cardioverters

An arrhythmia is any disorder of your heart rate or rhythm. It means that your heart beats too quickly, too slowly, or with an irregular pattern. Most arrhythmias result from problems in the electrical system of the heart. If your arrhythmia is serious, you may need a cardiac pacemaker or an implantable cardioverter defibrillator (ICD). They are devices that are implanted in your chest or abdomen.

A pacemaker helps control abnormal heart rhythms. It uses electrical pulses to prompt the heart to beat at a normal rate. It can speed up a slow heart rhythm, control a fast heart rhythm, and coordinate the chambers of the heart.

An ICD monitors heart rhythms. If it senses dangerous rhythms, it delivers shocks. This treatment is called defibrillation. An ICD can help control life-threatening arrhythmias, especially those that can cause sudden cardiac arrest (SCA). Most new ICDs can act as both a pacemaker and a defibrillator. Many ICDs also record the heart's electrical patterns when there is an abnormal heartbeat. This can help the doctor plan future treatment.

Getting a pacemaker or ICD requires minor surgery. You usually need to stay in the hospital for a day or two, so your doctor can make sure that the device is working well. You will probably be back to your normal activities within a few days.

Heart surgery can correct certain heart problems when other treatments haven't worked or can't be used.

In some cases, heart surgery may be a medical emergency. For example, surgery for a severe heart attack may need to be done right away. In other cases, you can plan heart surgery ahead of time. Some heart surgeries are major operations, such as heart bypass surgery for blocked arteries in the heart. Other surgeries are more minor heart procedures, such as putting in a pacemaker.

There are different types of heart surgery that can help treat many heart conditions:

• An implantable cardioverter defibrillator (ICD) to help prevent sudden cardiac arrest.
• A biventricular pacemaker to coordinate the heart's pumping action so it's more powerful.
• A ventricular assist device to help the heart pump blood.
• A total artificial heart to pump blood for the heart.

The approach a surgeon uses to do heart surgery depends on your heart problem, your general health, and other factors. Approaches to heart surgery include:

• Open-heart surgery (also called traditional heart surgery) is when the surgeon cuts the chest open to reach the heart. Because it's difficult to operate on a beating heart, medicines are used to stop the heart. A heart-lung bypass machine keeps oxygen-rich blood pumping through the body during the surgery.
• Off-pump heart surgery is open-heart surgery on a beating heart without using a heart-lung bypass machine. The surgeon holds the heart steady with a device. Surgeons may use off-pump heart surgery to do coronary artery bypass grafts (CABG), but only in certain cases.
• Minimally invasive heart surgery uses small cuts between the ribs. The cuts may be as small as 2 to 3 inches. The surgeon inserts tools into the chest through the cuts. This type of heart surgery may or may not use a heart-lung bypass machine.
• Robotic-assisted surgery is a type of minimally invasive surgery. The surgeon uses a computer to control tools on the arms of a robot. This allows the surgeon to be very accurate when doing difficult operations.

Like all surgery, heart surgery has risks even though the results are often excellent. The risks include:

• Bleeding
• Infection, fever, and swelling
• A problem from anesthesia (medicine that makes you sleep during surgery)
• Arrhythmia
• Damage to the heart, kidneys, liver, and lungs
• Stroke

The risks of heart surgery tend to be higher if:

• The surgery is an emergency.
• You have other medical conditions, including:
  • Diabetes
  • Kidney diseases
  • Lung diseases
  • Peripheral artery disease (PAD)

NIH: National Heart, Lung, and Blood Institute

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly stops beating. When that happens, blood stops flowing to the brain and other vital organs. If it is not treated, SCA usually causes death within minutes. But quick treatment with a defibrillator may be lifesaving.

A heart attack is different from an SCA. A heart attack happens when blood flow to the heart is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. With an SCA, the heart stops beating.

Sometimes an SCA can happen after or during recovery from a heart attack.

Your heart has an electrical system that controls the rate and rhythm of your heartbeat. An SCA can happen when the heart's electrical system is not working right and causes irregular heartbeats. Irregular heartbeats are called arrhythmias. There are different types. They may cause the heart to beat too fast, too slow, or with an irregular rhythm. Some can cause the heart to stop pumping blood to the body; this is the type that causes SCA.

Certain diseases and conditions can cause the electrical problems that lead to SCA. They include:

• Ventricular fibrillation, a type of arrhythmia where the ventricles (the heart's lower chambers) don't beat normally. Instead, they beat very fast and very irregularly. They can't pump blood to the body. This causes most SCAs.
• Coronary artery disease (CAD), also called ischemic heart disease. CAD happens when the arteries of the heart cannot deliver enough oxygen-rich blood to the heart. It is often caused by the buildup of plaque, a waxy substance, inside the lining of larger coronary arteries. The plaque blocks some or all of the blood flow to the heart.
• Some types of physical stress can cause your heart's electrical system to fail, such as
  • Intense physical activity in which your body releases the hormone adrenaline. This hormone can trigger SCA in people who have heart problems.
  • Very low blood levels of potassium or magnesium. These minerals play an important role in your heart's electrical system.
  • Major blood loss
  • Severe lack of oxygen
• Certain inherited disorders which can cause arrhythmias or problems with the structure of your heart
• Structural changes in the heart, such as an enlarged heart due to high blood pressure or advanced heart disease. Heart infections can also cause changes to the structure of the heart.

You are at higher risk for SCA if you:

• Have coronary artery disease (CAD). Most people with SCA have CAD. But CAD usually doesn't cause symptoms, so they may not know that they have it.
• Are older; your risk increases with age
• Are a man; it is more common in men than women
• Are Black or African American, especially if you have other conditions such as diabetes, high blood pressure, heart failure, or chronic kidney disease
• Have a personal history of heartbeats that aren't regular (arrhythmia)
• Have a personal or family history of SCA or inherited disorders that can cause arrhythmia
• Have a problem with drug or alcohol use
• Have had a heart attack
• Have heart failure

Usually, the first sign of SCA is loss of consciousness (fainting). This happens when the heart stops beating.

Some people may have a racing heartbeat or feel dizzy or light-headed just before they faint. And sometimes people have chest pain, shortness of breath, nausea, or vomiting in the hour before they have an SCA.

SCA happens without warning and requires emergency treatment. Health care providers rarely diagnose SCA with medical tests as it's happening. Instead, it is usually diagnosed after it happens. Providers do this by ruling out other causes of a person's sudden collapse.

If you are at high risk for SCA, your provider may refer you to a cardiologist, a doctor who specializes in heart diseases. The cardiologist may ask you to get various heart health tests to see how well you heart is working. He or she will work with you to decide whether you need treatment to prevent SCA.

SCA is an emergency. A person having SCA needs to be treated with a defibrillator right away. A defibrillator is a device sends an electric shock to the heart. The electric shock can restore a normal rhythm to a heart that's stopped beating. To work well, it needs to be done within minutes of the SCA.

Most police officers, emergency medical technicians, and other first responders are trained and equipped to use a defibrillator. Call 9-1-1 right away if someone has signs or symptoms of SCA. The sooner you call for help, the sooner lifesaving treatment can begin.

Many public places such as schools, businesses, and airports have automated external defibrillators (AEDs). AEDs are special defibrillators that untrained people can use if they think that someone has had SCA. AEDS are programmed to give an electric shock if they detect a dangerous arrhythmia. This prevents giving a shock to someone who may have fainted but isn't having SCA.

If you see someone who you think has had SCA, you should give cardiopulmonary resuscitation (CPR) until defibrillation can be done.

People who are at risk for SCA may want to consider having an AED at home. Ask your cardiologist to help you decide whether having an AED in your home might help you.

If you survive SCA, you'll likely be admitted to a hospital for ongoing care and treatment. In the hospital, your medical team will closely watch your heart. They may give you medicines to try to reduce the risk of another SCA.

They will also try to find out what caused your SCA. If you're diagnosed with coronary artery disease, you may have an angioplasty or coronary artery bypass surgery. These procedures help restore blood flow through narrowed or blocked coronary arteries.

Often, people who have had SCA get a device called an implantable cardioverter defibrillator (ICD). This small device is surgically placed under the skin in your chest or abdomen. An ICD uses electric pulses or shocks to help control dangerous arrhythmias.

You may be able to lower your risk of SCA by following a heart-healthy lifestyle. If you have coronary artery disease or another heart disease, treating that disease can also lower your risk of SCA. If you have had an SCA, getting an implantable cardioverter defibrillator (ICD) can lower your chance of having another SCA.

NIH: National Heart, Lung, and Blood Institute

An arrhythmia is a problem with the rate or rhythm of your heartbeat. It means that your heart beats too quickly, too slowly, or with an irregular pattern. When the heart beats faster than normal, it is called tachycardia. When the heart beats too slowly, it is called bradycardia. The most common type of arrhythmia is atrial fibrillation, which causes an irregular and fast heart beat.

Many factors can affect your heart's rhythm, such as having had a heart attack, smoking, congenital heart defects, and stress. Some substances or medicines may also cause arrhythmias.

Symptoms of arrhythmias include:

• Fast or slow heart beat
• Skipping beats
• Lightheadedness or dizziness
• Chest pain
• Shortness of breath
• Sweating

Your doctor can run tests to find out if you have an arrhythmia. Treatment to restore a normal heart rhythm may include medicines, an implantable cardioverter-defibrillator (ICD) or pacemaker, or sometimes surgery.

NIH: National Heart, Lung, and Blood Institute

Heart failure means that your heart can't pump enough oxygen-rich blood to meet your body's needs. Heart failure doesn't mean that your heart has stopped or is about to stop beating. But without enough blood flow, your organs may not work well, which can cause serious problems.

Heart failure can affect one or both sides of your heart:

• With right-sided heart failure, your heart is too weak to pump enough blood to your lungs to get oxygen.
• With left-sided heart failure, your heart can't pump enough oxygen-rich blood out to your body. This happens when the left side of your heart becomes either:
  • Too weak to pump enough blood.
  • Too thick or stiff to relax and fill with enough blood.

Left-sided heart failure is more common than right-sided heart failure.

Heart failure can start suddenly after a medical condition or injury damages your heart muscle. But in most cases, heart failure develops slowly from long-term medical conditions.

Conditions that can cause heart failure include:

• Arrhythmia (a problem with the rate or rhythm of your heartbeat)
• Cardiomyopathy
• Congenital heart defects or other types of heart diseases that you are born with
• Coronary artery disease
• Endocarditis
• Heart attack
• Heart valve diseases
• High blood pressure
• A blood clot in your lung
• Diabetes
• Certain severe lung diseases, such as COPD (chronic obstructive pulmonary disease)
• Obesity

Over time, left-sided heart failure can lead to right-sided heart failure.

Heart failure can happen at any age. It happens to both men and women, but men often develop it at a younger age than women. Your chance of developing heart failure increases if:

• You're 65 years old or older. Aging can weaken and stiffen your heart muscle.
• Your family health history includes relatives who have or have had heart failure.
• You have changes in your genes that affect your heart tissue.
• You have habits that can harm your heart, including:
  • Smoking
  • Eating foods high in fat, cholesterol, and sodium (salt)
  • Having an inactive lifestyle
  • Alcohol use disorder (AUD)
  • Illegal drug use
• You have other medical conditions that can affect your heart, including:
  • Any heart or blood vessel conditions, including high blood pressure
  • Serious lung diseases
  • Infection, such as HIV or COVID-19
  • Obesity
  • Diabetes
  • Sleep apnea
  • Chronic kidney disease
  • Anemia
  • Iron overload disease
  • Cancer treatments that can harm your heart, such as radiation and chemotherapy
• You are African American. African Americans are more likely to develop heart failure and have more serious cases at younger ages than people of other races. Factors such as stigma, discrimination, income, education, and geographic region can also affect their risk of heart failure.

The symptoms of heart failure depend on which side of your heart is affected and how serious your condition has become. Most symptoms are caused by reduced blood flow to your organs and fluid buildup in your body.

Fluid buildup happens because the flow of blood through your heart is too slow. As a result, blood backs up in the vessels that return the blood to your heart. Fluid may leak from the blood vessels and collect in the tissues of your body, causing swelling (edema) and other problems.

Symptoms of heart failure may include:

• Feeling short of breath (like you can't get enough air) when you do things like climbing stairs. This may be one of the first symptoms you notice.
• Fatigue or weakness even after rest.
• Coughing.
• Swelling and weight gain from fluid in your ankles, lower legs, or abdomen (belly).
• Difficulty sleeping when lying flat.
• Nausea and loss of appetite.
• Swelling in the veins of your neck.
• Needing to urinate (pee) often.

At first you may have no symptoms or mild symptoms. As the disease gets worse, your symptoms will usually bother you more.

Fluid buildup and reduced blood flow to your organs can lead to serious problems, including:

• Breathing problems from fluid in and around your lungs (also called congestive heart failure)
• Kidney or liver damage including cirrhosis
• Malnutrition if fluid buildup makes eating uncomfortable or if your stomach doesn't get enough blood flow to digest food properly
• Other heart conditions, such as irregular heartbeat and sudden cardiac arrest
• Pulmonary hypertension

To find out if you have heart failure, your doctor will:

• Ask about your medical history, including your symptoms
• Ask about your family health history, including relatives who have had heart failure
• Do a physical exam
• Will likely order heart tests and blood tests, including a brain natriuretic peptide (BNP) test

In some cases, your doctor may refer you to a cardiologist (a doctor who specializes in heart diseases) for tests, diagnosis, and care.

Your treatment will depend on the type of heart failure you have and how serious it is. There's no cure for heart failure. But treatment can help you live longer with fewer symptoms.

Even with treatment, heart failure usually gets worse over time, so you'll likely need treatment for the rest of your life.

Most treatment plans include:

• Taking medicine
• Eating less sodium and drinking less liquid to control fluid buildup
• Making other changes, such as quitting smoking, managing stress, and getting as much physical activity as your health care provider recommends
• Treating any conditions that may make heart failure worse

You may need heart surgery if:

• You have a congenital heart defect or damage to your heart that can be fixed.
• The left side of your heart is getting weaker and putting a device in your chest could help. Devices include:
  • An implantable cardioverter defibrillator.
  • A biventricular pacemaker (cardiac resynchronization therapy).
  • A mechanical heart pump (a ventricular assist device (VAD) or a total artificial heart).
• Your heart doctor recommends a heart transplant because your heart failure is life-threatening and nothing else is helping.

As part of your treatment, you'll need to pay close attention to your symptoms, because heart failure can worsen suddenly. Your provider may suggest a cardiac rehabilitation program to help you learn how to manage your condition.

You may be able to prevent or delay heart failure if you:

• Work with your provider to manage any health conditions that increase your risk of developing heart failure
• Make healthy changes in your eating, exercise, and other daily habits to help prevent heart disease

NIH: National Heart, Lung, and Blood Institute