Spotlight On: Heart Rhythm Disorders

Panic attack? Or heart rhythm condition?

Pam Mason, M.D., a UVA Health System cardiologist, specializes in treating heart rhythm disorders. She answers questions about these disorders and explains how in younger women they may be mistaken for a panic attack. 

What are some common heart rhythm disorders?

Abnormalities in heart rhythm (also called arrhythmias) can be due to heart rhythms that are too slow or heart rhythms that are too fast. Younger women with structurally normal hearts are more likely to have heart rhythms that are too fast. These are not life-threatening, but do cause palpitations, chest discomfort and even fainting.

As women age, atrial fibrillation becomes more common. This causes a fast irregular heart beat, and can put patients at risk for stroke in some cases.

In patients who have had heart attacks or heart failure, more concerning heart rhythm abnormalities are more likely to be seen. Slower heart rhythms are usually found in older patients. These are very treatable with pacemakers.

What are common signs and symptoms of heart rhythm disorders?

Patients with fast heart rhythms may feel palpitations, shortness of breath, chest discomfort or dizziness. In some cases, particularly with more concerning heart rhythm abnormalities patients may faint. It is not uncommon for young women with an abnormally fast heart rhythm to be diagnosed with panic attacks.

Patients with slow heart rhythms often feel dizzy and occasionally faint. They also experience fatigue and poor exercise tolerance. However, a large number of patients with either fast or slow heart rhythms have no symptoms at all.

When I think of heart rhythm, I think of pacemakers. Is this something only older women should be concerned with?

Slower heart rhythms requiring pacemakers are usually found in older women, but not always. Concerning symptoms should always be investigated regardless of the patient’s age. Faster heart rhythms are actually most commonly found in younger women. These often cause a great deal of symptoms and are very amenable to treatment.

If my symptoms are very mild, why should I still seek treatment?

While many heart rhythm abnormalities are not life-threatening, some are, and all concerning symptoms should be evaluated. There is a great deal of variability in the symptoms that patients have in response to various heart rhythm abnormalities, and serious heart rhythm disturbances can be associated with only mild symptoms. In addition, heart rhythm abnormalities can be associated with other medical conditions, such as thyroid problems or autoimmune disorders.

What are the treatment options for those with heart rhythm problems?

For patients with abnormally fast heart rhythms, which are not life-threatening but cause severe symptoms, there are several options.  Patients with very infrequent symptoms may choose a “watchful waiting” approach. When symptoms are more frequent, medications can help. Ablation (a procedure that uses radio-frequency waves to eliminate the heart rhythm disturbance) is also available. These procedures have a high success rate and very few complications, and are recommended for patients with severe symptoms.

Patients with slow heart rhythms may require pacemakers. Patients with very concerning fast rhythms may be recommended for implantable defibrillators. These devices can deliver life-saving shocks to patients. Implantation of pacemakers and defibrillators are minor surgical procedures. And today’s devices are highly reliable.

Read more about heart rhythm problems in the winter 2008 issue (out in November) of UVA Health System’s Vim & Vigor. If you don’t already receive this family health magazine at home, subscribe today. It’s free.