Common Conditions
HEART FAILURE
Heart failure is a condition in which the heart is unable to pump blood effectively to meet the body's demands, leading to symptoms such as breathlessness, fatigue, fluid retention, and reduced exercise tolerance. It is classified as heart failure with reduced ejection fraction (HFrEF) when the left ventricular systolic function is impaired or heart failure with preserved ejection fraction (HFpEF) when diastolic dysfunction is the primary issue. Common causes include ischemic heart disease, hypertension, cardiomyopathies, and valvular heart disease. Diagnosis involves clinical assessment, echocardiography, and biomarkers like NT-proBNP. Treatment focuses on lifestyle modifications, medications such as beta-blockers, ACE inhibitors, MRAs, and SGLT2 inhibitors, and, in severe cases, device therapy with implantable defibrillators or cardiac resynchronization therapy. Advanced heart failure may require heart transplantation or mechanical circulatory support.
ATRIAL FLUTTER
Atrial flutter is a type of supraventricular tachycardia characterized by a rapid but organized electrical circuit in the atria, typically causing atrial rates of around 250–350 beats per minute. Unlike atrial fibrillation, where electrical activity is chaotic, atrial flutter follows a more regular pattern, often resulting in a consistent but fast ventricular response. Symptoms may include palpitations, breathlessness, dizziness, fatigue, and, in some cases, chest discomfort. Atrial flutter increases the risk of stroke due to blood stasis and clot formation, similar to atrial fibrillation. It is commonly associated with conditions such as hypertension, coronary artery disease, heart failure, and post-cardiac surgery states. Treatment options include rate control medications, anticoagulation for stroke prevention, and rhythm control strategies such as electrical cardioversion or antiarrhythmic drugs. Catheter ablation, particularly targeting the cavotricuspid isthmus in typical atrial flutter, is often a highly effective and curative intervention.
SUPRAVENTRICUALR TACHYCARDIA
Supraventricular tachycardia (SVT) is a rapid heart rhythm originating above the ventricles, typically in the atria or the atrioventricular (AV) node. It is characterized by sudden episodes of a fast but regular heart rate, often exceeding 150 beats per minute. Symptoms can include palpitations, dizziness, breathlessness, chest discomfort, and, in some cases, syncope. SVT is commonly caused by re-entrant circuits, such as atrioventricular nodal re-entrant tachycardia (AVNRT) and atrioventricular re-entrant tachycardia (AVRT), often associated with accessory pathways like Wolff-Parkinson-White (WPW) syndrome. Triggers include stress, caffeine, alcohol, and certain medications. Acute management involves vagal maneuvers, such as the Valsalva maneuver, or intravenous adenosine to terminate the arrhythmia. Long-term treatment options include beta-blockers, calcium channel blockers, or catheter ablation, which offers a high success rate and potential cure by eliminating the abnormal electrical pathway.
VENTRICULAR TACHYCARDIA & VENTRICULAR ECTOPY
Ventricular tachycardia (VT) and ventricular ectopy are abnormal heart rhythms originating from the ventricles. VT is a fast, potentially life-threatening arrhythmia characterized by three or more consecutive ventricular beats at a rate exceeding 100 beats per minute. It can be sustained or non-sustained and may lead to syncope, hemodynamic instability, or degenerate into ventricular fibrillation, causing cardiac arrest. VT is commonly associated with structural heart disease, ischemia, cardiomyopathies, or electrolyte imbalances. In contrast, ventricular ectopy refers to premature ventricular contractions (PVCs), which are isolated extra beats that may be asymptomatic or cause palpitations. Frequent PVCs or VT can impair cardiac function and increase the risk of heart failure. Management depends on symptoms and underlying causes, ranging from observation and lifestyle modifications to antiarrhythmic medications, catheter ablation, or implantable cardioverter-defibrillators (ICDs) for high-risk patients.
BRADYCARDIA (SLOW RHYTHM)
Bradycardia is a slow heart rhythm, typically defined as a heart rate of fewer than 60 beats per minute. While it can be normal in well-conditioned athletes, it may indicate an underlying problem if associated with symptoms such as fatigue, dizziness, breathlessness, syncope, or exercise intolerance. Bradycardia can result from sinoatrial node dysfunction (sick sinus syndrome), atrioventricular (AV) block, metabolic disorders, medications such as beta-blockers, or underlying structural heart disease. In some cases, mild bradycardia requires no treatment, but if symptomatic or causing hemodynamic compromise, management may involve addressing underlying causes, discontinuing exacerbating medications, or, in severe cases, implanting a permanent pacemaker to maintain an adequate heart rate and prevent complications like syncope or heart failure.
HEART BLOCK
Heart block is a disruption in the electrical conduction between the atria and ventricles, leading to a slow or irregular heart rhythm. It is classified into three degrees: first-degree heart block, where conduction is delayed but all impulses reach the ventricles; second-degree heart block, where some impulses fail to conduct (Mobitz type I and II); and third-degree (complete) heart block, where no atrial impulses reach the ventricles, leading to an independent and slower ventricular rhythm. Causes include age-related degeneration, ischemic heart disease, myocarditis, and medications affecting conduction. While mild forms may not require treatment, more severe cases, particularly symptomatic second-degree Mobitz II or complete heart block, often necessitate pacemaker implantation to maintain an adequate heart rate and prevent syncope or sudden cardiac arrest.
HYPERTENSION
Hypertension, or high blood pressure, is a chronic condition in which the force of blood against the arterial walls is consistently elevated, increasing the risk of cardiovascular diseases. It is categorized as primary (essential) hypertension, with no identifiable cause, or secondary hypertension, which results from conditions such as kidney disease, endocrine disorders, or medication side effects. Often asymptomatic, hypertension can lead to complications like stroke, heart attack, heart failure, and kidney disease if left untreated. Diagnosis is based on repeated blood pressure measurements, with lifestyle modifications, including a healthy diet, regular exercise, and reduced salt intake, forming the first line of management. Pharmacological treatment with antihypertensive medications, such as ACE inhibitors, beta-blockers, calcium channel blockers, or diuretics, is recommended based on individual risk factors and disease severity.
ATRIAL FIBRILLATION (AF) (AFib)
Atrial fibrillation (AF) is a common cardiac arrhythmia characterized by rapid and irregular electrical activity in the atria, leading to uncoordinated atrial contractions and ineffective blood pumping. This increases the risk of stroke, heart failure, and other cardiovascular complications. AF can present with palpitations, breathlessness, dizziness, fatigue, or even be asymptomatic. It is classified as paroxysmal (self-terminating), persistent (lasting more than seven days), or permanent (where sinus rhythm restoration is not pursued). Risk factors include hypertension, coronary artery disease, heart failure, obesity, excessive alcohol intake, and hyperthyroidism. Management involves rate or rhythm control with medications or catheter ablation, alongside stroke prevention using anticoagulation therapy based on the CHA₂DS₂-VASc score. Lifestyle modifications, including weight management and reducing alcohol intake, also play a crucial role in AF treatment and prevention.