Heart Rhythm Disorders (cont.)
Benjamin Wedro, MD, FACEP, FAAEM
Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- How does the heart work?
- What is a heart rhythm disorder (arrhythmia)?
- What causes heart rhythm disorders?
- What are the signs and symptoms of heart rhythm disorders?
- What are the different types of heart rhythm disorders?
- Premature atrial contractions (PACs) and premature ventricular contractions (PVCs)
- Sinus tachycardia
- Sinus bradycardia
- Abnormal heart rhythms
- Ventricular fibrillation (V-fib)
- Ventricular tachycardia (V-tach)
- Paroxysmal supraventricular tachycardia (PSVT)
- Wolff-Parkinson-White (WPW) syndrome
- Atrial fibrillation (A-fib)
- Atrial flutter
- Heart blocks
- When to seek medical care
- How are heart rhythm disorders diagnosed?
- What is the treatment for heart rhythm disorders?
- What is the prognosis for heart rhythm disorders?
- Can heart rhythm disorders be prevented?
- Find a local Cardiologist in your town
What is the treatment for heart rhythm disorders?
There is no one treatment for a heart rhythm abnormality. When the patient is unstable, with no pulse or blood pressure, or when they are unconscious, American Heart Association guidelines are available to direct care to hopefully restore the heart rhythm to normal and return a pulse.
For V-fib and V-tach, electricity may be the most important drug, and the heart is shocked back into a heart rhythm, hopefully compatible with life. Other common medications used in crisis situations depend upon the life-threatening rhythm and may include epinephrine (adrenalin), atropine, and amiodarone.
For patients with supraventricular tachycardia (SVT), the goal is not only to slow down the heart rate but also to identify which rhythm is present. Vasovagal maneuvers, like holding one's breath and bearing down as if to have a bowel movement may resolve the situation, or it may slow the rate temporarily to make the diagnosis. Adenosine can be injected and may convert SVT to normal sinus rhythm by slowing the electrical impulse at the AV node. It can also be used as a diagnostic challenge to help identify atrial fibrillation or atrial flutter with rapid ventricular response.
For atrial fibrillation with rapid ventricular response, the initial goal is to slow the rate and maintain normal blood pressure. Calcium channel clockers like diltiazem and beta blockers like metoprolol may be used intravenously to control rate. Digoxin is a second-line mediation that may be helpful when first-line medications fail. In unstable patients, with chest pain, shortness of breath, or decreased consciousness, cardioversion with an electric shock may be required. The decision to electively convert A-fib to normal sinus rhythm depends upon the patient and situation and is often a decision left to the primary care professional. The question regarding anticoagulation also will need to be addressed.
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