Does arrhythmia require hospitalization?

Written by Chen Ya
Geriatrics
Updated on September 11, 2024
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Arrhythmia treatment should be determined based on the patient's symptoms, type of arrhythmia, and its impact on hemodynamics. For instance, minor conditions like slight sinus bradycardia, irregular sinus rhythm, occasional atrial premature contractions, and first-degree atrioventricular block, which have minimal impact on hemodynamics and no significant clinical manifestation or structural heart disease, do not necessitate hospitalization. However, more severe arrhythmias such as sick sinus syndrome, rapid atrial fibrillation, paroxysmal supraventricular tachycardia, and sustained ventricular tachycardia, which can cause symptoms like palpitations, chest tightness, dizziness, low blood pressure, sweating, and in severe cases, fainting, Adam-Stokes syndrome, and even sudden cardiac death, require prompt medical attention and hospitalization for treatment.

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Written by Liu Ying
Cardiology
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Causes of arrhythmia

There are many causes of arrhythmia, which can be physiological or pathological. Pathological causes can originate from the heart itself or from other diseases. For instance, normal individuals might experience sinus arrhythmia, and circumstances such as staying up late, emotional excitement, or excessive fatigue can lead to premature beats or sinus tachycardia, among others. Other diseases, such as hyperthyroidism or fever, can cause an increased heart rate. For example, pulmonary embolism can lead to atrial fibrillation. Heart-related diseases, like heart failure, can cause ventricular premature beats, and diseases of the sinoatrial node itself can lead to sick sinus syndrome, among others.

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Written by Wang Li Bing
Intensive Care Medicine Department
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What tests are done for arrhythmia?

Arrhythmia is also relatively common in clinical practice, and its common detection method is mainly the electrocardiogram (ECG). ECG is a simple and non-invasive operation that helps to identify the type of arrhythmia. Another method is the 24-hour Holter monitor, which can record all heart rate changes occurring within 24 hours. If an arrhythmia occurs, it is crucial to seek medical attention promptly, visiting a cardiology department. Treatment may involve antiarrhythmic medications, and if possible, a complete electrophysiological examination can be performed.

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Written by Chen Ya
Geriatrics
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Arrhythmia is caused by what?

Arrhythmia is caused by abnormal excitation of the sinoatrial node or excitation originating outside the sinoatrial node, with slow conduction, blockage, or conduction through abnormal pathways. This results in the frequency and (or) rhythm abnormalities of heartbeats, which are collectively referred to as arrhythmias. Most of the causes include the following: one is genetic arrhythmias, often due to gene channel mutations, such as the commonly seen long QT syndrome, short QT syndrome, Brugada syndrome, etc. There are also acquired arrhythmias, seen in various organic heart diseases, including coronary atherosclerotic heart disease, commonly referred to as coronary heart disease, cardiomyopathy, myocarditis, and rheumatic heart disease, particularly prevalent during heart failure or acute myocardial infarction. Arrhythmias are also not uncommon in basically healthy individuals or patients with autonomic dysfunction. Other causes include electrolyte imbalance or endocrine disorders, and sometimes anesthesia, hypothermia, or surgery, such as thoracic or cardiac surgery, or medications, central nervous system diseases may also cause arrhythmias, but the specific reasons are not very clear.

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Written by Wei Shi Liang
Intensive Care Unit
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Can arrhythmia be cured?

Arrhythmias come in many types, most of which are curable. Once arrhythmia occurs clinically, an electrocardiogram should be performed as soon as possible to determine the type of arrhythmia. Common arrhythmias can be classified into tachyarrhythmias and bradyarrhythmias, and based on the location of occurrence, into supraventricular arrhythmias and ventricular arrhythmias. Clinically common are supraventricular arrhythmias, such as sinus tachycardia, junctional tachycardia, along with atrial tachycardia, atrial fibrillation, and atrial flutter. These generally do not affect the stability of hemodynamics and are relatively easy to treat. On the other hand, ventricular arrhythmias such as ventricular fibrillation, ventricular tachycardia, and sinus arrest are clinically challenging to cure and require aggressive resuscitation.

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Written by Wei Shi Liang
Intensive Care Unit
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Ventricular arrhythmias include the following types.

Common ventricular arrhythmias mainly include premature ventricular contractions, ventricular tachycardia, ventricular flutter, and ventricular fibrillation. Premature ventricular contractions appear on the electrocardiogram as prematurely occurring wide and abnormal QRS complexes. If asymptomatic, no treatment is needed; if symptomatic, receptor blockers can be used for treatment. Ventricular tachycardia is clearly indicated on the electrocardiogram by wide and abnormal QRS complexes, with heart rates ranging from 140 bpm to 200 bpm. The primary treatment is to remove the cause, and electrical cardioversion can be used when hemodynamics are unstable. Ventricular flutter and fibrillation, their ventricular rates are generally above 250 bpm, and treatment is crucial.