow between them, they do so suddenly, and you would feel tearing chest and back pain. Even a sharp blow to your chest could cause aortic dissection. It may happen as aserious complication of uncontrolled high BP. Clinically, aortic dissection effects closely resemble those of a heart attack, but various diagnostic tests can tell the difference. When aortic dissection is severe, the aorta will rupture. For many people, a dissected or ruptured aorta is fatal. However, this disorder doesn’t damage your heart muscle, so if caught quickly an aortic dissection can be repaired surgically.

What are myocarditis and pericarditis?

Myocarditis is the inflammation of the heart muscle itself, whereas pericarditis is the inflammation of the pericardium (the sac surrounding the heart). Very often, myocarditis can coexist with pericarditis. Either disorder may be caused by a variety of viruses and bacteria, but it may be idiopathic (arising from an unknown cause). Nevertheless, in the majority of cases a virus is responsible, particularly for pericarditis.

Often you can relieve chest pain from pericarditis by sitting up. At first glance, the symptoms mimic those of a heart attack, but physical findings along with various diagnostic tests can distinguish between the two. Affected patients often have a mild fever.

Term:

Idiopathic - arising from an unknown cause.

 

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(33) Heart Attack and Cardiac Disorders

Acute Coronary Syndrome and Heart Attack

HEART ATTACK FACTS

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Can bone and muscle diseases and disorders cause pain like that of a heart attack?

Injured chest muscles or ribs, particularly a broken (fractured) rib due to any number of injuries, can produce severe pain that may resemble pain from a heart attack. However, as in treating most other mimicking disorders, your doctor would be able to arrive at a diagnosis by asking you about your symptoms and by chest x-ray examination and other diagnostic tests.

Sore muscles due to vigorous physical activities, particularly competitive sports, also may cause pain in the chest, shoulders, and arms. Severe arthritis of the ribs may cause pain, sometimes similar to cardiac pain.

Another disorder that can imitate the pain of a heart attack is shingles (herpes zoster in medical terms). A virus (the same virus that produces chicken pox) causes shingles, which would produce intense pain and a band of blisters on your back around your chest wall(along the nerve distribution). At times, it can seem like a heart attack, but the diagnosis is obvious to a doctor in most cases.

DIAGNOSING AHEART ATTACK

What is an electrocardiogram, and what is its diagnostic value?

An electrocardiogram (ECG or EKG) is the most important first test used to diagnose a heart attack. An ECG records the electrical activity of your heart through wires and electrodes attached to the skin of your arms, legs, and chest wall. Your heart’s sinus node generates electrical impulses that are recorded as wave patterns displayed on a monitor or are printed on paper. Since damaged heart muscle fails to conduct electrical impulses normally, the ECG may show an old (prior) heart attack or an acute (new) heart attack in progress.

The most important wave pattern in diagnosing a heart attack is the large Q wave and the S-T segment elevation (ECG segment from the endpoint of the QRS complex to the beginning of the T wave; When the entire thickness of your heart muscle is damaged, a large Q wave is shown on the ECG (then it’s called a Q-wave myocardial infarction or a Q-wave heart attack). On the other hand, the term non-Q-wave MI is used when the ECG shows only an S-T segment change without the large Q wave. A non-Q-wave MI occurs when primarily the inner layer of your heart muscle is damaged. When the ECG displays a large Q wave with the S-T segment elevation in a heart attack, the heart attack is considered to be acute, and the damage is in progress. As mentioned, a heart attack is considered to be old when there is a Q wave with no S-T segment elevation. Clinically, a Q-wave heart attack is said to be more serious than a non-Q-wave heart attack.

The ECG is also very important for diagnosing a variety of abnormal heart rhythms (cardiac arrhythmias; In addition, the ECG provides extremely important information to your doctor in ruling out the diagnosis of a heart attack in dealing with various diseases and disorders that produce chest pain resembling that of a heart attack.

What blood tests are available for diagnosing a heart attack?

Certain enzymes (protein molecules) normally found in the heart muscle leak out into the bloodstream when a heart attack damages the heart muscle. A blood test will show increased levels of these enzymes in the blood. (The blood test used most commonly to look for the presence of various enzymes is the measurement of CK-MB: creatine kinase myocardial band.

(Our discussion here doesn’t go into the technical explanation of the CK-MB marker.) Although CKMB has been standard marker, it’s not very accurate, since elevated levels can be found also in people without heart damage. Other enzymes may include troponins, myoglobin, and C-reactive protein.

Who needs a stress test? What is its diagnostic value?

Several different kinds of stress tests are used, but the test used most commonly is the treadmill stress test. Obviously, a stress test should not be performed when a heart attack is acute (i.e., in progress). The stress test is usually performed for screening or as a first-line evaluation of symptoms, particularly those of chest pain. This test evaluates how your heart and blood vessels respond to exertion; the results may indicate whether your chest pain is due to a coronary artery disease (CAD), particularly angina. A stress test is essential for evaluating chest pain and marked shortness of breath, particularly that which is related to physical exercise. However, your doctor first would ensure against the probability of an acute (new) heart attack. The test is especially an important screening and diagnostic test for anyone with one or more coronary risk factors, even for those without a history of heart symptoms, including chest pain.

In a treadmill exercise stress test, you would walk on a motor-driven treadmill while a doctor monitors and records your ECG picture and your blood pressure (BP). During the test, your heart workload progressively increases until any significant symptom (e.g., chest pain) or some ECG abnormality develops. Every 3 minutes, a faster speed and an increase in the elevation (or slope) of the treadmill progressively increases your heart’s workload. If you are unable to walk on a treadmill, doctors can provide you with other forms of exercise, such as pedaling a stationary bicycle or performing arm exercises and various pharmacologic (nonexercise) stress tests. People with arthritis or other problems with walking can use such nonexercise stress tests as adenosine, dipyridamole, or dobutamine. These pharmacologic agents “stress” your heart (in the good sense of that term) by mimicking the effects of physical exercise. Imaging tests provide useful additional diagnostic information by producing pictures of your heart during and after physical exercise or pharmacologic stress testing.

Imaging tests may be used alone or may clarify the results of previous stress tests without using imaging.

Term:

Stress test - test that evaluates how the heart and blood vessels respond to exertion and may allow diagnosis of coronary artery disease; may be performed using a treadmill or various chemicals (e.g.,dobutamine, adenosine).

 

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(32) Heart Attack and Cardiac Disorders

Is it a Panic Attack or Heart Attack?

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Can gastrointestinal diseases or disorders act like a heart attack?

Myocarditis is the inflammation of the heart muscle itself, whereas pericarditis is the inflammation of the pericardium (the sac surrounding the heart). Very often, myocarditis can coexist with pericarditis. Either disorder may be caused by a variety of viruses and bacteria, but it may be idiopathic (arising from an unknown cause). Nevertheless, in the majority of cases a virus is responsible, particularly for pericarditis.

Often you can relieve chest pain from pericarditis by sitting up. At first glance, the symptoms mimic those of a heart attack, but physical findings along with various diagnostic tests can distinguish between the two.

Affected patients often have a mild fever. Idiopathic arising from an unknown cause.

In some instances, various gastrointestinal diseases or disorders can cause you to think you’re undergoing a heart attack. Heartburn, for example, occurs when stomach (gastric) acid washes up from the stomach into the esophagus. Heartburn can produce a burning sensation behind the breastbone (sternum). Chest pain due to heartburn usually occurs after you eat a meal and may last for hours. Heartburn tends to occur more often when you bend forward at the waist or lie down.

Often it’s accompanied by a sour taste and the feeling of food reentering your mouth (regurgitation, a medical term for vomiting).

Other disorders that can imitate the symptoms of a heart attack center on the esophagus. They, too, cause chest pain similar to that of a heart attack. They include esophageal spasm, esophagitis (inflammation of the esophagus), and achalasia (explained below).

In esophageal spasm (spasm of the esophagus), the muscles that normally move foods down your esophagus while swallowing lose their coordination. This can lead to painful muscle spasms. Since both esophageal spasm and angina can be relieved by nitroglycerin, you might mistake this condition for angina or even heart attack.

Another swallowing disorder, achalasia, causes chest pain. What happens when achlasia occurs is that the valve in your lower esophagus fails to open properly to allow food to enter your stomach. Instead, the food backs up into the esophagus (regurgitation, or vomiting), and that action produces chest pain and heartburn. Esophagitis, an inflammation of the esophagus, also can cause chest pain. Diseases or disorders of the gallbladder, such as gallstones (stones that form in your gallbladder) andcholecystitis (inflammation of the gallbladder), produce upper abdominal pain that on the surface might cause you to think you were having a heart attack. In the majority of cases, however, the characteristic symptoms and various diagnostic tests can distinguish one from the other.

Sometimes, peptic ulcer pain may feel like that of a heart attack. If you experienced a bout of peptic ulcer, however, you probably would have a history of stomach trouble for weeks, months, or even years. The pain is always related to food.

Hiatal hernia is the bursting or splitting of a portion of your stomach into your chest through the hiatus (space or gap) between your diaphragm (a muscle that separates various intestinal organs from the chest cavity) and your esophagus. This hiatal hernia also causes chest pain that may on the surface mimic pain from angina or a heart attack. However, once again, the characteristic clinical picture and various diagnostic tests can identify which is which.

Terms:

Esophagitis - inflammation of the esophagus.

Achalasia - disorder in which the valve in the lower esophagus fails to open properly to allow food to enter the stomach. Instead, food backs up into the esophagus, leading to chest pain.

Hiatal hernia - herniation of a portion of the stomach through the diaphragmaticesophageal hiatus into the chest, leading to chest pain.

What is Tietze’s syndrome?

Tietze’s syndrome is a form of costochondritis. In this disorder, the cartilage (a fibrous connective tissue) of your rib cage, particularly the cartilage that joins your ribs to your sternum (breastbone), becomes inflamed from an unknown cause. The pain of Tietze’s syndrome may occur suddenly, and it can be severe. Naturally, you might think you were having a heart attack, because the pain can be similar. However, this pain can always be reproduced or increased by pressure directly on your rib cage, particularly on your sternum or the ribs near your breastbone. In a heart attack, onthe other hand, direct pressure on the chest wall would not influence your pain. Heart disease is not associated with Tietze’s syndrome.

Terms:

Tietze’s syndrome  - a condition in which the cartilage of the rib cage, particularly that joining the ribs to the sternum (breastbone), becomes inflamed due to unknown causes and often triggers chest pain.

Costochondritis - inflammation of the rib cartilage.

What is a panic attack?

For certain people, an unusual fear can cause an intense anxiety reaction. That can bring on chest pain, rapid heartbeats, hyperventilation (rapid breathing), profuse sweating, and shortness of breath. A panic attack may on the surface imitate a heart attack, but there is no relationship between the two. Panic attacks are a form of emotional disorder that seems to run in families, and they can be treated successfully in most cases.

 

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(34) Heart Attack and Cardiac Disorders

3D Medical Animation - What is a Heart Attack?

 

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What is a nuclear scan, and what is its diagnostic value?

An echocardiogram uses sound waves to produce an image of your heart. An echocardiogram machine directs sound waves at your heart through a wand-like device (called a transducer) held against your chest. The sound waves bounce off your heart, reflect back through the chest wall, and proceeded electronically to produce video images of your heart on a monitor screen. An echocardiogram can identify an area of your heart muscle that’s been damaged by a heart attack and can show the status of your heart’s pumping action.

What is a coronary angiogram, and what is its diagnostic value?

A coronary angiogram (arteriogram) is the definitive and most accurate diagnostic test for coronary artery disease. A coronary angiogram can precisely identify specific sites and degree of a narrowing (stenosis) or blockage of your coronary arteries. Therefore, a coronary angiogram is essential before any attempt to perform a coronary artery dilatation by coronary angioplasty (PTCA) or a coronary artery bypass surgery.

In a coronary angiogram, a doctor inserts a catheter (a long thin tube) into an artery in your groin area (or, less commonly, in your arm) and threads it through that artery to your heart arteries. Then the doctor injects a liquid dye into your coronary arteries by way of the catheter. As the dye (called contrast agent) flows through those coronary arteries, the doctor can accurately identify any narrowing (stenosis) and blockage of those arteries using a series of x rays and videotapes.

Are other tests available?

Several other tests are available for the diagnosis and treatment of coronary artery disease either directly or indirectly. The chest x ray can evaluate the condition of your lungs and the size and shape of your heart and major blood vessels. A chest x ray is particularly useful also for monitoring the management of various complications from a heart attack.

Electron beam computerized tomography (EBCT), also called an ultrafast CT scan, and scans your coronary arteries for signs of calcium within plaques that can cause coronary artery narrowing or blockage. When it detects a substantial amount of calcium, it almost certainly points to a diagnosis of coronary artery disease, because plaques contain some calcium in the majority of cases.

Magnetic resonance imaging (MRI) with enhanced software can provide accurate information about arterial blood flow, including that in very small coronary arteries not visible when using a coronary angiogram.

Terms:

Coronary angiogram (arteriogram) - x-ray study in which dye is used to demonstrate the degree and the location of coronary artery narrowing or blockage.

Electron beam computerized tomography (EBCT) - a new diagnostic test to detect calcium within plaques of coronary artery

Magnetic resonance imaging (MRI) - a form of special diagnostic x-ray tests that can be used to diagnose coronary artery narrowing or blockage.

What is ventricular wall rupture?

Ventricular wall rupture (rupture of the heart muscle of the ventricles) is the most serious and life-threatening complication of a heart attack. This is because the disorder causes rupture of the pumping chambers of the heart. As soon as the ventricles rupture, there will be no heart function at all, and sudden cardiac death is the immediate outcome. For nearly every patient who experiences ventricular wall rupture, there is no possible treatment.

What is congestive heart failure and what are its usual symptoms?

The heart muscle damage from a heart attack may be so extensive that the remaining heart muscle is unable to provide adequate pumping action. Consequently, blood flow to tissues and organs throughout the body (including the heart itself) markedly decreases, leading to congestion in the lungs and to a variety of symptoms and signs. This event is termed congestive heart failure (CHF) or simply heart failure.

CHF displays various signs and symptoms. Shortness of breath (dyspnea), especially during physical exertion or upon lying down; fatigue and weakness; and edema (swelling) of the legs, ankles, and feet are symptoms characteristic of CHF. It also can lead to wheezing or coughing up white or pink blood-tinged phlegm (sputum); swelling of the abdomen and rapid weight gain from fluid retention; and engorged neck veins. Those experiencing CHF would have dizzy or fainting spells (syncope) and palpitations from abnormal heart rhythms (cardiac arrhythmias). Nausea and loss of appetite would also be evident. CHF can even cause diminished alertness and difficulty in concentrating.

What is cardiogenic shock?

Cardiogenic shock occurs after insufficient blood circulation to your body, including the heart muscle itself. It’s the result of low and ineffective blood pressure (BP) brought on by a markedly diminished pumping action of the heart during or immediately after a heart attack. In cardiogenic shock, coronary arteries do not receive sufficient blood, so the heart becomes weaker, and the blood circulation further decreases. Unfortunately, this vicious cycle is fatal in most cases. In 7 to 15% of cases, cardiogenic shock often occurs during the first few days after an acute heart attack.

Cardiogenic shock tends to occur when 40% or more of the left ventricle is damaged by a heart attack, and advanced disease is often found in three major coronary arteries. Usually, cardiogenic shock is associated with advanced CHF in heart attack victims. (The scope of this book prevents discussion of the management of cardiogenic shock.)

What are cardiac arrhythmias and how should they be handled?

Various abnormal heart rhythms, known as cardiac arrhythmias, frequently occur after a heart attack damages the heart muscle. Abnormal heart rhythms may be benign (i.e., not harmful) and self-limited, but serious arrhythmias often lead to sudden death. Abnormal heart rhythms may be slow (called bradycardia or bradyarrhythmia), fast (called tachycardia or tachyarrthymia), or irregular. In most cases, if you were affected by this disorder you would need an artificial cardiac pacemaker, an electrical device that activates the heart with batteries, for a persisting slow heart rhythm. For rapid heart rhythms, on the other hand, your doctor could prescribe any of several medications (e.g., beta blockers, calcium channel blockers, lidocaine, procainamide, amiodarone, and the like). To handle life-threatening rapid arrhythmia (ventricular fibrillation), your doctor would immediately apply electric shock, the only life-saving measure.

Cardiac arrhythmia (also called cardiac dysrhythmia) may appear as too fast, too slow, or irregular heartbeats. Certain stimulants, such as stress, tobacco smoking, caffeine, and alcohol, can cause you to experience a variety of cardiac arrhythmias, even if you’re apparently healthy. Under those circumstances, you wouldn’t need any particular treatment other than eliminating or controlling the abovementioned stimulants. However, more than 4 million Americans suffer from recurrent or symptomatic arrhythmias that usually require treatment. Clinically, significant arrhythmias usually occur in older adults with coronary artery disease when the electrical system of the heart is disturbed. Serious arrhythmias commonly are by-products of coronary artery disease damage to the heart, particularly that resulting from a heart attack. Life-threatening arrhythmia, particularly ventricular fibrillation, must be terminated within a few minutes to prevent sudden death, especially in patients experiencing an acute heart attack.

Terms:

Heart failure - inability of the heart to pump adequately; also called congestive heart failure.

Dyspnea - shortness of breath.

Edema - fluid accumulation resulting in swelling, commonly due to heart failure.

Cardiogenic shock - life-threatening complication of a heart attack, common signs of which include hypotension, clammy skin, unclear mental state, markedly reduced urine output, and very poor pumping action of the heart.

Cardiac arrhythmia - abnormal (slow, rapid, or irregular) heart rhythm.

Bradyarrhythmia - abnormally slow heart rhythm (also called bradycardia).

Tachyarrhythmia (or tachycardia) - rapid heart rhythm.

Artificial cardiac pacemaker - electrical device that activates the heart using batteries, used temporarily or implanted permanently.

Defibrillation - an electric shock applied to the chest to restore the regular heart rhythm.

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