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When does cardiac arrhythmia become life threatening?

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When does acute cardiac arrhythmia become life threatening? Lately I have been having episodes of heart skips, some pretty "big," to the point it's uncomfortable afterwards like being a bit lightheaded that lasts only a few seconds. Thanks, Pete

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Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

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Dear Pete, Anyone who suspects he has a heart rhythm problem needs to see a doctor immediately. This is the kind of problem that often should be seen as soon as suspected, in an emergency room. It could be a minor issue, but it could also quickly be life threatening. A good internist, family physician, or emergency medicine physician may even choose to refer you to a cardiologist for an immediate evaluation.

A cardiac arrhythmia is an abnormal beating of the heart. Normally the heart beats in a regular fashion in which the timing between beats is the same and the intensity of the heartbeat is the same for each beat. For each heartbeat, an electrical conduction through the heart stimulates the orderly contraction of the muscular sack known as the heart. This leads to pumping of blood to the rest of the body and maintenance of a good blood pressure. If the heart rate should be too fast or the heart beats in an irregular fashion, the heart's ability to pump blood can be compromised. Decreases of the flow of blood to the brain can lead to lightheadedness or even loss of consciousness or death. The lightheadedness or loss of consciousness can last for a few sections or a longer time. Patients with an arrhythmia may notice palpitations, a fast heartbeat, shortness of breath or feel nothing.

Some arrhythmias are caused by simple things and are easy to treat if diagnosed. Some people get them after consuming too much of a stimulant such as caffeine in coffee or soft drinks. For these folks the answer is simply decaffeinated drinks. Other foods can also cause some arrhythmias. Some drugs can also cause arrhythmia such as decongestant cold medicines. Drugs such as nicotine from cigarettes or cocaine also cause arrhythmias.

Some of the more severe causes of arrhythmia can include inherited electrical conduction defects in the heart. These conditions can be complicated and need to be evaluated by a specialist. For example, children of women who have lupus are at risk for certain cardiac electrical conduction disorders. Some conduction disorders are caused by heart developmental defects that often do not manifest themselves in adulthood.

Some arrhythmias are due to damage to the heart muscle. This can be due to blockage of the heart arteries (this is called coronary artery disease). Decreased oxygen to the heart muscle can cause the heart to beat irregularly. Severely decreased oxygen can lead to death of the heart muscle and damage to the heart's electrical conduction system. A weakening of the heart due to years of high blood pressure can even cause arrhythmia due to an enlarging of the heart and weakening of the heart muscle. Rarely, we see a weakened heart muscle due to viral infection of the heart.

All arrhythmias should be taken seriously. We categorize them by where in the heart the arrhythmia is occurring. The atria are the upper part of the heart and the ventricles are the larger pump part of the heart in the bottom. Generally, atrial arrhythmias are less of a risk to health compared with ventricular arrhythmias. Untreated atrial arrhythmias can cause blood clots to form in the heart. These clots can break loose and lead to strokes if the clots lodge in the brain. Ventricular arrhythmias can lead to a dramatic decrease in blood flow to the brain and other organs. This can lead to sudden death.

Some arrhythmias are treated with anti-arrhythmic medicines. Some are treated with a pacemaker, which is an instrument that electrically stimulates the heart to beat normally. Some arrhythmias even require an implanted defibrillator that monitors the heart and shocks the heart back to a normal rhythm should a dangerous rhythm develop. In some cases doctors may even do a surgical modification of the electrical system to prevent arrhythmias.

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