How are arrhythmias diagnosed?
Sometimes an arrhythmia can be detected by listening to the heart with a stethoscope. However, the electrocardiogram ( ECG or EKG) is the most precise method for diagnosing an arrhythmia. An arrhythmia may not occur at the time of the exam even though symptoms are present at other times. In such cases, tests will be done, if necessary, to find out whether an arrhythmia is causing the symptoms.
First, your health care provider will take a medical history and do a thorough physical exam. Then one or more tests may be used to check for an arrhythmia and to decide whether it is caused by heart disease.
The two main types of diagnostic tests for arrhythmias are:
- Electrocardiogram (ECG or EKG). An electrocardiogram is a record of the electrical activity of the heart. Disks are placed on the chest and connected by wires to a recording machine. The heart's electrical signals cause a pen to draw lines across a strip of graph paper in the ECG machine. The doctor studies the shapes of these lines to check for any changes in the normal rhythm.
- Electrophysiologic study (EPS). An electrophysiologic study is a test for arrhythmias that involves cardiac catheterization. Very thin, flexible tubes (catheters) are placed in a vein of an arm or leg and advanced to the right atrium and ventricle. This procedure allows doctors to find the site and type of arrhythmia and how it responds to treatment.
How are arrhythmias treated?
Many arrhythmias require no treatment whatsoever. Serious arrhythmias are treated in several ways depending on what is causing the arrhythmia. Sometimes the heart disease is treated to control the arrhythmia, or the arrhythmia itself may be treated using one or more of the following treatments.
Drugs
There are several kinds of drugs used to treat arrhythmias. One or more drugs may be used. Drugs are carefully chosen because they can cause side effects. In some cases, they can cause arrhythmias or make arrhythmias worse. For this reason, the benefits of the drug are carefully weighed against any risks associated with taking it. It is important not to change the dose or type of your medication unless you check with your health care provider first.
If you are taking drugs for an arrhythmia, one of the following tests will probably be used to see whether treatment is working: a 24-hour electrocardiogram (ECG) while you are on drug therapy, an exercise ECG, or a special technique to see how easily the arrhythmia can be caused. Blood levels of antiarrhythmic drugs may also be checked. See also: Heart Rhythm Drugs
To quickly restore a heart to its normal rhythm, your health care provider may apply an electrical shock to the chest wall. Called cardioversion, this treatment is most often used in emergency situations. After cardioversion, drugs are usually prescribed to prevent the arrhythmia from recurring.
These devices are used to correct serious ventricular arrhythmias that can lead to sudden death. The defibrillator is surgically placed inside the patient's chest. There, it monitors the heart's rhythm and quickly identifies serious arrhythmias. With an electrical shock, it immediately disrupts a deadly arrhythmia.
Pacemaker
An artificial pacemaker can take charge of sending electrical signals to make the heart beat if the heart's natural pacemaker is not working properly or its electrical pathway is blocked. During a simple operation, this electrical device is placed under the skin. A lead extends from the device to the right side of the heart, where it is permanently anchored.
Surgery
When an arrhythmia cannot be controlled by other treatments, doctors may perform surgery. After locating the heart tissue that is causing the arrhythmia, the tissue is altered or removed so that it will not produce the arrhythmia.
How can arrhythmias be prevented?
If heart disease is not causing the arrhythmia, your health care provider may suggest that you avoid what is causing it. For example, if caffeine or alcohol is the cause, the doctor may ask you not to drink coffee, tea, colas, or alcoholic beverages.
References
1. Rosamond W, Flegal K, Friday G, et al. Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. February 6, 2007 2007;115(5):e69-171.
