Heart rhythm disturbance

The heart, for its proper function of pumping blood, must contract in a rhythmic and regular way. This rhythm is given by the heart's natural “pacemaker” center, the so-called sinus node; From it, the electrical impulse travels through the conduction tissue to the rest of the heart muscle, generating the beat.

Physiological changes that take place due to aging, with replacement of pacemaker tissue and conduction through fibrous tissue, among others, make beat control and its efficiency less. This is how arrhythmias appear, which are losses of the normal regular rhythm of the heart. These can occur with a normal heart rate, faster (tachyarrhythmias) or slower (bradyarrhythmias). All of them can give symptoms and have important repercussions.

Cardiac arrhythmia in the elderly

Arrhythmias are a relevant problem in the elderly due to the high prevalence of underlying heart disease and. Arrhythmias by themselves are associated with increased morbidity and mortality in this age group.

Atrial fibrillation is the most commonly observed sustained arrhythmia in clinical practice. Its incidence increases with age and the presence of structural heart disease. Is a major cause of cerebral thromboembolism, especially in the elderly. In it there is a loss of the regular rhythm replaced by a chaotic rhythm. It causes palpitations, heart failure, and exercise intolerance, but also cognitive impairment or delirium in elderly patients with predisposing factors.

Main causes

The facts triggers of atrial fibrillation They can be thyroid disorders, fever, decreased oxygen in the blood (due to respiratory diseases), toxins such as alcohol, drugs or other heart diseases (heart attacks, valvular heart disease, high blood pressure, etc.).

Other arrhythmias are those produced by pacemaker node blockages or the conduction tissue, which mainly produce slow rhythms, bradycardias. In them, the clinic is usually of heart failure and secondary to the deficit in the arrival of blood flow to the different systems of the body (fainting or syncope, exercise intolerance, angina pectoris).

Also exist rapid arrhythmias or tachyarrhythmias, most of them produced by alterations in the conduction tissue that produce a kind of short-circuiting of the heartbeat stimulus. Here, as the heartbeat is too fast, it does not allow time for the ventricles to fill properly, leading to heart failure, as in bradycardia.

Diagnosis

The basic study of a patient in which an arrhythmia is detected should be the one, as well as a blood test to detect alterations in mineral salts, metabolic or anemia; An echocardiogram and, in specific cases, electrophysiological studies should also be performed.

Treatment

Although the principles for the assessment and arrhythmia treatment applied to all age groups, the approach to the geriatric patient has been modified especially by the increased risk that exists in the pharmacological and interventional therapy, the pharmacokinetic alterations and the little-established long-term benefit in the elderly patients.

The control of the heart rate with drugs and anticoagulation in the case of atrial fibrillation, it is the recommended strategy in most patients. In cases of recent onset, in non-frail patients, a return to a regular heart rhythm can be attempted by controlled electrical shocks, electrical cardioversion. In cases of tachyarrhythmias due to conduction tissue disturbances, suppression of the abnormal area can be attempted using radio waves. For bradycardias, a permanent pacemaker is often recommended.

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