How Are Abnormal Heart Rhythms Typically Diagnosed?

Dr. William O'Neill answers the question: 'Diagnosing Abnormal Heart Rhythms?'

— -- Question: How are abnormal heart rhythms typically diagnosed?

Answer :When you go to the doctor the doctor tells you that you have an arrhythmia. Then the first thing that's done is an electrocardiogram -- it's a 12 lead EKG that is about a three-second sample of what the heartbeat is like.

Normally that's not enough to really be able to diagnose arrhythmias, and normally doctors will put a Holter monitor on. This is a device that goes on the chest and it's left in place for 24 hours. So you get put in place at a doctor's office, you go home, you do whatever you want to do, the next day you come back and take it off. And it's basically a tape recording that tapes all of the heart beats for a 24 hour period of time. Those then can be examined to see whether or not there's any dangerous arrhythmias that are present.

Occasionally people have very spotty or irregular abnormalities. They'll complain of problems maybe once a month or once a week. And there are actually now loop recorders that can be placed. They're small little sort of like mini pacemakers that are placed underneath the skin. A very small incision is made. The device is placed inside the chest, and those are actually left in place for a month. So we can do a basically do a full recording of every single heart beat that you have for a month in order to really try to find whether or not you have a severe problem.

The other thing that can often be done is that a device can be given, it's called a trans telephonic monitor, where you can actually call in and the device put on a phone over your chest or the device and that will transmit to a remote facility whether or not you have any problems, what the heart rhythm is during the problems that you're presenting. So those are all the tools we have to really kind of try to diagnose.

In rare cases when there's a very severe concern, the doctor, the electrophysiologist will actually place you in the hospital in an attempt to provoke some of these irregular abnormalities to really try to pin down what the cause is. So we've got a wide spectrum of tools at our armamentarium. Largely depending how much at risk people are. Most people if they've not had underlying heart disease, almost all of the arrhythmias that they have are not life-threatening, so we don't go to this huge extent to try to sort out exactly what the arrhythmia is.

But in people that have severe underlying heart disease, we often have to do very very aggressive measures to really try to pin down these problems because there is specific medication that can be done, or specific treatments depending on the rhythm abnormality is.