From the Guidelines
An irregular regular heartbeat, also known as an arrhythmia, requires immediate medical evaluation to determine the underlying cause and appropriate treatment, as it can be a symptom of a life-threatening condition. If you're experiencing this symptom, contact your healthcare provider or seek emergency care if accompanied by chest pain, shortness of breath, or dizziness. According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1, common arrhythmias include atrial fibrillation, premature beats, and tachycardia.
Key Considerations
- Treatment depends on the specific type and severity of the arrhythmia, but may include medications like beta-blockers (metoprolol 25-100mg daily), calcium channel blockers (diltiazem 120-360mg daily), or antiarrhythmics (amiodarone 200mg daily) 1.
- Some patients require procedures such as cardioversion, ablation, or pacemaker implantation 1.
- While waiting for medical care, avoid stimulants like caffeine and alcohol, practice stress reduction techniques, and monitor your pulse.
- Arrhythmias occur when the electrical signals controlling your heartbeat malfunction, which can happen due to heart disease, electrolyte imbalances, medication side effects, or structural heart abnormalities 1.
- Self-diagnosis is dangerous as many arrhythmias have similar symptoms but require different treatments 1.
Importance of Medical Evaluation
A thorough medical evaluation is crucial to determine the underlying cause of the arrhythmia and to develop an effective treatment plan. This evaluation should include a clinical history, physical examination, and diagnostic tests such as electrocardiogram (ECG) and echocardiogram 1.
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From the FDA Drug Label
High doses of digoxin may produce a variety of rhythm disturbances, such as first-degree, second-degree (Wenckebach), or third-degree heart block (including asystole); atrial tachycardia with block; AV dissociation; accelerated junctional (nodal) rhythm; unifocal or multiform ventricular premature contractions (especially bigeminy or trigeminy); ventricular tachycardia; and ventricular fibrillation.
The drug digoxin can cause irregular heartbeat due to various rhythm disturbances at high doses, including atrial tachycardia, ventricular tachycardia, and ventricular fibrillation 2.
- Key points:
- High doses of digoxin can lead to rhythm disturbances.
- These disturbances can include irregular heartbeats such as atrial and ventricular tachycardia.
- The risk of these disturbances can be mitigated by adjusting the dose of digoxin.
From the Research
Irregular Regular Heartbeat
- An irregular regular heartbeat, also known as atrial fibrillation (AF), is a common heart condition characterized by an irregular and often rapid heart rate 3.
- The management of AF typically involves either rhythm control or rate control, with the goal of preventing complications such as stroke and heart failure 3.
- Rate control is often achieved using beta-blockers, which are usually required to achieve adequate ventricular rate control, defined as a resting rate of less than 100 beats per minute 3.
- Non-dihydropyridine calcium channel blockers are often contraindicated in patients with AF and heart failure with systolic dysfunction, and digoxin may be used in combination with a beta-blocker to achieve satisfactory rate control 3.
Treatment Options
- Beta-blockers are commonly used to treat AF, but their efficacy and safety have been debated, particularly in patients with heart failure and reduced ejection fraction 3.
- Apixaban, a non-vitamin K antagonist oral anticoagulant (NOAC), has been shown to be effective and safe in patients with AF, including those with bioprosthetic valve replacement or valve repair 4.
- A comparison of NOACs, including apixaban, dabigatran, and rivaroxaban, found that they were more effective than warfarin in preventing stroke, but had varying risks of bleeding 5.
- In patients with AF and aortic stenosis, NOACs were associated with a higher risk of thromboembolism but a lower risk of major bleeding compared to warfarin 6.
Key Findings
- The choice of treatment for AF depends on various factors, including the presence of heart failure, systolic dysfunction, and other comorbidities 3.
- NOACs, such as apixaban, may be a reasonable option for patients with AF, including those with bioprosthetic valve replacement or valve repair, and those with aortic stenosis 4, 6.
- However, the efficacy and safety of NOACs compared to warfarin may vary depending on the specific patient population and clinical context 5, 6.