Heart Rhythm Disturbances Flashcards
What is Arrhythmia?
How might people present or explain this? ‘Fluttering, Pounding, Can hear it in their ears, Whooshing, Racing’ Consider subjective versus objective definitions – the heart is a very personal thing. Thinking point – how do you think an arrhythmia would feel for you?
Defining Arrhythmia
* Merriam Webster definition – ‘an alteration in rhythm of the heartbeat either in time or force’
* American Heart Association definition – ‘any change from the normal sequence of electrical impulses’
* Very important to try to distinguish between genuine arrhythmia and palpitations – the former is a true, objective irregularity of heart rhythm while the latter is a subjective perception
* The general definition of palpitations tend to be an awareness of your own heartbeat, or a sensation of the heart beating faster or stronger or irregularly.
* Note that it can be normal to be aware of your heartbeat when exercising or when lying still
Thinking point – what might cause a patient to be more aware of their own healthy heartbeat?
How does the electrical conduction system of the heart work?
While we quickly recap the electrical conduction system of the heart to get an overview of where arrhythmias may arise, let’s remind ourselves that not all arrhythmias cause palpitations, and not all palpitations are caused by arrhythmias.
Key stages in electrical conduction:
* Sinoatrial node fires - the pacemaker starts things off
* This triggers the atrioventricular node to fire
* This travels down the bundle branches and through Purkinje fibres and causes a contraction of the ventricles
If something misfires, a person may not experience palpatations while they do have an arrthymia, and vice versa.
How do you know if a palpitation is dangerous?
Palpitations pose a patient safety issue for a herbalist because they can occur under a range of different circumstances:
* as a normal response to exercise
* as a reaction to stress and anxiety
* OR as an indicator of serious illness or arrhythmia
Relying on a patient’s subjective experience and description of palpitations will likely not be helpful – they may experience all of these types of palpitations as the same sensation
Try and think of the types of questions you might ask a patient to develop a better understanding of their palpitations – think about areas of their case history that might be illuminating
How do you identify palpitations or arrhythmia?
Limits to practice and when to refer
* Skilled case history taking and physical examination may allow you to distinguish benign palpitations from concerning ones
* Only medical investigation allows any degree of certainty however
Relevant investigations to which you can direct your patient include:
* ECG – electrocardiogram; relatively non-invasive or timeconsuming, involving attachment of small adhesive pads to chest, arms and legs to monitor the electrical activity of the heart
* Stress ECG – the same method of measurement as a resting ECG but conducted on an exercise device to measure impacts of exercise on the heart
* Ambulatory ECG or Holter monitor – similarly to the stress ECG, worn over the course of a few days to assess the impact of normal activity on the heart
It is advisable to consider referring any patient with new palpitations to their GP for assessment.
What are red flags in arrhythmia presentation?
If a patient presenting with new palpitations notes any of these symptoms or details in their case history, prompt referral is essential if they mention:
* Dizziness or loss of consciousness
* Unexplained blackout or collapse
* Associated chest pain
* Known history of heart disease
* Family history of arrhythmia or sudden death
How to refer – think about how you would approach the referral process, depending on the urgency of referral, and what you need to know to make an effective referral communication
What is the role of the herbalist in heart rhythm disturbance?
- Arrhythmia presentations vary fairly widely – an overview understanding of differing presentations is essential in order to correctly interpret the patients past medical history
- As arrhythmia is potentially life threatening, recognition of the limits to practice is vital – it would be inappropriate to attempt to treat palpitations that you have diagnosed if they have not been investigated by a GP
- Patient safety is paramount! Consider the patient who won’t visit their GP – they prefer to trust their herbalist and are wary of orthodox medicine. How can you be an effective advocate for their health and build a necessary bridge to ensure they access appropriate investigations and medication if this is necessary
