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How to Treat Irregular Heart Rhythm
Arrythmia is irregular heart rhythm and can produce symptoms in some patients. Dr. Subodh Devabhaktuni, UAMS cardiologist and electrophysiologist, discusses this condition.
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Learn more about Subodh Devabhaktuni, MD
Subodh Devabhaktuni, MD
Subodh Devabhaktuni, M.D., is a cardiologist and electrophysiologist who specializes in heart rhythm problems. He is also an assistant professor in the Department of Internal Medicine in the UAMS College of Medicine. Devabhaktuni graduated from medical school in 2007 from Guntur Medical College in Guntur, Andhra Pradesh, India. He became board certified in internal medicine in 2012 and in cardiology in 2017. He completed his residency in internal medicine at the University of Nevada School of Medicine in Las Vegas, Nevada, where he also held a cardiology fellowship. Devabhaktuni most recently held a fellowship in clinical cardiac electrophysiology and served as the chief cardiac electrophysiology fellow at the Indiana University School of Medicine at Krannert Institute of Cardiology in Indianapolis, Indiana.Learn more about Subodh Devabhaktuni, MD
Transcription:
How to Treat Irregular Heart Rhythm
Alyne Ellis (Host): Are you tired a lot? Dizzy? Do you have shortness of breath? These are just a few of the symptoms that might mean you have arrhythmia. Here to tell us more is Dr. Subodh Devabhaktuni, a Cardiologist and Electrophysiologist who specializes in heart rhythm problems at UAMS, the University of Arkansas for Medical Sciences. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Alyne Ellis. Doctor, what exactly is happening to the heart when you have arrhythmia?
Subodh Devabhaktuni, MD (Guest): The normal heart rhythm is called a sinus rhythm. It’s a rhythm produced by the natural pacemaker cells inside the heart. So, when rhythm is other than this sinus rhythm, we call it as arrythmia. Some people have symptoms like heart beating fast, they say there is palpitations or heart racing, or some describe it as fluttering in the chest. Some people get short of breath, chest pain and some complain of fatigue.
So, what’s happening is these heart rhythm problems can be either regular or irregular the heart arrythmias. There are different kinds of heart arrythmias. Most common thing we see is the irregular heart rhythm which is called atrial fibrillation. That is the most common irregular heart rhythm we see. this is often in elderly more than like 60 to 65 years of age.
Host: And does it mean that your heart is skipping a beat every once in a while? Or what?
Dr. Devabhaktuni: Right. The skipping a beat it depends on what you take it. There are a couple of arrythmias where there are extra beats coming from – normally the heart beats regularly. But sometimes a beat comes in early. This beat can be coming from the top chambers in the heart or coming from the bottom chambers in the heart. So, typically, we describe this as skipped beats. They come in early. We call this as premature atrial contraction so PACs or premature ventricular contractions which are coming from the bottom chambers which is called PVCs. This is typically what we describe as skipped beats.
Host: And what are some of the things that can cause this condition besides age?
Dr. Devabhaktuni: Yeah, the PACs and PVCs it can happen to all of us. We do a monitor on you or me or someone else, we have PACs and PVCs occasionally. That’s quite normal. But if you are having a lot of them, then that is not normal. That’s when people are symptomatic, and we need to treat them.
Host: And when do you need to talk to your doctor once you experience some of this?
Dr. Devabhaktuni: Any patient who is experiencing skipped beats, or palpitations or fluttering in the chest I would ask them to get medical advice. And then what we typically do is if patients are complaining of those, we put them on a monitor. These monitors are different types from 24 hours to 48 hours to a week or a couple of weeks and to a month. So, we do put them on these monitors and then they can press a button on this monitor whenever they have symptoms and it will record the heart rhythm at that point. Then we know that symptoms are because of this abnormal heart rhythm so that we can treat it appropriately, after we diagnose what it is.
Host: How is arrythmia treated?
Dr. Devabhaktuni: So, arrythmia is treated in different ways. Most commonly, what we initially use is the beta blockers, the medication we use to treat for hypertension like metoprolol, carvedilol, and also there are some other medications like calcium channel blockers like Cardizem, verapamil. These are the initial choice of medications to treat these like extra beats but if the symptoms are more frequent and not controlled with these medications, there are certain medications which are – we call them as anti-arrhythmic medications. That means these medications help to keep the rhythm in normal which is a sinus rhythm.
So, these medications are usually prescribed by a cardiologist and especially cardiac specialists who are trained in treating this heart rhythm problem. Because these anti-arrhythmics, we can’t use them in every patient we have to be very careful. Although, they are used to treat heart arrythmias, they can cause heart arrythmias by themselves if you are not careful.
Host: And what can one do and not do once you are diagnosed with this condition?
Dr. Devabhaktuni: Most of the time, we advise them to do whatever they can like exercise, eating healthy diet. Some people, these arrythmias are triggered by like excessive caffeine intake, excessive alcohol. They clearly attribute the symptoms to these. So, in those patients, we advise them – if it is clearly getting the symptoms from caffeine or alcohol; we ask them to avoid them. Or at least drink it to moderation every day.
Host: And can it be that you would – with diet and exercise, be able to control it without medication?
Dr. Devabhaktuni: Typically not, but again, exercise and healthy diet always plays a role in the bigger picture, making heart healthy. That’s what we are aiming for and not specifically to treat this especially the heart arrythmia problem, we are talking about the atrial fibrillation which is the irregular heart rhythm where the top chambers quiver. In those patients, exercise and weightloss are shown to improve their symptoms in AFib, especially in their problem we treat with medications and if not controlled, there are procedures called ablation where we treat these heart arrythmia. The most common ablation we do is for AFib. It’s not a cure for AFib but we can help the patients who are symptomatic from atrial fibrillation with this procedure called ablation.
Host: And finally, can arrythmia then lead you into a heart attack?
Dr. Devabhaktuni: Usually typically not. Most of the heart arrythmias they don’t – heart attack is totally different. Arrythmias are different. I’d say there’s – arrythmias are a part of the electrical system in the heart and a heart attack is part of plumbing. So, it’s like the blood vessels which supply the heart, they are like pipes. If there is a blockage in there, then you get heart attack. If you get heart attack, you can get arrythmias. But if you have arrythmias, it’s very, very unusual unless you have a blockage to have a heart attack. These arrythmias by themselves cause symptoms like palpitations, fluttering in the chest, or chest pain, typically not a heart attack.
Host: And what are the symptoms that on should really rush to a doctor or an emergency room for?
Dr. Devabhaktuni: In terms of especially chest pain, I would say, tightness in the chest or heaviness in the chest and then palpitations. Some people have symptoms like dizziness, or they pass out from these arrythmias. Then I would suggest to seek medical attention. The main thing is, and you check your pulse and if it runs in like 160s, 180s, then definitely you should seek medical attention immediately.
Host: Is there anything else you would like to add Doctor?
Dr. Devabhaktuni: These heart rhythm problems most of them are not life threatening except a few of them where you have cardiac arrest from this heart rhythm problems coming from the bottom chambers. Most of the time, heart rhythm problems coming from the top chambers, they are not life threatening. And especially in patients with AFib like the irregular heart rhythm, we see every day. These patients depending on their risk factors they have like hypertension, diabetes, stroke; the AFib can cause stroke. So, we typically give blood thinners in these patients. We do a scoring system, if you have two or more points, then we put them on blood thinners to prevent the strokes. Because these strokes can be devastating to the patients. They could be massive strokes. Some people die from these strokes.
So, we typically give blood thinners not aspirin or that kind of blood thinner. But a stronger blood thinner to prevent the strokes in these patients. Sometimes unfortunately, these AFib patients cannot feel any symptoms. It just gets recognized whenever they come to the clinic, in a primary physician’s care clinic, they check the heart, it’s beating irregularly, they do EKG then they figure out the patient is in AFib. So, as soon as we diagnose patients with AFib, it’s very important to make sure whether they are getting them they need a blood thinner or not. And they should seek a cardiologist’s advice at the time.
Host: And one final question, I’m assuming that as you get older, the percentage of people who get this goes up, so would you recommend that you have your heart checked at some certain point when you age?
Dr. Devabhaktuni: Yeah, they should be part of their regular primary care wellness clinic visits. They check your heart, they check your heart, blood pressure, heart rate so and on physical exam, if you find that the heart is beating irregularly, that should be addressed with an EKG and then refer to a cardiologist if needed.
Host: Thanks so much Doctor, for your time and insight today. Dr. Devabhaktuni is a Cardiologist and Electrophysiologist who specializes in heart rhythm problems at UAMS, the University of Arkansas for Medical Sciences. For more information on arrythmia, visit www.uamshealth.com. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics that may interest you. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Alyne Ellis. Thanks for listening.
How to Treat Irregular Heart Rhythm
Alyne Ellis (Host): Are you tired a lot? Dizzy? Do you have shortness of breath? These are just a few of the symptoms that might mean you have arrhythmia. Here to tell us more is Dr. Subodh Devabhaktuni, a Cardiologist and Electrophysiologist who specializes in heart rhythm problems at UAMS, the University of Arkansas for Medical Sciences. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Alyne Ellis. Doctor, what exactly is happening to the heart when you have arrhythmia?
Subodh Devabhaktuni, MD (Guest): The normal heart rhythm is called a sinus rhythm. It’s a rhythm produced by the natural pacemaker cells inside the heart. So, when rhythm is other than this sinus rhythm, we call it as arrythmia. Some people have symptoms like heart beating fast, they say there is palpitations or heart racing, or some describe it as fluttering in the chest. Some people get short of breath, chest pain and some complain of fatigue.
So, what’s happening is these heart rhythm problems can be either regular or irregular the heart arrythmias. There are different kinds of heart arrythmias. Most common thing we see is the irregular heart rhythm which is called atrial fibrillation. That is the most common irregular heart rhythm we see. this is often in elderly more than like 60 to 65 years of age.
Host: And does it mean that your heart is skipping a beat every once in a while? Or what?
Dr. Devabhaktuni: Right. The skipping a beat it depends on what you take it. There are a couple of arrythmias where there are extra beats coming from – normally the heart beats regularly. But sometimes a beat comes in early. This beat can be coming from the top chambers in the heart or coming from the bottom chambers in the heart. So, typically, we describe this as skipped beats. They come in early. We call this as premature atrial contraction so PACs or premature ventricular contractions which are coming from the bottom chambers which is called PVCs. This is typically what we describe as skipped beats.
Host: And what are some of the things that can cause this condition besides age?
Dr. Devabhaktuni: Yeah, the PACs and PVCs it can happen to all of us. We do a monitor on you or me or someone else, we have PACs and PVCs occasionally. That’s quite normal. But if you are having a lot of them, then that is not normal. That’s when people are symptomatic, and we need to treat them.
Host: And when do you need to talk to your doctor once you experience some of this?
Dr. Devabhaktuni: Any patient who is experiencing skipped beats, or palpitations or fluttering in the chest I would ask them to get medical advice. And then what we typically do is if patients are complaining of those, we put them on a monitor. These monitors are different types from 24 hours to 48 hours to a week or a couple of weeks and to a month. So, we do put them on these monitors and then they can press a button on this monitor whenever they have symptoms and it will record the heart rhythm at that point. Then we know that symptoms are because of this abnormal heart rhythm so that we can treat it appropriately, after we diagnose what it is.
Host: How is arrythmia treated?
Dr. Devabhaktuni: So, arrythmia is treated in different ways. Most commonly, what we initially use is the beta blockers, the medication we use to treat for hypertension like metoprolol, carvedilol, and also there are some other medications like calcium channel blockers like Cardizem, verapamil. These are the initial choice of medications to treat these like extra beats but if the symptoms are more frequent and not controlled with these medications, there are certain medications which are – we call them as anti-arrhythmic medications. That means these medications help to keep the rhythm in normal which is a sinus rhythm.
So, these medications are usually prescribed by a cardiologist and especially cardiac specialists who are trained in treating this heart rhythm problem. Because these anti-arrhythmics, we can’t use them in every patient we have to be very careful. Although, they are used to treat heart arrythmias, they can cause heart arrythmias by themselves if you are not careful.
Host: And what can one do and not do once you are diagnosed with this condition?
Dr. Devabhaktuni: Most of the time, we advise them to do whatever they can like exercise, eating healthy diet. Some people, these arrythmias are triggered by like excessive caffeine intake, excessive alcohol. They clearly attribute the symptoms to these. So, in those patients, we advise them – if it is clearly getting the symptoms from caffeine or alcohol; we ask them to avoid them. Or at least drink it to moderation every day.
Host: And can it be that you would – with diet and exercise, be able to control it without medication?
Dr. Devabhaktuni: Typically not, but again, exercise and healthy diet always plays a role in the bigger picture, making heart healthy. That’s what we are aiming for and not specifically to treat this especially the heart arrythmia problem, we are talking about the atrial fibrillation which is the irregular heart rhythm where the top chambers quiver. In those patients, exercise and weightloss are shown to improve their symptoms in AFib, especially in their problem we treat with medications and if not controlled, there are procedures called ablation where we treat these heart arrythmia. The most common ablation we do is for AFib. It’s not a cure for AFib but we can help the patients who are symptomatic from atrial fibrillation with this procedure called ablation.
Host: And finally, can arrythmia then lead you into a heart attack?
Dr. Devabhaktuni: Usually typically not. Most of the heart arrythmias they don’t – heart attack is totally different. Arrythmias are different. I’d say there’s – arrythmias are a part of the electrical system in the heart and a heart attack is part of plumbing. So, it’s like the blood vessels which supply the heart, they are like pipes. If there is a blockage in there, then you get heart attack. If you get heart attack, you can get arrythmias. But if you have arrythmias, it’s very, very unusual unless you have a blockage to have a heart attack. These arrythmias by themselves cause symptoms like palpitations, fluttering in the chest, or chest pain, typically not a heart attack.
Host: And what are the symptoms that on should really rush to a doctor or an emergency room for?
Dr. Devabhaktuni: In terms of especially chest pain, I would say, tightness in the chest or heaviness in the chest and then palpitations. Some people have symptoms like dizziness, or they pass out from these arrythmias. Then I would suggest to seek medical attention. The main thing is, and you check your pulse and if it runs in like 160s, 180s, then definitely you should seek medical attention immediately.
Host: Is there anything else you would like to add Doctor?
Dr. Devabhaktuni: These heart rhythm problems most of them are not life threatening except a few of them where you have cardiac arrest from this heart rhythm problems coming from the bottom chambers. Most of the time, heart rhythm problems coming from the top chambers, they are not life threatening. And especially in patients with AFib like the irregular heart rhythm, we see every day. These patients depending on their risk factors they have like hypertension, diabetes, stroke; the AFib can cause stroke. So, we typically give blood thinners in these patients. We do a scoring system, if you have two or more points, then we put them on blood thinners to prevent the strokes. Because these strokes can be devastating to the patients. They could be massive strokes. Some people die from these strokes.
So, we typically give blood thinners not aspirin or that kind of blood thinner. But a stronger blood thinner to prevent the strokes in these patients. Sometimes unfortunately, these AFib patients cannot feel any symptoms. It just gets recognized whenever they come to the clinic, in a primary physician’s care clinic, they check the heart, it’s beating irregularly, they do EKG then they figure out the patient is in AFib. So, as soon as we diagnose patients with AFib, it’s very important to make sure whether they are getting them they need a blood thinner or not. And they should seek a cardiologist’s advice at the time.
Host: And one final question, I’m assuming that as you get older, the percentage of people who get this goes up, so would you recommend that you have your heart checked at some certain point when you age?
Dr. Devabhaktuni: Yeah, they should be part of their regular primary care wellness clinic visits. They check your heart, they check your heart, blood pressure, heart rate so and on physical exam, if you find that the heart is beating irregularly, that should be addressed with an EKG and then refer to a cardiologist if needed.
Host: Thanks so much Doctor, for your time and insight today. Dr. Devabhaktuni is a Cardiologist and Electrophysiologist who specializes in heart rhythm problems at UAMS, the University of Arkansas for Medical Sciences. For more information on arrythmia, visit www.uamshealth.com. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics that may interest you. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I’m Alyne Ellis. Thanks for listening.