2023-06-04 06:58:58
Sporadic arrhythmias are not always alarming, but if they repeat and/or if other pathologies are present, it is advisable to talk to your doctor to start the most suitable checks
A crazy heart, crazy as hell: because when it does its job we don’t realize its beats, but if it goes crazy it’s hard not to notice. Sometimes the pulse they become erratic, other times they are too fast or slower than they should be. They are all different forms of arrhythmias, disturbances of the normal heart rhythm that they can also be an unfortunate legacy of Covid-19: a Swedish study, presented at the last congress of theEuropean Heart Rhythm Associationhas shown that in those who have had the disease in a serious form, such as to require mechanical ventilation, the risk of arrhythmias increases significantly.
The (unpleasant) legacy of Covid
The data, collected on over 3 thousand patients compared with 28 thousand people who had not been hospitalized in intensive care for the infection, show that in the following 6-9 months the probability of bradycardia (slowing of the rhythm) and that of having to resort to Pacemaker implantation increased 9-fold, the risk of atrial fibrillation 13-fold, the risk of tachycardia in general 14-fold and the probability of ventricular tachycardia even 16-fold.
Who needs mechanical ventilation in case of Covid-19 in general an already frail patient, the addition of an arrhythmia can further compromise its health; moreover, further studies show that following the infection the probability of heart rhythm disturbances is higher even in those who have not had the disease in a serious form or have been hospitalized in intensive care, he specified Marcus Stahlberg of the Karolinska Institute in Stockholm, coordinator of the survey. Therefore, if after Covid-19 you notice palpitations or irregular heartbeats, it is better to undergo a cardiological check.
Two and a half billion heartbeats
Over the course of a lifetime, the average heart beats about 2.5 billion times. Each beat arises from an electrical impulse that is generated in cellule-pacemaker and then, spreading through the heart muscles, it makes them contract in a perfectly coordinated way. That some beats can sporadically jump, speed up or slow down a reasonable possibility given the quantity, but the rhythm alterations are generally worrying.
However, they should not always alarm: that’s why understanding when to talk to your doctor is necessary and how accurate Claudius Tondodirector of the Arrhythmology Department of the Monzino Cardiological Center in Milan, sporadic arrhythmias do not need further investigation: in many cases they are associated with specific contexts, for example after eating due to stomach distension (gastro-cardiac syndrome and depends on an upward pressure of the diaphragm which induces tachycardia, ndr). If the person experiencing irregular heartbeat has cardiovascular disease, such as hypertension, or other diseases, such as diabetes, better investigate. In addition to the presence of diseases, too other alarm bells they must push for some more checks: if there is breathlessness, if the oxygen level in the blood measured with the oximeter is low or if the rhythm is very accelerated at rest, it is better to at least talk about it to the family doctor.
The right pace
A normal resting rhythm falls within about 100 beats per minutea value around 110 is still tolerable: if, however, you exceed 120, it is good to investigate further and understand whether the tachycardia can be explained by thyroid disorders, inflammation or other. Long-Covid, for example, is often associated with an increase of even 10-15 extra beats per minute that persists for months specs Joseph Augello, Head of Electrophysiology and Cardiostimulation at the Citt Studi Clinical Institute in Milan. For further information, the family doctor can prescribe an electrocardiogram which, however, as Tondo underlines, is not always decisive, because anomalies occur in the minutes of unspoken observation; even the Holter that records the pulse in 24 hours can sometimes be of little use, so today the 7-day Holter is often used. In some cases, for example the elderly, it is possible u
be technologies that allow home registration such as smartwatches or smartphones: today, thanks to artificial intelligence, the sensitivity in detecting abnormalities of the heartbeat is over 90%. The specificity, i.e. the ability to distinguish between the various causes of the irregularity such as atrial fibrillation or extrasystoles, is instead a little lower.
The most frequent forms
The most frequent arrhythmia l’extrasistoliaperceived as the heart that seems to skip a beat or have one too many. In 8 cases out of 10 benign and a specialist visit, a Holter monitor and a cardiac ultrasound are enough to eliminate the suspicion of serious ailments, says Augello. If doubts remain, one can be made Cardiac MRI to exclude, for example, whether it is a result of myocarditis (inflammation of the heart, ndr) or birth defects of the heart muscle. The echocardiogram is also useful because it identifies cases in which the heart no longer contracts well or has an enlarged volume, elements indicative of heart disease, adds Tondo.
In these situations the extrasystole could be the tip of the iceberg e an electrophysiological study of the heart would be advisable, which allows you to identify the origin of the arrhythmia and understand if it could give dangerous episodes and therefore it is appropriate to intervene to resolve it. Moreover, sometimes it is necessary to take measures even regardless of the entity of the ventricular extrasystole because it is the perception of the patient varies greatly: some do not tolerate a number of extrasystoles that would be normal on paper, others have many without experiencing discomfort. However, when extrasystoles are very numerous, it is always advisable to set up a therapy because over time they reduce the heart’s ability to contract, progressively and subtly.
What are the treatments
Treatments provide the use of antiarrhythmic drugs, to be chosen according to the type of rhythm alterations; however the options are not many and it may happen, if there is not a satisfactory answer, to have to undergo an ablation procedure. In practice, it is a matter of hitting the point where the heart tissue goes crazy with methods that eliminate the offending cells: possible procedures use, for example, radiofrequencies for hot ablation, or technologies that use cold, such as the cryoballoonor again electroporation, with which a high voltage electric field is created on the membrane of the cardiac cells to be silenced, to form pores which cause the leakage of electrolytes and therefore cell death. For ablation is still experienced as a more dangerous heart operationor for example coronary angioplasty, notes Augello.
non cos: with the new methods and systems that map the area on which to intervene, a safe and minimally invasive procedure that can be performed by accessing the femoral vein in two points and can last even just an hour, thanks for example to the possibility of delivering a higher heat for shorter times. Very low complication rate. In some cases, however, it is not even necessary to enter the heart to intervene: when the arrhythmic short circuit arises in peripheral areas, it is enough to “lean” on the heart from the outside: thanks to ever more precise electro-anatomical maps, which, through intracardiac ultrasound or magnetic resonance, reconstruct a panorama of the real heart and in the smallest details. Thus, each patient can be a candidate for the most suitable, effective and safe procedure.
Efficacy and safety of ablation techniques (today often used above all for atrial fibrillation, see side ndr) are very high: the electric field used, for example, is specific for cardiac cells and does not affect those of the esophagus, bronchi or lungs, confirms Tondo. The result that in a few seconds, the abnormal electric circuit can be cleared from which the arrhythmia originates, solving the problem once and for all.
Do women’s hearts beat faster?
Some arrhythmias are more frequent, for example certain forms of tachycardia or long QT syndrome, in which each beat takes longer than it should to finish. It may be due to estrogen: the female hormone, according to a recent Swedish study published in Science Advances, affect ion channels which are found on the membrane of cardiac cells and which are responsible for the passage of electric currents which initiate and then propagate the beats; some genetic mutations connected to familial forms of arrhythmia are also associated with a greater sensitivity to estrogens, however they are also facilitated by other unisex factors, such as pollution: a study conducted in Padua has shown that dangerous ventricular arrhythmias increase when smog increasesSo much so that the authors suggest that people most at risk, for example those with an implantable defibrillator, check pollution levels before going out and use air purifiers at home.
Where, however, it would be good not to smoke, not even electronic cigarettes: a research on Nature Communications showed that in animals some e-cig liquids, for example propylene glycol or menthol flavors, modify the electrical conduction in the heart and alter the rhythm, increasing the likelihood of ventricular arrhythmias.
Sudden deaths among young people
The sudden changes of the heart are also scary because they are often the basis of sudden deaths of young or very young people, apparently in perfect health: in these cases it is often congenital heart diseases that manifest themselves with fatal arrhythmias, not infrequently after a sporting effort. An example the arrhythmogenic cardiomyopathyin which cardiac muscle cells are replaced by non-contractile fat cells: one of the most frequent causes of sudden cardiac arrest in under 35 athletes, who do not show any problems as children but then, after the age of 20, begin to have irregular pulses which they can increase heart rate paroxysmal and potentially fatal during exercise.
Researchers at the University of Utah have recently discovered that in these patients a protein, important for establishing connections between one heart cell and another, is produced in small quantities; they then used mice modified to have the same kind of deficiency and used a gene therapy which, in addition to bringing the levels of the protein back to normal, also improved their arrhythmia by restoring normal cardiac electrical activity. An encouraging result, even if far from an application on humans.
The same goes for another strategy: the graphene tattoo experimented on animals at Northwestern University in Chicago: a sheet of this material was applied to the hearts of mice and made it possible to trace the beats but also to intervene, a bit like a defibrillator, to restore the right rhythm in the event of arrhythmias.
June 4, 2023 (change June 4, 2023 | 06:57)
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