Chapter Three

Certain heart diseases

Introduction

Certain heart diseases Abnormal atrial rhythms 3.1

Cardiac arrhythmia, cardiac arrhythmias, or cardiac arrhythmias are the differences in the
heart rate and the electrical signal transmission systems in the heart muscle. Arrhythmia is
called arrhythmia for short. These differences in heart rhythm can manifest themselves as
acceleration or slowing of the heart rate, and symptoms can appear as an irregular
heartbeat, or as palpitations. Disorders of the system differ among themselves in their
importance and danger to the patient's life. Some of them are considered a manifestation of
diversity that has no satisfactory value, and some of them pose a threat to the patient's life,
or a disease that must be treated Most cases of arrhythmia are harmless, but some can be
serious or even life-threatening. When the heartbeat is too slow, too fast, or irregular, the
heart may not be able to pump enough blood to the body and thus leads to ischemia of
these organs, which in turn damages the brain, heart, and other vital organs and may lead to
periodic shock. Diagnosis of arrhythmia begins with hearing the medical history, where some
patients narrate tachycardia or palpitations, sometimes patients feel the heart acceleration,
then they are asked about its precursors, if any, how it starts suddenly or the pulse
accelerates gradually, and in cases of slow heart, the patient tells For drowsiness or syncope
or fainting of the patient. This is followed by palpation of the pulse, where the speed and
regularity of the pulse can be assessed or not, and heart contractions and diastoles can be
heard using a stethoscope. The most important tool for diagnosing arrhythmias is the
electrocardiogram (ECG) since arrhythmias cannot be diagnosed without an Megamedia his
to Justice. This gives an impression of: Some patients notice tachycardia, some patients feel
palpitations and some feel systole, others can describe tachycardia. The extent of affected
and the degree of suffering of the patient. Conditions that accompany disturbances of
fatigue and rest, or stimulants. Frequency of disturbances: daily, weekly or monthly?
Describe the onset and end of rhythmic episodes, beginning suddenly or gradually? A
description of the precursors to systemic seizures. Accompanying symptoms such as
dizziness or lightheadedness, and slow heartbeat is sometimes accompanied by drowsiness
and general weakness. Did the patient faint? And how often? What are the circumstances
that accompanied it? The pathological history varies according to the type of arrhythmia, as
tachycardia has symptoms that differ from those of cardiac decelerations, and some
arrhythmias pose a threat to the patient's life, and sudden cardiac arrest may be the first
symptom in rare cases. justice. Main article: Electrocardiogram The electrocardiogram gives
important information about heart rhythm and detects many arrhythmias. It is considered
the main tool in diagnosing arrhythmias, especially if it is possible to obtain an
electrocardiogram at the moment the patient feels disturbed. There are types of
examination, including Chart at rest or during the shift Justice It is a chart that is drawn in
the clinic in a state of rest, and it shows the current rhythm of the heart, and it can also
detect many arrhythmias that appear during the resting period of the heart, and the chart
can be drawn in moments when the patient feels arrhythmia, then the drawing is called an
attack chart, given that it was drawn during the show's frenzy. Paroxysmal arrhythmias vary
with each other in the frequency of the disturbance, there are disturbances that the patient
feels daily, here it is sufficient to record for 24 hours, but in cases where arrhythmias occur
varying by weeks or months, it is necessary to analyze the electrocardiogram for periods
ranging according to the frequency of attacks From weeks to years. There are several devices
developed to diagnose such cases, including the "Holter examination" or electrocardiogram
over 24 hours, and is used by planning a three-electrode electrocardiogram to analyze the
electrocardiogram over an entire day, and note the disturbances in the rhythm during that
period. “Spider ECG”: It is called so because the device is fixed on the patient’s chest, and
then the wires are attached to the patient’s chest in a spider-like or spider web. Such devices
record the electrocardiogram for periods of up to several weeks. The Event Recorder: This is
a hand-sized device that the patient carries with him, and when he feels arrhythmia, he
places the device on his chest to record an electrocardiogram for 30 seconds, for example.
Implanted Loop Recorder or Implanted Event Recorder:[1] These devices are the size of a
USB flash drive, which is implanted under the skin, and they analyze the ECG and record any
disturbances that the device notices. Some of these devices enable the patient to record the
disturbances believed to be occurring in minutes retrospectively, and the measurements are
.analyzed periodically

Myocardial infarction (heart attack) 3.2

Myocardial Infarction MI or Acute Myocardial Infarction AMI, also known as a heart attack[4]
or heart attack, is an acute life-threatening heart disease caused by blood retention caused
by a blockage of a coronary artery resulting in damage or complete death to part of the
heart muscle. A seizure is often a life-threatening medical emergency that calls for
immediate medical attention. The condition is diagnosed by the patient’s medical history
and results of an ECG and blood heart enzymes. The most necessary procedure to take
immediately is to restore blood flow to the heart, so you should quickly transfer the injured
person immediately to a hospital or a doctor or bring the doctor to the patient's site to treat
him. Time here plays a very important role. It is necessary to speed up for blood flow in the
coronary artery to be reflowed with one or both: thrombus (which is blood clogged blood)
with anticoagulants, and angioplasty (also called arterial dilated artery dilation), which is the
penetration of a balloon on board to the blocked blood vessel, so that the balloon swells
when it is along with the thrombus and the thrombus recedes towards the sides and the
vessel space expands after it narrowed, allowing blood to flow through it. The coronary care
unit should closely monitor the patient for various developments and provide secondary
prevention measures to remove factors that may trigger further seizures (Fig 1)

The right and left coronary arteries feed the same heart muscle for the heart to function. A
drawing showing myocardial infarction, and blood not reaching part of the heart muscle
through the left coronary artery, while the right coronary artery is properly indicated in the
diagram above. Zone 1 has a black-shown blockage inside a branch of the left coronary
artery that feeds the lower part of the heart muscle. The zone is the anterior wall of the
heart muscle, which is not reached by blood after the blockage in the area. The artery can be
seen after the and changed color due to the lack of blood flow, as well as the color of the
area below the heart affected by the blockage of the artery is variable as a result of ischemia
and therefore lack of oxygen snugly (Fig 2)
Dizziness and syncope 3.3

is another word for fainting or passing out. Someone is considered to have )SINK-a-pee(
syncope if they become unconscious and go limp, then soon recover. For most people,
syncope occurs once in a great while, if ever, and is not a sign of serious illness. However, in
others, syncope can be the first and only warning sign before an episode of sudden cardiac
death. Syncope can also lead to serious injury. Talk to your physician if syncope happens
more often. Pre-syncope is the feeling that you are about to faint. Someone with pre-
syncope may be lightheaded dizzy or nauseated, have a visual "gray out" or trouble hearing,
have palpitations, or feel weak or suddenly sweaty. When discussing syncope with your
doctor, you should note episodes of pre-syncope as well. Becoming unconscious due to a
seizure, heart attack, head injury, stroke, intoxication, blow to the head, diabetic
hypoglycemia, or another emergency condition is not considered syncope. Someone who
faints should be moved so they are lying down to allow blood to flow to the brain. If they do
not regain consciousness promptly, start CPR. What causes syncope? Syncope occurs when
there is not enough blood flow to the brain. There are many potential causes, but the most
common ones include: Serious Cardiovascular Conditions(Cardiac Syncope)If fainting occurs
frequently and is not because of dehydration or sudden postural change, you may need to
be tested for a serious heart or vascular condition. Cardiac syncope often occurs suddenly,
without dizziness or other pre-syncope symptoms. Common causes of cardiac syncope:
Arrhythmia and abnormal heart rhythm: During episodes of heart arrhythmia, the heart
works inefficiently, and not enough oxygenated blood can circulate to the brain. Many types
of cardiac arrhythmias may cause syncope. These include bradyarrhythmia (the heart beats
too slowly) and tachyarrhythmias (the heart beats too fast). Aortic dissection is a tear in the
large artery that carries blood from the heart to the rest of the body. This is a very rare but
life-threatening condition. Aortic valve stenosis is a narrowing of the valve between the
heart and the aorta. Aortic valve stenosis can be congenital and present from birth or
can develop in old age. Reflex Syncope (Naturally Mediated Syncope, Vasovagal Syncope,
Vasodepressor Syncope, the Common Faint) Reflex syncope is the result of a reflex
response to some trigger, in which the heart slows or blood vessels dilate widen. This causes
blood pressure to drop, so less blood flows to the brain and fainting syncope or near-fainting
(pre-syncope) occurs. Reflex syncope is the most frequent cause of fainting. Vasovagal
syncope the common faint occurs in one-third of the population. It is by far the most
common form of reflex syncope. Vasovagal syncope is often triggered by a combination of
dehydration and upright posture. But it can also have an emotional trigger such as seeing
blood or "fainting at the sight of blood. Some Vasovagal Syncope Triggers Seeing blood not
considered a serious symptom Getting an injection or having blood drawn not considered
serious Standing up quickly (a "head rush" is considered pre-syncope) Standing upright for a
long time Sudden and unexpected trauma, stress or pain, such as being hit Blood
donation Other types of reflex syncope include: Situational syncope, a sudden reflex
response to a trigger other than those listed above. Triggers include Coughing, sneezing,
laughing, swallowing Pressure on the chest after exertion or exercise Defecating Urinating
(post-micturition syncope: occurs in men while standing to urinate)Eating a meal Sudden
abdominal pain Blowing a brass instrument or lifting weights. Carotid Sinus Syncope is a
response in older adults that occurs when pressure is applied to the carotid artery in the
neck. A hard twist of the neck, wearing a tight collar, and pressing on the artery are triggers
for carotid sinus syncope. Orthostatic Hypotension Orthostatic (upright) hypotension (low
blood pressure when standing) can also cause fainting because blood has trouble going
against gravity to reach the brain. Orthostatic hypotension is defined as a fall in systolic
blood pressure of 20 mms Hg or more on standing, resulting in syncope or pre-syncope.
Orthostatic hypotension is common in elderly individuals and is often exacerbated by
dehydration or medications that lower blood pressure, such as diuretics. Less commonly,
orthostatic hypotension can be caused by a neurologic condition such as Parkinson’s
disease or multisystem atrophy, formerly known as Shy-Drager syndrome. Postural
Orthostatic Tachycardia Syndrome (POTS)Postural orthostatic tachycardia syndrome
increased heart rate when standing, or POTS is a rare clinical syndrome characterized by an
increase in heart rate of at least 30 beats per minute on standing and orthostatic
intolerance. when standing brings on symptoms such as palpitations, lightheadedness, and
fatigue. POTS generally appears in young women. After excluding other causes, the diagnosis
is made on physical examination, medical history, and tilt-table test. Treatment usually
consists of increased salt and fluid intake, recumbent exercise not standing upright, and
education in avoiding triggers. POTS does not usually get worse with age How is syncope
diagnosed? It's important to identify the cause of syncope, if possible, to rule out a
dangerous heart condition. Depending on your symptoms and circumstances, the following
tests may be used to find the cause: On-site Diagnostic Tests. Electrocardiogram (ECG or
EKG): wires taped to various parts of your body to create a graph of your heart’s electrical
rhythm Exercise: ECG recorded while strenuously exercise
sing . Echocardiogram or transesophageal echocardiogram: ultrasound of the heart Physical
examination, including orthostatic vital signs and carotid sinus massage . Tilt table
test: measurement of heart rate and blood pressure in response to upright tilt, which
simulates prolonged standing Electrophysiology (EP): test that examines the heart’s
electrical activity from the inside; used to diagnose many heart rhythm disorders In-home
Diagnostic Monitors Holter: a portable ECG you wear continuously for one to seven days to
record your heart rhythms over time Event: a portable ECG you wear for one or two months,
which records only when triggered by an abnormal heart rhythm or when you manually
activate it.How is syncope treated? The treatment for syncope will depend upon the
underlying condition but may include: Catheter: a procedure to cauterize the specific heart
cells that cause abnormal heart rhythms Pacemakers: device inserted under the skin below
the collarbone to deliver regular electrical pulses through thin, highly durable wires attached
to the heart; used to treat bradycardia, heart block and some types of heart failure
Implantable: a small implanted device that delivers an electrical pulse to the heart to reset a
dangerously irregular heartbeat; often used to treat ventricular tachycardia or heart failure
Avoiding known triggers

Possible tachycardia patients 3.4

Tachycardia may not cause any symptoms or complications. But if left untreated, some
forms of tachycardia can lead to serious health problems, including heart failure, stroke, or
sudden cardiac death. Treatment for tachycardia may include specific maneuvers,
medication, cardioversion, or surgery to control a rapid heartbeat. Types. There are many
different types of tachycardia. Sinus tachycardia refers to a typical increase in the heart rate
often caused by exercise or stress. Other types of tachycardia are grouped according to the
part of the heart responsible for the fast heart rate and the cause. Common types of
tachycardia caused by irregular heart rhythms (arrhythmias) include Atrial fibrillation (A-fib).
This is the most common type of tachycardia. Chaotic, irregular electrical signals in the upper
chambers of the heart (atria) cause a fast heartbeat. A-fib may be temporary, but some
episodes won't end unless treated. Atrial flutter. Atrial flutter is similar to A-fib, but
heartbeats are more organized. Episodes of atrial flutter may go away themselves or may
require treatment. People who have atrial flutter also often have atrial fibrillation at other
times. Ventricular tachycardia. This type of arrhythmia starts in the lower heart chambers
ventricles The rapid heart rate doesn't allow the ventricles to fill and squeeze contract to
pump enough blood to the body. Ventricular tachycardia episodes may be brief and last only
a couple of seconds without causing harm. But episodes lasting more than a few seconds can
be life-threatening. Supraventricular tachycardia (SVT). Supraventricular tachycardia is a
broad term that includes arrhythmias that start above the ventricles. Supraventricular
tachycardia causes episodes of a pounding heartbeat (palpitations) that begin and end
abruptly. Ventricular fibrillation. Rapid, chaotic electrical signals cause the ventricles to
quiver instead of contracting in a coordinated way. This serious problem can lead to death if
the heart rhythm isn't restored within minutes. Most people who have ventricular fibrillation
have underlying heart disease or have experienced serious trauma, such as being struck by
lightning Mayo Clinic Minute: Identifying and treating atrial fibrillation . Mayo Clinic
electrophysiologist Fred Kusum, M.D., explains what happens in the heart to create atrial
fibrillation and what can be done to fix it. When the heart beats too fast, it may not pump
enough blood to the rest of the body. As a result, the organs and tissues may not get enough
oxygen

In general, tachycardia may lead to the following signs and see

A sensation of a racing, pounding heartbeat or flopping in the chest palpitation

Chest pain

Fainting syncope

Lightheadedness

Rapid pulse rate

Shortness of breath

Some people with tachycardia have no symptoms. The condition may be discovered when a
.physical exam or heart test is done for another reason

When to see a doctor

Some things can cause a rapid heart rate (tachycardia). If you feel like your heart is beating
.too fast, make an appointment to see a health care provider

Seek immediate medical help if you have shortness of breath, weakness, dizziness,
.lightheadedness, fainting or near fainting, and chest pain or discomfort

A type of tachycardia called ventricular fibrillation can cause blood pressure to drop
dramatically. Collapse can occur within seconds. Soon the affected person's breathing and
:pulse will stop. If this occurs, do the following

If you or someone nearby is well trained in CPR, start CPR. CPR can help maintain blood flow
.to the organs until an electrical shock (defibrillation) can be given

If you're not trained in CPR or worried about giving rescue breaths, then provide hands-only
CPR. Push hard and fast on the center of the chest at a rate of 100 to 120 compressions a
.minute until paramedics arrive. You don't need to do rescue breathing

If an automated external defibrillator (AED) is available nearby, have someone get the device
for you, and then follow the instructions. An AED is a portable defibrillation device that can
deliver a shock to reset the heart rhythm. No training is required to use the device. The AED
will tell you what to do. It's programmed to give a shock only when appropriate

Tachycardia is an increased heart rate for any reason. It can be a usual rise in heart .1
rate caused by exercise or stress response (sinus tachycardia). Sinus tachycardia is
.considered a symptom, not a disease

.Tachycardia can also be caused by an irregular heart rhythm (arrhythmia)

:Things that may lead to tachycardia include

Fever

Heavy alcohol use or alcohol withdrawal

High levels of caffeine

High or low blood pressure

The imbalance of substances in the blood called electrolytes — such as potassium, sodium,
calcium, and magnesium

Medication side effects Overactive thyroid (hyperthyroidism

Reduced volume of red blood cells (anemia), often caused by bleeding

Smoking

Use of illegal drugs, including stimulants such as cocaine or methamphetamine

Complications

Complications of tachycardia depend on o

The type of tachycardia

How fast the heart is beating

How long does the rapid heart rate lasts

If there are other heart conditions

Some people with tachycardia have an increased risk of developing a blood clot that could
cause a stroke (the risk is highest with atrial fibrillation) or heart attack. Your health care
.provider may prescribe a blood-thinning medication to help lower your risk

:Other potential complications of tachycardia include

Frequent fainting or unconsciousness

The inability of the heart to pump enough blood for heart failure

Sudden death, usually only associated with ventricular tachycardia or ventricular fibrillation

Prevention

The best ways to prevent tachycardia are to maintain a healthy heart and prevent heart
disease. If you already have heart disease, monitor it and follow your treatment plan. Be
.sure you understand your treatment plan and take all medications as prescribed
Lifestyle changes to reduce the risk of heart disease may help prevent heart arrhythmias
:that can cause tachycardia. Take the following steps

Eat a healthy diet. Choose a diet rich in whole grains, lean meat, low-fat dairy, and fruits and
.vegetables. Limit salt, sugar, alcohol, saturated fat, and trans fats

Exercise regularly. Try to exercise for at least 30 minutes on most days

.Maintain a healthy weight. Being overweight increases the risk of developing heart disease

Keep blood pressure and cholesterol levels under control. Make lifestyle changes and take
.medications as prescribed to control high blood pressure (hypertension) or high cholesterol

Stop smoking. If you smoke and can't quit on your own, talk to your health care provider
about strategies or programs to help break the smoking habit. Drink in moderation. If you
choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink
a day for women and up to two drinks a day for men. For some health conditions, it's
recommended that you completely avoid alcohol. Ask your health care provider for advice
specific to your condition. Don't use illegal drugs or stimulants, such as cocaine. Talk to your
health care provider about an appropriate program for you if you need help ending illegal
drug use. Use medications with caution. Some cold and cough medications contain
stimulants that may trigger a rapid heartbeat. Ask your health care provider which
medications you need to avoid. Limit caffeine. If you drink caffeinated beverages, do so in
moderation no more than one to two beverages dial Manage stress. Find ways to help
reduce emotional stress. Getting more exercise, practicing mindfulness, and connecting with
others in support groups are some ways to reduce stress. Go to scheduled checkups. Have
regular physical exams and report any changes in your heartbeat to your health care
provider. If your symptoms change or get worse or you develop new ones, tell your health
care provider immediately

Atrial flutter 3.5

is a type of abnormal heart rhythm, or arrhythmia. It occurs when a short circuit in the heart
causes the upper chambers (atria) to pump very rapidly. Atrial flutter is important not on
because of its symptoms but because it can cause a stroke that may result in permanent
disability or death. What happens during atrial flutter? A normal heartbeat begins with an
electrical impulse from the sinus node, a small area in the heart's right atrium (right upper
chamber). During atrial flutter, the short circuit of a circular electrical pathway allows the
electrical impulse to quickly move around the right atrium, causing between 240 and 340
contractions per minute. Rapid contractions prevent the chambers from filling between
beats. The ventricle's lower chambers also beat faster, though not usually quite as fast. The
rate is based on the ratio of atrial beats to ventricular beats. For example, a 2:1 block means
that for every two beats in the atria, the ventricles beat once. An arrhythmia centered in the
upper chambers of the heart is called supraventricular tachycardia (SVT), literally "fast
heartbeat above the ventricles." Note that when you feel your pulse for example, at your
wrist or neck you are feeling the beat of the left ventricle as it pumps blood to your arteries.
A normal heart rate is between 60 and 100 beats per minute. What are the different types
of atrial flutter? Atrial flutter is classified as typical or atypical (non-typical) depending on the
location of the short circuit the pathway that allows the electrical signal to move too fast
around the heart. While the symptoms are similar, the treatments may differ. Typical atrial
flutter is localized to the right atrium. This type of atrial flutter can be cured with a short
outpatient catheter ablation procedure. Atypical atrial flutter refers to atrial flutter arising in
the left atrium. Most types of atypical atrial flutter can also be treated with catheter
.ablation, but the procedure is longer and more involved

?What are the symptoms of atrial flutter

:Atrial flutter may cause no symptoms at all, or it may cause any of the following

Stroke

Palpitations (a fluttering in the chest)

Dizziness or fainting

Shortness of breath

Fatigue

What causes atrial flutter? Atrial flutter is usually an age-related arrhythmia because it rarely
:occurs before the age of 50 but then becomes more common. Other causes include

Prior cardiac surgery

Prior catheter ablation for atrial fibrillation

?What are the complications of atrial flutter

Blood left to pool in the upper chambers after an inefficient heartbeat increases the risk of
clot formation. If a blood clot travels from the heart into the bloodstream, it could become
.lodged in an artery and cause a stroke

If the heart beats very quickly over a long time, it may lead to cardiomyopathy, a weakening
of the heart muscle. How is atrial flutter diagnosed Atrial flutter is normally diagnosed in
your physician's office using an electrocardiogram (ECG or EKG). If the diagnosis is still in
question, your doctor may recommend a Holter monitor, an event monitor, or
an electrophysiological study, during which a narrow, flexible tube called a catheter is
threaded through a vein to your heart under light sedation. Fine wires inside the catheter
.can help pinpoint the abnormal signal
?How is atrial flutter treated

Sometimes, atrial flutter goes away by itself and no further action is needed. If it persists,
:your doctor may pursue any of the following treatments

Treatment of any underlying conditions

Catheter ablation — procedure to destroy the errant electrical pathways; performed

together with an electrophysiological study

Cardioversion — small, controlled shock to the chest done under anesthesia to provide
short-term correction of the heart rhythm

Medications to control the heart rhythm called antiarrhythmics, may be less effective than
catheter ablation

Medications to prevent blood clots