Arrhythmia

Arrhythmia is a common heart disease. In general, it refers to any form of abnormal heart rate or rhythm. There are various types of arrhythmia, of which, atrial fibrillation is the most common entity. It is estimated to be presented in 1% of the general population in Hong Kong. Although not immediately life-threatening, it causes a five-fold increase in stroke, three-fold increase in heart failure and two-fold increase in death.

(Special thanks to Dr NY Chan, Deputy Chief-of-Service, Department of Medicine & Geriatrics, Princess Margaret Hospital for reviewing the information of this page.)

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Arrhythmia refers to any form of abnormal heart rate or rhythm. The normal heart beats 60-100 times per minute when a person is at rest. And it is regular in rhythm.  When a person has slow heart rate, i.e. Less than 60 beats per minute; fast heart rate, i.e. more than 100 beats per minute at rest, he/she may have arrhythmia. Sometimes, a person may have normal heart rate but irregular rhythm. He/she may suffer from ectopic heart beats or atrial fibrillation.
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The common risk factors for arrhythmia include thyroid disease, hypertension, ischaemic heart disease, heart failure and valvular heart disease. In some patients, arrhythmia may be a side effect from drugs. Sometimes, no cause or risk factor may be identified for arrhythmia.
 
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Prevention and appropriate treatment for the risk factors and underlying causes of arrhythmia is important. Thyroid disease is amenable to medical treatment usually.  Appropriate lifestyle e.g. Healthy diet with low salt, low fat, low glucose and high fibre food; adequate exercise should be adopted for the prevention of hypertension and ischaemic heart disease. 
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Patients with arrhythmia may have symptoms of palpitations, dizziness, syncope, fatigue, shortness of breath and decrease in exercise tolerance. In severe situations, patient may have symptoms of slurred speech, visual disturbance and limb weakness suggesting stroke. Sudden death is the most dreadful symptom from some arrhythmias.
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相片  Electrocardiogram is the most important diagnostic tool. Sometimes prolonged monitoring of heart beat by 24-hour electrogram or event recorder may be needed. Blood tests, especially on electrolytes and thyroid function are mandatory. Depending on the history, physical examination and initial electrocardiogram, further investigations on the heart, namely treadmill test, CT coronary angiogram and catheter-based investigations may be needed.

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The underlying cause for arrhythmia should be looked for and treated accordingly. There are specific drugs, usually referred as anti-arrhythmic drugs for the treatment of various arrhythmias. Catheter ablation is an interventional and curative treatment option for some arrhythmias. For patients who have slow heart rate and symptoms like dizziness or syncope, pacemaker implantation may need to be considered. On the other hand, for patients who have fast heart rate and risk of sudden death, implantable cardioverter-defibrillator may need to be considered.

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A common type of arrhythmia, atrial fibrillation, may be complicated by stroke or heart failure. Ventricular tachycardia or fibrillation, which is dangerous arrhythmias, may be complicated by sudden cardiac death.

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Patients who have symptoms suggestive of arrhythmias, e.g. palpitations, syncope, should seek early medical attention. Patients who have risk factors for arrhythmias should have their medical conditions treated accordingly.
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