Talk:Arrhythmia

Causes

What causes arrhythmia? Are there too many things to put down? I'm sure most people come to this page, like me, because they are experiencing arrhythmia and are wondering what to do. Shouldn't there be sections here directed at the concerned layman explaining what symptoms warrant a visit to the doctor, what causes it, what triggers it, and so on. Kimholder 03:51, 28 March 2007 (UTC)

I was wondering what the relationship between antipsychotic medications with Sudden Cardiac Death warnings and Death from Cardiac dysrythmia is. Do these medications include dysrythmia in the warning? any idea whould be helpful. —Preceding unsigned comment added by 174.29.164.153 (talk) 20:11, 19 September 2010 (UTC)

ICD9

Is the ICD9 code correct? 427.9 is, I think, too specific. Even the icd9.chrisendres.com site linked to calls all of 427.x 'Cardiac dysrhythmias'. --user:Somej

SADS

Removed:

SADS, or sudden arrythmia death syndrome, is a rare condition blamed for some otherwise unexplained deaths. It is related to long QT syndrome, QT being the time taken by the heart to recover after each beat. Patients with long QT can be given beta-blocker drugs to slow the heartbeat, and are advised to refrain from competitive sports.

-> Plan to add a new page on long QT syndrome.

Over-complication

I cut the following cryptic bullet-point outline from the Diagnosis section. Some of them are now addressed (with explanation) in "Origin of impulse", but, as with most Powerpoint-style presentations detached from their lecture, I couldn't reconstruct the train of thought behind the rest of the bullets. I hope someone can add some of this content back in a way that will make sense to readers who aren't cardiologists. ←Hob 20:29, 2004 Sep 2 (UTC)

• Mode of initiation
• Automaticity
• Enhanced or abnormal
• Spontaneous onset of tachycardia
• No premature beats leading to the arrhythmia
• Gradual increase in the rate of the arrhythmia over the first 5-10 beats ("warm up")
• EKG appearance of the first tachycardia's beat is identical to the rest
• Reentry
• Initiation is with a premature beat followed by a slight pause
• This is followed by the arrhythmia (corresponding to premature beat, unidirectional block, slow conduction)
• "Warm up" is unusual
• EKG appearance of the first tachycardia beat need not be identical to the rest
• Mode of termination in response to overdrive pacing (pacing the heart at a rate faster than the tachycardia rate). Sometimes the application of electrical pacing from outside the heart itself is useful diagnostically. This is most commonly done by placing an electrode into the cardiac chambers and delivering electrical current across the endocardium
• Automaticity
• Often shows "overdrive suppression"
• The arrhythmia seems to be terminated by pacing only to return after several seconds with a gradual resumption of the pre-pacing rate
This is related to increased activity of the Na+ - K+ pump with Na+ loading. This causes the cell to have a more negative resting membrane potential and takes longer to reach threshold.
• Reentry
• Often terminates in response to overdrive pacing
• Without subsequent arrhythmia resumption

Tachycardia stops because paced impulses have entered circuit in both limbs causing bi-directional block

(Also, I really can't figure out what this paragraph was trying to say:)

The precise role of triggered activity as a mechanism on human arrhythmias has not been studied in adequate detail to characterize modes of initiation or response to pacing. Other means exist to differentiate more clearly among arrhythmias at the time of invasive electrophysiologic study.

Arrythmia

Cardiac dysrhythmia is technically more correct, as arrhythmia would imply that there is "no rhythm,"

In Greek "Rhythmia" means evidently "Rythm", (the Greek one being the original). So "Arrhythmia" indeed (not implied at all) means "no rhythm" as it is stated in the article.

But why this is not correct???. "No rhythm" doesn't mean "No pulse" or “No bit”. "Arrhythmia" means simply "pulse without rhythm".

Yet, I can still support the article’s suggestion, saying (as a Greek) that the word "Dysrtythmia" (Bad-rhythm) is also correct and identical in meaning (literature-wise - not aware if also medically). I guess that “Bad-rhythm” and “No-rhythm” is logically the same thing. I also guess that we could say “Mal-rhythm”..

--62.38.24.151 Dimitri GIANNAKOPOULOS / dimitri999@lycos.com / 00:20, 21 November 2005 (UTC)

Good points, but "arrhythmia" is more commonly used. Andrew73 02:35, 21 November 2005 (UTC)

Dysrhythmia is the more accurate term, and the term taught at my medical school. Visium 10:22, 24 August 2009 (UTC)

Defibrillation

I found this in the main article, so I transferred it to discussion:

" "In defibrillation, the recipient has lost consciousness so there is no need for sedation."

As someone who has recently had 17 defibrillations from an implanted unit, I can state, unequivocally, that it hurts like hell and the shock comes before there is any loss of consciousness. " Snodawg 22:32, 3 February 2006 (UTC) (P.S. I did not type this originally, merely transferred it)

I have sinus arrythmia and tried searching for it on here to see what we have and nothing on this page talks about it though it is one of the most common forms of arrhythmia for athletes and adolesence. I think it should be added. Anomalycp 18:01, 26 April 2006 (UTC) I stand corrected from the opening paragraph, perhaps we need to change it to a subheading in the "common arrhythmias" section. --User:Strolch1983 German wikipedia / 15:02, 27 March 2006 (UTC)

German wiki

Hallo, if you are ever interested in writting an article for the reentry mechanism in english, you can link it, if you want, with the German wikipedia article "Kreisende Erregung". best greetings. --Strolch1983

Computer model of reentry and fibrillation

I produced a PC based model that dynamically illustrated the mechanisms of reentry and fibrillation and other cardiac behaviour. I did this for my masters thesis in Biomed Engineering.

It allowed the student to set up the preconditions for the arrythmia and then watch it develop. I called it XCITE.

This was fifteen years ago. I don't know if it was ever picked up by educators. It was good.

Too fast/too slow/skip a few: my heart.

I have been searching the web for information, yet finding anything in "laymans" terms is almost impossible! The Dr. told me that my "middle" chamber of my heart is not beating correctly with the top and bottom. His recomendation is an imediate pace maker! I can feel it skipping 1-3 beats some times and it feels like some one is inside my chest punching outward. then it will race and at other times will slow down, i get extremely tired, and at times get suddenly dizzy and will lose my eyesight aprox. 3-6 seconds. then the dizzyness is gone and my eyesight comes back. during and EEG and EKG and echo, the techs. told me they had never seen some one with so many skipped beats.

MY QUESTION; what are some possible reasons for this to happen? and why is there no photo of the heart showing each chamber and the flow of function.

Further work to be done on this article...

Just reverted a change from last week that chopped about the first third of the article off... I'd be the first to admit there is a lot of work waiting to be done here, but axing the Definition, Manifestations and Mechanisms section probably didn't help its cause.

This article could use lotsof, some, any REFERENCES. The mechanism section needs copyediting... a lot of other arrhtymia articles (such as the VT and SVT) link to this bit. The treatment section needs expanding and linking. The chapter headings could be brought into line with the Manual of Style for Medical Articles And the whole thing needs to be looked at carefully by a non-doctor to de-jargon it.

I don't think it needs many more external links - Google gets you more university and medical school sites than you can poke a stick at! I'll keep chipping away at it from time to time... Happy editing.TamePhysician (talk) 05:32, 29 March 2008 (UTC)

News and Current Events

Would it be appropriate to add a section about SADS in the media? Various police agencies have blamed the death of prisoners/arestees on "Sudden Adult Death Syndrome"

Loimprevisto (talk) 14:12, 3 September 2008 (UTC)

I am starting on a Zio Patch heart monitor. It's similar to a Holter Monitor, but you use it for up to two weeks of dat a collection. The Zio Patch was a 2010 winner of the Medical Design Excellence Awards (MDEA) and here is more about the Zio Patch This is my first time using a wiki talk page, apologies if I didn't format correctly.

Edsregistry (talk) 22:09, 28 January 2014 (UTC)

References

Naming

There is only one arrhythmia it is asystole. The rest are dysrhythmias. The name of this page should be changed to reflect that.Doc James (talk · contribs · email) 16:13, 11 October 2009 (UTC)

As no one seems to mind I have moved the page from cardiac arrhythmia.Doc James (talk · contribs · email) 20:07, 14 December 2009 (UTC)

I've gone ahead and history merged the page. Cut and paste moves are a very bad idea because they break attribution; if you can't perform a page move yourself, ask for assistance from an administrator at Wikipedia:Requested moves. Graham87 03:29, 19 February 2010 (UTC)

Hey Graham will post you a note when I come across pages that need to be moved :-) thanks. Doc James (talk · contribs · email) 03:32, 19 February 2010 (UTC)

Types (aka section 3) needs two more subtypes

I noticed that 2 different mechanisms for causing dysrhythmias are missing - bypass tracts, where the impulse loops around the heart in abnormal ways, due to birth defects etc (see Wolff-Parkinson White Syndrome). The second is conduction blocks, see heart blocks for this. These should be added by someone who knows fully about it, I'm not confident enough to add the section (and have exams now :P) FruitywS (talk) 13:40, 23 April 2010 (UTC)

Analogy with problems

I pasted the following analogy of reentry to here, because some issues need fixing: Actually, even in the normal case, people would see other people standing up when they sit down after 3 seconds. A functional analogy could be to sit down and close the eyes for 3 seconds to avoid seeing other people standing up. But at this level it seems to be as complicated as what goes on in nerves, so an analogy seems of little help. 193.235.173.250 (talk) 12:51, 7 May 2010 (UTC)

By analogy, imagine a room full of people all given these instructions: "If you see anyone starting to stand up, then stand up for three seconds and sit back down." If people are quick enough to respond, the first person to stand will trigger a single wave which will then die out; but if there are stragglers on one side of the room, people who have already sat down will see them and start a second wave, and so on.

Does the above have a WP:MEDRS to cite? LeadSongDog come howl 13:51, 7 May 2010 (UTC)

Even with a reliable source I would be hesitant to add this analogy even though I agree it is rather nice.Doc James (talk · contribs · email) 14:55, 7 May 2010 (UTC)

Source

PMC 1502051 that editors here might find useful. LeadSongDog come howl! 17:06, 5 November 2010 (UTC)

sinus arrhythmia wrt alcohol abuse

As somebody who's just had to have an A-fib turned using electricity for the first time, with the problem most likely having been precipitated by my abuse of alcohol... From pure experience, I'm pretty much perfectly sure overuse of alcohol could be one of the things which causes sinus arrhythmia in adults, perhaps in conjunction with non-lifethreating, recurrent atrial fibrillation. Especially upon "sleeping it off". Earlier I've talked about my own experience by referring to "morning after hyperventilation", but now I think that's not it.

I haven't seen this one mentioned in either this article or the one about sinus arrhythmia, but after my most recent episode, it sounds like something that could/should be easily found in the literature as well. I can't write anything about the phenomenon, though, because I'm not in this field, so that I don't have access to the relevant research literature. Thus, I'd like to suggest somebody else around here could perhaps take a look at the addiction and cardiac research, to verify whether my intuition/anecdote pans out. After all, given the huge rate of alcohol abuse all over the world, and even my not having been able to find words for something that prolly forsaged a more serious arrhythmia, I'm pretty sure that this stuff should be on Wikipedia. I mean, if it proves to be a well-researched and easily citable result. Decoy (talk) 21:22, 24 August 2011 (UTC)

Define normal

Normal hearts are not perfectly rhythmic. Please add information about the details of the range of "normal" -- how many PACs, PVCs etc normal hearts have per 24 hrs, etc.-96.237.13.111 (talk) 14:12, 21 November 2011 (UTC)

File:EKG VF.jpg Nominated for Deletion

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Sentence that contradicts itself

There is a sentence that contradicts itself: "SADS is used to describe sudden death due to cardiac arrest brought on by an arrhythmia in the absence of any structural heart disease on autopsy. The most common cause of sudden death in the US is coronary artery disease.[citation needed]" If there is an absence of any structural heart disease in autopsy, then why does it go on to say that the cause is coronary artery disease, which WOULD show as a structural heart problem on autopsy? Medical experts please enlighten and perhaps correct that sentence as it is very misleading. 58.167.196.2 (talk) 03:29, 29 November 2012 (UTC)

Gene therapy

Can this treatment be mentioned in the article ?: Gene Therapy for fixing heart rythm disorder

About the article title

I saw dear Doc James has redirected the article to current name (Cardiac Dysrhythmia) with this reasoning that arrhythmia means there is no rhythm at [1] but I think this is a personal reasoning and we should use terms that used in scientific literature. A simple googling can show that "arrhythmia" is using in medical literature for example by American heart association at here or you can see many book titles here or more important that MeSH has chosen "Arrhythmia" at here. Dysrhythmia is an old term that had been used in 1970s and 1980s. However dysrhythmia is used in cerebral context as "cerebral dysrhythmia" or "Thalamocortical dysrhythmia". I think we should change the title to "Arrhythmia" event without "cardiac" word. Baqeri (talk) 15:52, 9 January 2015 (UTC)

Among review articles from the last 5 years they are used about the same number of times 4514 for arrhythmia and 4067 for dysrhythmia

Additionally the World Health Organization uses the term "cardiac dysrhythmia" [2] We should really go with the international classification rather than the local American one. Doc James (talk · contribs · email) 16:01, 9 January 2015 (UTC)

Despite not having strong views on the article title, I must add:

• The main term in WHO's ICD-9 is dysrhythmia, but in ICD-10 is arrhythmia
• Part V in the latest edition of Braunwald's Heart Disease is titled "Arrhythmias, sudden death and syncope".
• The common clinical term for relevant drugs is "antiarrhythmics". --NikosGouliaros (talk) 17:16, 9 January 2015 (UTC)

NikosGouliaros, thanks for mentioning ICD term changing. I tried but I couldn't reach ICD 10 or 11. It is a strong criterion for article titles in Wikipedia. see this, but about the equal number of articles in PubMed, I think PubMed uses an algorithm that consider "arrhythmia" and "dysrhythmia" as a same concept. For example check this article. This is the second article in search of "review" articles in "recent 5 years" for "dysrhythmia" but you cannot find even one word of "dysrhythmia" however in this article more than 20 times "arrhythmia" used. This is a key point in PubMed Search. Baqeri (talk) 19:30, 9 January 2015 (UTC)

Yes can move back to cardiac arrhythmia. The term arrhythmia is also applied to sleep such as Circadian arrhythmia Doc James (talk · contribs · email) 20:32, 11 January 2015 (UTC)

Histamine

Have moved this content here "Histamine modifies the heart rhythm and is responsible for many cardiac arrhythmias. The major arrhythmogenic actions of histamine are an H1-receptor-mediated slowing of atrioventricular conduction and H2-receptor-mediated changes in sinus rate and ventricular automaticity. Central nervous system H1-histamine receptors may mediate cardiac arrhythmias that occur after intracerebral hemorrhage or similar intracranial insults. Histamine, via the H2-receptor, attenuates the tachycardia produced by stimulation of cardiac sympathetic nerves or exogenous norepinephrine. H2-receptor blockade in this setting might therefore be expected to exacerbate ventricular arrhythmias secondary to loss of the histamine-mediated attenuation of sympathetic activity. The weight of clinical and experimental data justifies a trial of H1 and H2 receptor blockers when conventional antiarrhythmic therapy fails in the treatment of life-threatening cardiac arrhythmias in a clinical setting suggestive of histamine release."

We should use something newer than 1986. Doc James (talk · contribs · email) 21:16, 10 January 2015 (UTC)

The cited source is a review article, by a third-party, containing and referring published secondary sources and, accurately reflecting current medical knowledge. The fact that is was published in 1986 does not mean that the information ceases to be valid. If you can show that the information I extracted from the source has been superseded, became obsolete, or negated in any way, then prove it but, please do not simply delete the whole contribution. There is always the "Clarification needed" in superscript that could be added to invite further clarifications. The source meets the high-quality reliable sources guidelines. It is a review published in a reputable medical journal, reliably referring academic and professional books and work written by experts in the relevant field. The information that I posted in the article is not content that could be considered as coming from a primary source either. You are welcome to reword my contribution if you think you can improve it but, to simply delete it would deprive Wikipedia of important information. Thank you. 98.217.155.45 (talk) 10:49, 11 January 2015 (UTC)

If it accurately reflects current knowledge than you should be able to find something from the last 10 years. See WP:MEDDATE. Antihistamines appear to increase the risk of dysrhythmias [3]. Doc James (talk · contribs · email) 20:27, 11 January 2015 (UTC)

There are lots of primary source articles published within the last 10 years about studies involving histamine or it's inhibition, and cardiac effects including dysrhythmias. Just look at the usual databases (Pubmed, etc.). My source, albeit being older, is the best topic-specific review with second sources I found so far, with not much time to look for more. Regarding WP:MEDDATE, it says "These instructions... may need to be relaxed in areas where... few reviews are being published". While trying to accommodate your recentism, and agreeing with you on "Antihistamines appear to increase the risk of dysrhythmias" in some cases (yet, I've known several anecdotal cases where the opposite has been true and, H1-inhibitors treated PAC and supra-ventricular arrhythmias successfully, with better side effects profile than beta-blockers), I limited my contribution to our consensus on a lightweight claim. Your disruptive editing is approaching edit warring, further action may need to be taken against your disruptions. 98.217.155.45 (talk) 06:23, 12 January 2015 (UTC)

We have 348 reviews from the last 5 years for "cardiac arrhythmia" [4] Hardly a an area with "few reviews" Doc James (talk · contribs · email) 06:44, 12 January 2015 (UTC)

We are talking here about the few reviews specifically on histamine and dysrhythmias, not just any review on "cardiac arrhythmia". 98.217.155.45 (talk) 07:03, 12 January 2015 (UTC)

If no one since than has commented on it is likely wrong. Doc James (talk · contribs · email) 07:07, 12 January 2015 (UTC)

Not necessarily. That is nonsense. It can very well prove that the sourced review is just fine.98.217.155.45 (talk) 07:40, 12 January 2015 (UTC)

• Comment from an uninvolved editor (via WT:MED): I think the biomedical claims here, including the one that "Histamine... is responsible for many cardiac arrhythmias", would require recent reliable medical sources. If these can't be produced (I haven't spotted any obvious recent reviews - tho this non-MEDRS editorial is at least pertinent) then I feel that due weight in the article is a real editorial concern. As regards antihistamines, I think PMID 20210720 (2010) might also be relevant here. 86.181.67.166 (talk) 14:40, 12 January 2015 (UTC)

Adding: As regards allergic reactions, this recent potential MEDRS wouldn't seem to provide the necessary support for the claim that histamine is responsible for *many* cardiac arrhythmias. 86.181.67.166 (talk) 14:54, 12 January 2015 (UTC)

• The IP made a claim with an article which is MEDRS compliant other than being out or WP:MEDDATE. Doc James seems to have presented a source published later which gives information contrary to the older source. I think it is reasonable to ask that there be a response to information in the newer source, because it often happens in medicine that new information replaces older information. I say this because I anticipate that finding a newer source should not be difficult. Blue Rasberry (talk) 14:55, 12 January 2015 (UTC)

...though sometimes not altogether straightforward either. 86.181.67.166 (talk) 15:09, 12 January 2015 (UTC), a separate logged-out "IP")

Possibly helpful: ACC/AHA/ESC Guidelines for the Management of Patients with Supraventricular Arrhythmias European Society of Cardiology 2003, see end of p.14 and there-cited ref 101. LeadSongDog come howl! 22:51, 12 January 2015 (UTC)

Arbitrary break: moved content

I moved the following paragraph from the main page due to concerns about weighting and the way some of it is framed under "==Differential diagnosis=="^[?]

Histamine modifies the heart rhythm and is responsible for many cardiac arrhythmias. The major arrhythmogenic actions of histamine are an H1-receptor-mediated slowing of atrioventricular conduction and H2-receptor-mediated changes in sinus rate and ventricular automaticity. Also, some antihistamines appear to increase the risk of dysrhythmias.

86.181.67.166 (talk) 09:14, 13 January 2015 (UTC)