Most people are blissfully unaware of arrhythmias, says Trudie Lobban MBE, Founder and Trustee of Arrhythmia Alliance. But that has to change, because anyone with undiagnosed arrhythmia is at high risk of a debilitating or life-threatening AF-related stroke or sudden cardiac death. And arrhythmias are treatable — if diagnosed and treated.

Arrhythmia Alliance is a coalition of charities, patients, carers, healthcare professionals, medical organisations, policy makers, allied professionals and all those with an interest in cardiac arrhythmias (heart rhythm disorders). “One of our aims is to make arrhythmia a household word by 2020,” says Lobban, “so that everybody knows about and understands it, and knows the rhythm of their own heart.” This is key because arrhythmias are abnormal heart rhythms that are either too fast, too slow or irregular.

“At Arrhythmia Alliance, we talk about 'Detect, Protect, Correct',” says Lobban. “Detect arrhythmia through a simple pulse check; Protect against AF-related stroke with anti-coagulation therapy (not aspirin); and Correct the irregular heart rhythm with access to appropriate treatment.”


What is the difference between arrhythmia and a heart attack?


Unlike a heart-attack, which Lobban describes as “a problem with the heart's plumbing” (because of, say, a blocked artery or a burst blood vessel), arrhythmia should be thought of as an “electrical fault”, which can cause the heart's complete and immediate shut down.

To put it into context, Lobban uses the illustration of a washing machine. “If you have a leak in your washing machine, it may nevertheless get to the end of its cycle,” she says. “OK, so it will be full of water, but its lights will still be on. That's a heart-attack — and a person who has one may have the chance to call for emergency help. If you have a power-cut or a blown fuse, however, the washing machine suddenly stops – it is dead. That's sudden cardiac arrest (SCA).” SCA kills more people in the Western world than lung cancer, breast cancer and AIDS combined and, in the UK, 100,000 people die from it every year. It can be caused by an arrhythmia such as ventricular tachycardia, a rapid abnormal heart rhythm. With rapid CPR (cardiopulmonary resuscitation) and the use of an automated external defibrillator (AED), the person has up to 70 per cent chance of survival – without an AED it is almost certain death.


Affecting people of all ages


The most common form of arrhythmia — and the number one cause of AF-related stroke — is atrial fibrillation (AF), when the heart beats erratically and irregularly. Incredibly, 1.5 million people in England have AF, and it is estimated that another half a million have the condition but are undiagnosed.

“The heart has four chambers through which the blood flows freely,” explains Lobban. “But if each of those chambers begins quivering at a different rate, the blood has difficulty flowing and a clot can form. If a clot breaks off, it can travel and cause heart failure, thrombosis or an AF-related stroke. AF-related strokes are often more devastating — or fatal – than other forms of stroke.” People whose symptoms include breathlessness, tiredness and heart palpitations should see their doctor to check for AF.  A simple pulse check can detect an irregular heart rhythm and with new technology such as handheld electrocardiogram.

(ECG) monitors – we can be diagnosed quickly and provide evidence for our doctor for appropriate anticoagulation therapy to reduce the risk of an AF-related stroke plus access to appropriate treatment for AF.


Fainting and your heart


Syncope — the Greek word for 'faint' — may be a sign of arrhythmia. “Fainting might happen because of low blood pressure or because of overheating. All too often, though, it's because of an arrhythmia — and a potentially fatal one, which could lead to sudden cardiac arrest; there is no such thing as a 'simple faint'.” Sudden cardiac death can affect anyone at any age; AF affects one in four people over 65 years of age. Some arrhythmias are genetic and can lead to sudden cardiac arrest.


Importance of pulse checking


Of course, we all get heart palpitations from time to time, but there is a quick way to reassure yourself if you are worried about an arrhythmia: with a simple pulse check. Anyone experiencing irregular or abnormal heart rhythms but whose pulse is regular, is unlikely to need medical attention. Anyone whose heart is racing and whose pulse is irregular during a period of rest should see a medical practitioner as a matter of urgency. “If we are all aware of our pulse rhythm, we can reduce death and AF-related strokes, and also reduce the burden on the NHS by visits from the worried well,” says Lobban.

If your healthcare professional does diagnose an arrhythmia, the next steps depend on what kind you have. You should seek further advice from them if your pulse races some or most of the time and you have been feeling unwell. Even if you don’t feel unwell but your pulse feels irregular (jumping around) you should also seek medical advice. We are all different and so are our pulse rates so it can be difficult to assess irregular rhythms. If your heart rate is consistently above 120bpm or below 40bpm you should seek advice from a medical professional.

Remember there is no such thing as a ‘simple faint’. If a person experiences a loss of consciousness they need a 12-lead ECG to rule out an underlying, potentially fatal arrhythmia. In working together we can perfect the patient pathway and enable the ‘patient’ to go back to being a ‘person’.