Thursday, 15 October 2015

How to fix the heart skips?

Bradycardia: Artificial Pacemaker
figure 1.  Artificial Pacemaker placement
For bradycardia patients, doctors usually hold off any medications that slows their heartbeat, and treat the conditions by implanting a permanent or temporary pacemaker (Arrhythmia Alliance, 2012). An artificial pacemaker is a small battery operated device, that is approximately the size of a fifty pence piece, used to detect and fires a small electrical impulse to stimulate the heart wall to make it contract and to make the heart beats. It is planted just under the skin of your chest (below your collar bone) and insulated lead wires that connects to the pacemaker are attached to the heart to help your heart muscle pump blood regularly (National Heart Foundation Australia, 2015;Adelaide-Meath National Children's Hospital, 2015) . The lead also provides the information on the heartbeat’s natural activity. The body will not reject artificial pacemaker.

Tachycardia: Vagal Maneuvers, Cardioversion, Catheter Ablation and Pharmacological Medications
Vagal maneuver is a set of physical activities that stimulate the Vagus nerve, the nerve serving the structures of the chest, abdomen, head and neck, which supplies parasympathetic impulses to the myocardium (heart muscle) and trigger the release of acetylcholine to put halt on the conduction of electrical impulses and decrease the rapidity of the heart (Healthwise Staff, 2012;Wang & Estes, 2014). The maneuvers are gagging, holding your breath and bearing down (Valsalva maneuver), immersing your face in ice-cold water (diving reflex), coughing and Carotid massage (neck massage). 

figure 2. Cardioversion
Cardioversion uses electrode patches to deliver a split-second energetic shock to the heart muscles while the patient is sleeping, the shock applied will interrupt the abnormal heart rhythm and return a normal heartbeat (Intermountain Healthcare, 2011;Texas Cardiac Arrhythmia Institute, 2015;Tandri, 2015). This quick procedure may need to be repeated to effectively restore a normal heart rhythm under the direction of a team of highly trained doctors, nurses and technologists in the electrophysiology lab (Intermountain Healthcare, 2011). 

figure 3. Catheter Ablation
Catheter ablation uses radiofrequency energy to destroy (ablate) a small area of the tissue of the heart which is causing arrhythmia. Guided with x-rays, the doctor will insert several small catheters (thin, flexible tubes) through the veins in the groin or neck and direct them to the tissues that interrupt the heart’s electrical activity then thermal energy (extreme heat) or cryoenergy (extreme cold) energy will be emitted to the problematic tissues through one of the catheters (National Institute of Health, 2012;American Heart Association, 2014;Cleveland Clinic, 2015;Ashikaga, 2015). This energy also disconnects the electrical pathway of the abnormal rhythm.
There are three main pharmacological drugs being prescribed to an arrhythmic patient, they are the anti-arrhythmic drugs, the calcium channel blockers and beta-blockers (American Heart Association, 2014;Healthline Networks, 2015). Anti-arrhythmic drugs either cease the abnormal transmission of electrical impulses send by the natural pacemaker tissue that is firing too fast to the heart tissues (American Heart Association, 2014). The drugs are in a form of pills or in a form of intravenous (IV) drip, they work to correct and restore the normal rhythm of the heart. Next is the calcium channel blockers, which is also known as "calcium antagonists." Calcium is an electrolyte that functions as the heart regulator, imbalance of calcium will cause arrhythmia. Thus, calcium channel blockers work by blocking the movement of the calcium electrolytes into the heart and blood vessel tissue (Healthline Networks, 2015). It can be taken in a form of pill or in a form of intravenous (IV) drip. Lastly, beta-blockers, which is also known as ‘beta-adrenoceptor blocking’ that blocks adrenaline hormones from stimulating rapid firing of electrical impulses to the heart tissues, thus results in a decrease of heart beats, reduction of cardiac stress output and lessening of the arterial blood pressure (Healthline Networks, 2015).

Bradycardia and Tachycardia: Implantable Cardioverter Defibrillator (ICD) and Surgeries
figure 4. ICD
Implantable Cardioverter Defibrillator (ICD) monitors the heartbeat constantly and automatically will detect any irregular heart followed by a short electrical shock to the heart to sustain a normal heart rate (Cheng, 2015). The shock is generally expressed by patients as being “kicked in the chest,” as it gives a momentary chest pain. The device must be check and/or replaced every four months. It consists of a titanium-encased pulse generator (the size of a small box of raisins) that contains a lithium battery and electrical circuitry and capacitors attached to one, two or three leads (wires) that are inserted into the heart and it is implanted under the skin beneath the collarbone (Cheng, 2015).
            Two of the main surgeries for treating arrhythmia are the maze procedures and coronary artery bypass grafting (CABG) surgery  (University of California San Francisco, 2015). Maze surgery treats arrhythmia by making small cuts or burns in the heart tissues that will prevent the transmission of abnormal electrical signals or by making a "maze" of new electrical routes to let electrical impulses move easily to the heart tissues (Texas Heart Institue, 2015;University of California San Francisco, 2015). CABG is when a healthy artery or vein is extracted from other parts of the body grafted in between the blocked coronary artery, thus creating a new route for blood to move to the heart tissues (National Institute of Health, 2012).

Adherence to Medical Advices and Preventive Measures
The most important part that an arrhythmic patient needs to adhere is to follow the timeliness of the medicated drug prescribed and to check the functionality of the planted devices if they previously underwent those procedures. This is to prevent arrhythmia to advance into a heart attack or a stroke.
As for the medication, the patient can monitor their consumption by relying to the device called Medication Event Monitoring System (MEMS). MEMS is a tracking medication usage device without any active patient input. It consists of an electronic memory integrated into a cap designed to fit a normal medicine bottle, it records the number of act on when the cap is opened to remove a pill (Brannon & Feist, 2014).
The health belief model can also be applied, from the previous consultations with the doctors; patients should already know the fact that they are susceptible in getting a heart attack or stroke as they are already arrhythmic. With that they will come to acknowledge the severity of getting a heart attack or stroke. Following that, they would search and take the initiative to know more on how to improve their conditions and to maintain it that way, in which it is their way of perceiving the benefits of health-enhancing behavior. Lastly, knowing their limits for the level of exercising or kinds of foods that they can eat without reaching the excess point is their way of perceiving barriers towards the health-enhancing behaviors (Brannon & Feist, 2014). For example, exercising too much may cause their heart to beat faster than usual or eating too much omega-3 rich foods may cause electrolyte imbalance.


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