Heart Rhythm Disorders: Causes, Symptoms, and Treatments

Heart rhythm issues, arrhythmias?

I apologize for the lengthy message, but I would like to ask about my condition.
Previously, I often felt discomfort in my heart, experiencing sudden episodes of rapid heartbeat.
After frequent occurrences, I went to the hospital for a 24-hour Holter ECG, which showed the following:
1.
The baseline ECG showed sinus rhythm with a heart rate of 46-112 beats per minute.
The average heart rate was 71 beats per minute.
2.
There was sinus bradycardia without long pauses.
3.
No paroxysmal supraventricular tachycardia (PSVT), paroxysmal atrial fibrillation (PAF), ventricular tachycardia (VT), or ventricular fibrillation (VF).
4.
A few premature ventricular contractions (PVCs) were noted (total of 42 beats), and premature atrial contractions (PACs) (total of 8 beats) during the examination period.
5.
No marked events were recorded.
I have been taking antiarrhythmic medication for a year, which initially reduced the frequency of episodes.
However, after being diagnosed with an autoimmune disease (medications: Belimumab and Prednisone), I began to experience sudden episodes of rapid heartbeat without warning, or my heart would race after irregular beats.
Particularly at night, I would wake up with my heart racing to over 160 beats per minute, accompanied by shaking, numbness, and difficulty breathing, almost fainting.
I went to the emergency room, where blood tests and an ECG were normal, but I experienced several episodes of rapid heartbeat while there.
The heart rhythm was normal at that time, but the doctor admitted me for observation.
An echocardiogram during my hospital stay showed normal results, with the following report:
Echocardiogram Report:
- Atrium and Aortic Root: AO (mm) = 31, LA (mm) = 26
- Left Ventricle: IVS (mm) = 7, PW (mm) = 6, EDD (mm) = 39, ESD (mm) = 25, LVEF (by M-mode measurement) = 66%
- Valves: MS: nil; MR: nil; AS: nil; AR: nil; TS: nil; TR: nil; PS: nil; PR: nil;
- Conclusion:
- Rhythm and Appearance: Sinus rhythm
- Left ventricle: Systolic function: Normal; Wall motion: Normal; Diastolic function: Normal
- Right ventricle: Systolic function: Normal
Later, the doctor prescribed antiarrhythmic medication again and suggested I see a psychiatrist.
The psychiatrist prescribed Clonazepam, Escitalopram, and Quetiapine, which helped reduce the frequency of irregular beats.
However, I still experience panic and mild episodes of rapid heartbeat when in unfamiliar or remote places, but they usually resolve quickly.
The psychiatrist has tapered my medications over the past two months, but recently I have started to feel occasional rapid heartbeats.
Today, while sitting and doing nothing, my heart suddenly began to beat irregularly and forcefully for about 3-5 minutes (previously, episodes lasted only 2-3 beats before returning to normal).
It then accelerated further, causing shaking and difficulty breathing.
I quickly took my antiarrhythmic medication, which helped calm my heart rate.
However, when I measured my heart rate with a device, it still showed irregularities.
This episode lasted about ten minutes, but after measuring again, my heart rate returned to normal.
I haven't experienced this in a long time.

I am concerned if my heart condition has worsened.
Is there a risk of sudden cardiac death? I am also anxious about traveling abroad next month.
Additionally, I would like to know if Belimumab and Prednisone are suitable for my heart condition.
Thank you for your guidance.

Dou Dou, 30~39 year old female. Ask Date: 2023/10/11

Dr. He Dongjin reply Cardiology

Hello, it seems that the symptoms you are experiencing are likely due to autonomic nervous system dysregulation and anxiety, which can lead to panic attacks.
This is not indicative of a worsening heart condition, and you are not at risk of sudden death.
Please do not scare yourself.
The medications you mentioned, such as Clonazepam and Paroxetine, are not related to this issue.
If these are your usual medications, continue taking them as prescribed.
Changhua Hospital is concerned about your well-being.

Reply Date: 2023/10/11

More Info

Understanding heart rhythm disorders is crucial for managing symptoms and preventing complications. Based on your description, it seems you have experienced a range of symptoms associated with heart rhythm irregularities, including episodes of rapid heartbeats, palpitations, and anxiety. These symptoms can be distressing and may lead to further health concerns if not properly addressed.

Causes of Heart Rhythm Disorders
Heart rhythm disorders, or arrhythmias, can arise from various factors, including:
1. Structural Heart Issues: Conditions such as valve problems (like mitral valve prolapse), cardiomyopathy, or previous heart attacks can lead to arrhythmias.

2. Electrolyte Imbalances: Abnormal levels of potassium, magnesium, or calcium can disrupt the electrical signals in the heart.

3. Autonomic Nervous System Dysfunction: Stress, anxiety, and other emotional factors can influence heart rate and rhythm, often leading to palpitations or increased heart rate.

4. Medications: Some medications can cause or exacerbate arrhythmias.

5. Underlying Health Conditions: Conditions such as hyperthyroidism, diabetes, or autoimmune diseases can also contribute to heart rhythm issues.

Symptoms
Common symptoms of heart rhythm disorders include:
- Palpitations (feeling like your heart is racing, pounding, or fluttering)
- Dizziness or lightheadedness
- Shortness of breath
- Chest pain or discomfort
- Fatigue
In your case, the episodes of your heart racing to 160 beats per minute, especially during the night, along with feelings of shaking and difficulty breathing, are concerning and warrant further evaluation.

Diagnosis
The Holter monitor results you provided indicate that you have experienced some premature ventricular contractions (PVCs) and premature atrial contractions (PACs). While a few PVCs can be benign, frequent occurrences, especially in conjunction with symptoms, may require further investigation. Your average heart rate and the presence of bradycardia (slow heart rate) are also noteworthy.

Treatment Options
1. Medications: Antiarrhythmic medications, such as the ones you are currently taking, can help manage your symptoms. It’s essential to follow your physician's advice regarding these medications, as they can help stabilize your heart rhythm.

2. Lifestyle Modifications: Regular exercise, a balanced diet, and stress management techniques (like mindfulness or cognitive behavioral therapy) can significantly impact your heart health and overall well-being.

3. Monitoring: Regular follow-ups with your healthcare provider are crucial. If your symptoms worsen or new symptoms arise, further testing, such as an echocardiogram or stress test, may be necessary.

4. Psychological Support: Since anxiety can exacerbate heart rhythm issues, working with a mental health professional can be beneficial. Techniques such as cognitive behavioral therapy (CBT) can help manage anxiety and reduce the frequency of panic attacks.

Concerns About Sudden Death
While it’s natural to worry about the severity of your condition, it’s important to remember that not all arrhythmias are life-threatening. Your healthcare provider can assess your risk based on your specific symptoms, history, and test results. If you have concerns about sudden cardiac death, discussing them openly with your doctor can provide clarity and reassurance.

Conclusion
Given your symptoms and the complexity of your condition, it is advisable to maintain open communication with your healthcare team. If you feel uncertain about your current treatment plan or the medications you are taking, such as the autoimmune medications (必賴克廔 and 普達錠), consult your physician for tailored advice. They can help determine the appropriateness of these medications in relation to your heart health and overall treatment strategy.

Lastly, if you are planning to travel, ensure you have a plan in place for managing your symptoms and access to medical care if needed. It’s essential to prioritize your health and well-being as you navigate these challenges.

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