Background

      What is Arrhythmia?

      Treatments for Arrhythmia

  Living with Arrhythmias

      Memory

      Emotional Well-Being

      Effects on Family

      At Home and Away from Home

      Driving

      Physical Activity

      Sleep and Energy Level

      Physical Intimacy

      Effects of Device Treatment

      Effects of Drug Treatment

      Doctor Visits

  Typical Arrhythmia Patients

      Patty

      Bob

      Larry

Your heart is a pump. Its action is controlled by electrical signals it produces. When the signals come too quickly, the heart beats too fast. One form of arrhythmia is a rapid heartbeat, called tachycardia (tackey-car-dia). You may feel faint or dizzy and can pass out. A tachycardia can be dangerous and even life-threatening.

When a rapid heartbeat becomes irregular, it is called fibrillation. If your heart goes into fibrillation, blood flow halts and you lose consciousness. This condition, called cardiac arrest, will result in death, unless reversed within a few minutes.

These irregular beats may begin from different chambers of the heart. Ventricular fibrillation, for example starts in the lower chamber, or ventricles of the heart.

Treatments for Arrhythmias

There are two major treatments for ventricular tachycardia or ventricular fibrillation.

One is a pacemaker-like device called an Implantable Cardioverter Defibrillator (ICD). In this treatment, a brief electric shock to the chest will reset the electrical system of the heart and restore a regular rhythm. The shock can be administered by an emergency team or by an ICD. The other treatment is medication, e.g. Amiodarone or Sotalol, which help in prevention of more arrhythmias.

If you were diagnosed with arrhythmia, you might have only one of these treatments or both.

1. Implantable Cardioverter Defibrillator (ICD)

Your doctor may recommend an ICD if you are thought to be in danger of sudden cardiac death or if you have had cardiac arrest. The ICD offers protection against sudden cardiac death. The device monitors your heart rate. If the rate is dangerously fast, the ICD delivers a shock to the heart to restore normal rhythm.

The ICD is implanted in an operation. More surgery is needed about every three years to replace the generator.

2. Amiodarone

Some patients with arrhythmia have their irregular heartbeat treated with a single medication e.g. Amiodarone or a combination of a device and medication. Medication is usually taken daily. Some possible side effects include skin discoloration and shortness of breath. In rare cases, lung-related conditions have resulted.

Aspects of Living with Arrhythmias

Having an arrhythmia may affect many different aspects of a person's life. For any single area, a person may be affected a little, a lot, or somewhere in between. We will ask you to think about these aspects in terms of how they would affect your quality of life. This list was developed from discussions with 70 arrhythmia patients and their families.

A. Memory Memory includes being able to do things such as: recall people's names remember appointments or messages without writing them down finding your way in a well-known place remembering faces recalling where you put things avoiding saying the same thing twice Arrhythmia's effect on memory varies greatly. Some people experience little change after the diagnosis. Others, whose brains may have lacked oxygen during a cardiac arrest, have trouble with all the aspects of memory listed above. "Except for those three days I spent in the hospital after my last episode, I remember everything pretty much as well as I used to." "I can remember what happened when I was six, but what happened yesterday, I have difficulty telling you."

B. Emotional Well-Being Having an arrhythmia, having it treated, and living with uncertainty about the future may often affect a person's emotional state. A patient may feel anxious and depressed more often than before. When a person is anxious, he or she feels nervous, tense, and fearful. Being depressed means feeling sad, discouraged, and hopeless. If a person is seriously depressed, he or she may at times feel suicidal. "Anywhere you go, you are very scared. You don't know what to expect." "You have a lot of time to just to think about things and worry. I got involved in some of the things I had done before and that helped a lot." A diagnosis of arrhythmia or the experience of a heart attack or a cardiac arrest causes tremendous disruption of a person's life. There may be a mixture of shock, fear, anger, anxiety, and depression. The experience can trigger an unsettling confrontation with mortality. At the same time, there are feelings of uncertainty and helplessness about the future. While you may have some control over your choice of treatment, you may feel no control over your heart condition as a whole or the side effects of treatment. Uncertainty about when an episode might occur is realistic; a diagnosis of arrhythmia creates an ambiguous situation with no guaranteed outcome. This situation can have a wide range of effects on a person's confidence about the future. Some people are confident while others feel overwhelmed and apprehensive. "I go out every morning and I figure, hell, ain't nothing going to happen to me." "It's scary because there's no symptoms, no warning. It (the arrhythmic episode) just happens."

C. Effects on the Family Arrhythmias affect not only patients but also their families. The changes brought about by having a life-threatening illness may make the patient more dependent on family. Spouses or children may have to take on new roles. These changes can cause conflicts. Family members are affected by the uncertainty of the situation and worry about what would happen to them if the patient died. Having a device or effective medicines can bring relief and reduce anxiety, especially if the patient has had a cardiac arrest. "The device is an insurance policy for my wife." "He had an episode at home. We had to do something; to live second by second was not working."

D. At Home and Away from Home Having an arrhythmia may affect a person's ability to work outside the home. For someone who is retired, paid employment may not be important. But for others, an arrhythmia may force them to retire or reduce their work commitment. Some patients may return to work full time. Arrhythmia also has a range of effects on a person's ability to do work around their home. For some, there is no effect; some may need help with household chores. "I was out of the hospital in two or three days. I went out to work right after." "When I was home from the hospital, I was off of work for six months."

E. Driving Some people with arrhythmia drive as before. But others have their driving restricted, either partially or totally. Driving restrictions add to the inconvenience of having arrhythmia and may also increase a person's dependence on others. "I try to avoid the freeway, but if I have to drive, the main thing is to make sure you have a good grip on the steering wheel." "Between my wife and I, I'm still the better driver. There's no reason why she needs to do all the driving for me now."

F. Physical Activity Heart problems can affect a person's ability to do regular or strenuous physical activities. Activities include walking on level ground, lifting a bag of groceries, or doing light housework. Strenuous activities include climbing a flight of stairs, running, or doing heavy housework. The effects, which are due to shortness of breath, can range from no limits to being bed bound. "I play soccer, I roller blade; nothing stops me." "He gets tired very easy. At the same time, he'll be all out of breath."

G. Sleep and Energy Level Having an arrhythmia may affect your ability to sleep. You may get less sleep, or the sleep you do get still leaves you tired. These effects can range from none to quite severe. "I couldn't sleep at night. I can't get good sleep." "He's not the one who can't sleep at night. He doesn't even know what' s going on, the monitor showed how he slept right through his rhythm." The disease itself or its treatments can cause you to feel tired and listless. Your energy level may change. "Some days I just feel fine and other days I feel...people like us have good days and bad days." " My arrhythmia doesn't affect my energy level at all."

H. Physical Intimacy Having an arrhythmia may affect your enjoyment of sex. Your heart condition or the treatments you receive for it may make you tired or decrease your interest in sex. Also, you may be apprehensive about having sex because it might bring on tachycardia or fibrillation. Some people report no effect on their interest in sex or in their sexual activity. Others are fearful of having sexual relations. " I've had three kids ...it's such a part of me that my husband and I don't feel it's a problem." "We haven't had sex since the implant."

I. Effects of Device Treatment Having an ICD involves having an operation to implant the device, which includes a generator and leads. The patient must visit the doctor every two to three months to have the device checked. About every three years, the patient must have surgery to replace the generator. The device can be felt at the waistline where it is worn. discomfort at the beltline; making belts more difficult to wear. Some patients experience few or no shocks from their devices, while others experience many shocks. In a small percent of the cases, there are mechanical problems with the devices. Most patients find the devices reassuring, but a few have so many problems that they want the device removed. "Remember when we had the big earthquake? Well, that's what it feels like. It goes, Pow. That's it. So it's nothing. You can still do whatever you want." "I don't know how this would feel when it goes off." Getting shocks and worrying about shocks is an important aspect of having an ICD. A few patients with ICDs may get no shocks. Most have a few shocks and some have many shocks. The severity of shocks is also important. A shock may be felt as mildly to extremely unpleasant. For some people, the first shock is reassuring, because it proves to them that the device protects them. Some people are not bothered much by the shocks. Others have to make changes in their lives because of them. For example, one patient reported taking sponge baths after being shocked in the shower. "It's like you carry an umbrella everywhere you go, whether it's raining or not. I wish I could just rip it out." "With the device, I don't worry about anything."

J. Effects of Drug Treatment Use of the medication to treat arrhythmia varies in a number of ways. First, the drug may be prescribed directly or after a patient has gone through an Electrophysiology Study (EPS). Second, the appropriate drug/dosage level may be determined easily or after several adjustments. Third, side effects may range from none to severe. And, fourth, effectiveness ranges from high (no episodes of arrhythmia) to low (life-threatening arrhythmia). "He was not himself. He would just sort of drop off and go to sleep and his life was so diminished. We changed the medicine." "Amiodarone, you mean the Cordarone, it hasn't bothered me a bit."

K. Doctor Visits Having an arrhythmia may change the way you use health care. There may be little change, or the number of visits and consultations with other physicians may increase. "The problem is the lack of coordination between all my doctors. ..they're treating parts rather than the whole." "We went to three different doctors before we got here. It's like the difference between a Cadillac and a Model T, the quality of the care here is just incomparable."

Some Typical Arrhythmia Patients

In order to help you understand just what it means to have an arrhythmia, below are several descriptions given about hypothetical arrhythmia patients. Although the people are made up, the symptoms and feelings that they describe are very real and true to the condition.

A. Patty Patty is a 40-year-old woman who has an ICD. It was implanted two years ago after she had a cardiac arrest. She was in a coma for several days and had some brain damage that continues to cause her memory problems. Patty stayed home from her marketing job for six months after getting her device and says she was depressed during that period. She has returned to work on a part time basis, working 25 hours a week. She worries about keeping her job and fears she may become financially dependent on others. Her ICD fired a dozen times in the first few months after it was implanted. After changing medicines, she no longer has shocks.

B. Bob Bob is a 67-year-old retired banker who had an ICD implanted after collapsing while shopping three years ago. He was told not to drive for six months after getting the device. He now drives locally, but avoids the freeway. He has device has never gone off. Bob has a history of heart problems, high blood pressure, and colon cancer. He rates his arrhythmia as less important than his other medical problems. But he says that it has led him to think about his mortality and has added more uncertainty to his life. Bob's wife says she worries about him all the time. If she wakes up in the middle of the night, she checks to make sure he is breathing.

C. Larry Larry is a 58-year-old engineer who took disability retirement because of his heart problems. His energy level varies greatly. On good days, his activities are similar to those of other retired people. On bad days, he rests in bed or watches TV. Larry has frequent tachycardia, which has been treated with several different medicines. Initially, he took another medication, but became frequently tired. Then he changed to Amiodarone. The medication stopped his irregular heart beats, but caused some mild side effects such as constipation. Larry changed his eating habits, which has helped him.

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