G.A.G. Cardiovascular S.L. - Heart and vascular disorders

Abnormal heart rhythms (arrhythmias)

Abnormal heart rhythms (arrhythmias)

What is an arrhythmia?

An arrhythmia (also called dysrhythmia) is an irregular or abnormal heartbeat.

What causes arrhythmias?

Arrhythmias can be caused by:
  • Coronary artery disease.
  • High blood pressure.
  • Changes in the heart muscle (cardiomyopathy).
  • Valve disorders.
  • Electrolyte imbalances in the blood, such as sodium or potassium.
  • Injury from a heart attack.
  • The healing process after heart surgery.
  • Other medical conditions.

What is my pulse?

Your pulse indicates your heart rate, or the number of times your heart beats in one minute. Pulse rates vary from person to person. Your pulse is slower when you are at rest and increases when you exercise, since more oxygen- rich blood is needed by the body during exercise.
How do I take my pulse?

You can tell how fast your heart is beating by feeling your pulse. You can feel your pulse on your wrist or neck. Place the tips of your index and middle fingers on the inner wrist of your other arm, just below the base of your thumb. Or, place the tips of your index and middle fingers on your lower neck, on either side of your windpipe. Press lightly with your fingers until you feel the blood pulsing beneath your fingers. You may need to move your fingers around slightly up or down until you feel the pulsing.

You can count the number of beats in 10 seconds and multiply by 6 to determine your heart rate in beats per minute. A normal heart rate, at rest, is 50 to 100 beats per minute.

 What are the types of arrhythmias?

  • Tachycardia: A fast heart rhythm with a rate of more than 100 beats per minute.
  • Bradycardia: A slow heart rhythm with a rate below 60 beats per minute.
  • Supraventricular arrhythmias: Arrhythmias that begin in the atria (the heart’s upper chambers). “Supra” means above; “ventricular” refers to the lower chambers of the heart, or ventricles.
  • Ventricular arrhythmias: Arrhythmias that begin in the ventricles (the heart’s lower chambers).
  • Bradyarrhythmias: Slow heart rhythms that may be caused by disease in the heart’s conduction system, such as the sinoatrial (SA) node, atrioventricular (AV) node or HIS-Purkinje network.

What are the symptoms of an arrhythmia?

An arrhythmia may be “silent” and not cause any symptoms. A doctor can detect an irregular heartbeat during an examination by taking your pulse, listening to your heart or by performing diagnostic tests.

If symptoms occur, they may include:
  • Palpitations: A feeling of skipped heartbeats, fluttering, "flip-flops" or feeling that the heart is "running away".
  • Pounding in the chest.
  • Dizziness or feeling lightheaded.
  • Shortness of breath.
  • Chest discomfort.
  • Weakness or fatigue (feeling very tired).

What Is Arrhythmogenic Right Ventricular Dysplasia (ARVD)?

(also called arrhythmogenic right ventricular cardiomyopathy)
ARVD is a rare form of cardiomyopathy in which the heart muscle of the right ventricle (RV) is replaced by fat and/or fibrous tissue. The right ventricle is dilated and contracts poorly. As a result, the ability of the heart to pump blood is usually weakened. Patients with ARVD often have arrhythmias (abnormal heart rhythms), which can increase the risk of sudden cardiac arrest or death.

What causes Arrhythmogenic Right Ventricular Dysplasia?

The cause of ARVD is unknown. It occurs in about 1 in 5,000 people. ARVD can occur with no family history, although often it runs in families. A family history of ARVD is present in at least 30 to 50 percent of cases. Therefore, it is recommended that all first- and second-degree family members (parents, siblings, children, grandchildren, uncle, aunt, nephew, niece) be evaluated carefully for this form of cardiomyopathy, even in the absence of symptoms.

Researchers have found two patterns of inheritance for ARVD:
  • Autosomal dominant - When one parent has ARVD. Studies show that in these families, the family members have a 50 percent chance of inheriting the condition, although the symptoms and age of onset may be different between family members. ARVD is more prevalent in some geographic locations, such as Italy.
  • Autosomal recessive (one form is called Naxos disease) - Characterized by the symptoms of ARVD listed above. Naxos disease is associated with a thickening of the outer layer of skin on the palms of the hands and soles of the feet (hyperkeratosis) and thick, "wool-like" hair.

Not all the specific genes have been identified as a cause for ARVD. Researchers are attempting to identify the specific gene mutations and locations of chromosomes associated with ARVD.

ARVD may also be related to non-genetic causes such as congenital abnormalities (affecting the right ventricle), viral or inflammatory myocarditis. 

Syncope

Syncope

What is syncope?

Syncope (pronounced “sin ko pea”) is the medical term for fainting or passing out. It is caused by a temporary drop in the amount of blood that flows to the brain.

Syncope can happen if you have a sudden drop in blood pressure, a drop in heart rate, or changes in the amount of blood in areas of your body. If you pass out, you will likely become conscious and alert right away, but you may be feel confused for a bit.

The ANS automatically controls many functions of the body, such as breathing, blood pressure, heart rate and bladder control. Most times, these things happen without us noticing.

How common is syncope?

Syncope is a common condition. It affects 3% of men and 3.5% of women at some point in life. Syncope is more common as you get older and affects up to 6% of people over age 75. The condition can occur at any age and happens in people with and without other medical problems.

What are the symptoms of syncope?

The most common symptoms of syncope include:
  • Blacking out.
  • Feeling lightheaded.
  • Falling for no reason.
  • Feeling dizzy.
  • Feeling drowsy or groggy.
  • Fainting, especially after eating or exercising.
  • Feeling unsteady or weak when standing.
  • Changes in vision, such as seeing spots or having tunnel vision.
  • Headaches.
Many times, patients feel an episode of syncope coming on. They have what are called “premonitory symptoms,” such as feeling lightheaded, nauseous, and heart palpitations (irregular heartbeats that feel like “fluttering” in the chest). If you have syncope, you will likely be able to keep from fainting if you sit or lie down and put your legs up if you feel these symptoms.

Syncope can be a sign of a more serious condition. So, it is important to get treatment right away after you have an episode of syncope. Most patients can prevent problems with syncope once they get an accurate diagnosis and proper treatment.

What causes syncope?

Syncope can be caused by many things. Many patients have a medical condition they may or may not know about that affects the nervous system or heart. You may also have a condition that affects blood flow through your body and causes your blood pressure to drop when you change positions (for example, going from lying down to standing).

Brugada Syndrome

Brugada Syndrome

What is Brugada syndrome?

Brugada syndrome is a condition that causes an abnormal heart rhythm in the heart’s lower chambers (ventricles). This irregular heartbeat can cause fainting (syncope) and lead to sudden cardiac death (SCD).

Brugada syndrome is a rare disease that is inherited (genetic) from at least one parent. It was first discovered in 1992. A lot has been learned about the condition since then, but there are still many unanswered questions. Researchers continue to study Brugada syndrome and test new treatments.
What causes Brugada syndrome?

Brugada syndrome is often caused by a genetic mutation. The defect changes the way the heart’s ion channels work (a problem called a channelopathy).

Who is at risk of having Brugada syndrome?
Brugada syndrome is more common in males than females. In fact, men are 8 to 10 times more likely than women to have the condition. All patients with a family history of SCD or Brugada syndrome should be screened for the disease. 

Short Q-T Syndrome (SQTS)

Short Q-T Syndrome (SQTS)

What is short Q-T syndrome (SQTS)?

Short Q-T syndrome is a rare genetic type of abnormal heart rhythm that was discovered in 1999.

The electrical activity of the heart is produced by the flow of ions (electrically charged particles of sodium, calcium, potassium, and chloride) in and out of the cells of the heart. Tiny ion channels control this flow. The Q-T interval is the section on the electrocardiogram (ECG) that represents the time it takes for the electrical system to fire an impulse through the ventricles (lower chambers of the heart) and then recharge. It is translated to the time it takes for the heart muscle to contract and then recover.

If you have SQTS, your heart beats at a normal rate, but the time it takes to recover (the Q-T interval) is much shorter. Another difference in patients with SQTS is that the Q-T interval does not change as the speed of the heartbeat changes. In healthy people, the Q-T interval gets longer when the heart beats slower and shorter when the heart beats faster.

Ebstein's Anomaly in Adults

Ebstein's Anomaly in Adults

What is Ebstein’s anomaly?

Ebstein’s anomaly, also called Ebstein’s malformation, is a rare, congenital (present at birth) heart defect.

In patients with Ebstein’s anomaly, the valve between the chambers on the right side of the heart (the tricuspid valve) does not close correctly. The right side of the heart is where blood returns from the rest of the body and gets pumped out to the lungs to pick up oxygen again.

The tricuspid valve has three small flaps (leaflets). Normally, these leaflets open so that blood can flow from the right atrium (the top chamber of the heart) down into the right ventricle (the bottom chamber of the heart). The valve closes while the heart pumps so that blood cannot flow backwards.

If you have Ebstein’s anomaly, the flaps on the tricuspid valve are abnormally shaped, too large or adhered to the heart wall so they cannot move. It’s not unusual for two of the valve flaps to be down in the ventricle where they don’t belong. As a result of these abnormalities, the valve cannot open and close correctly, and blood can leak backwards into the atrium.

The misplaced valve flaps in the ventricle cause a section of the ventricle to become part of the right atrium. This creates an oversized right atrium and also causes the right ventricle to expand as it pumps harder and harder to push the blood to the lungs. Over time, the enlarged right side of the heart weakens and heart failure develops.

Bundle Branch Block

Bundle Branch Block

What are the bundle branches?

Normally, your heart beats in a nice, regular fashion. The heartbeat starts in the upper chambers of the heart in an area called the SA node. The impulse then moves to the AV node. The AV node is an area of tissue that carries the impulse through the Bundle of His and then splits into two wire-like branches (the bundle branches). The branches carry the impulse to the Purkinje fibers, which are located in the muscular walls of the ventricles, and cause them to contract.

What is a bundle branch block?

A bundle branch block means the electrical impulses that control the heartbeat cannot move properly throughout the heart. A block in the branches causes the impulses to travel slower than normal.

Diagnosis of bundle branch block

A bundle branch block can be seen on an electrocardiogram (EKG).

How LBBB can affect other cardiovascular tests and conditions

Stress testing and heart attack:

Left bundle branch block can make it more difficult to diagnose left ventricular hypertrophy (LVH) and ischemia (decreased blood supply to the heart) during exercise stress testing and during a heart attack.

If you have LBBB, make sure your doctor knows about the condition before you have a stress test. You may need additional testing or a different kind of stress test (done with medicine, not exercise).

You should also carry a copy of your EKG with you.

If you think you are having a heart attack, be sure to tell your doctor or nurse that you have LBBB and give them the copy of the EKG. This will help them see changes in your heart.

If you have signs of LVH, your doctor will use an echocardiogram to diagnose the condition. 

Heart Palpitations

Palpitaciones del corazón

What are heart palpitations?

Heart palpitations are heartbeat sensations that you suddenly become aware of because they feel like your heart is “pounding” or “racing.” They may feel like you have exercised or they may feel like a flutter, a skipped or extra beat, or a heartbeat that simply does not feel normal. Palpitations can occur at any time - while you are simply sitting or moving about normally as you perform your daily activities.

Palpitations can be felt in your chest, throat or neck. Although heart palpitations may be startling, they may or may not be related to an abnormal heart rate and are often not serious or harmful.

What causes heart palpitations?

Heart palpitations may be caused by:
  • Emotions, such as anxiety, stress, fear, panic.
  • Exercise.
  • Pregnancy.
  • Caffeine found in coffee, teas, chocolate, colas, some sports drinks and foods.
  • Certain medical conditions: overactive thyroid, low blood sugar, low potassium level, low oxygen level or low carbon dioxide level in the blood, fever, anemia, dehydration, loss of blood, shock.
  • Certain medications: asthma inhalers and decongestants, beta blockers (taken for high blood pressure or heart disease), thyroid and antiarrhythmic medications, and some over-the-counter medications that act as stimulants, such as cough and cold medicines, and some herbal or nutritional supplements.
  • Illegal street drugs: cocaine and amphetamines (speed).
  • Nicotine found in tobacco products.