Arrhythmia - any medical experts?

Loke1997

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I have characters who I want to have arrhythmia (irregular heartbeat). It's a main plot point. I know most people can get it at some points in their life for short periods of time due to things like stress / drinking etc and it's usually nothing to be afraid of as long as it's short lived.

However, I want my character to have it constantly (though not extreme). So her heartbeat is always irregular. Is this possible?

Would it be possible to lead a healthy life this way, or would it certainly result in a heart attack? The character is very physically fit, and is constantly running / fighting. I want the character to be diagnosed with it, but I don't want to give the readers any bad medical advice. Would it be okay for the doctor to say something like, "Yes, she has it. No, it's not life-threatening. Most people with arrhythmia lead normal lives, yes, especially considering she hasn't noticed it so far," etc. That's what it seems to be from what I read, but would it be the same if the character has it constantly?

Thanks!
 

mccardey

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I googled "chronic arrhythmia" and that certainly seems to be a thing. But I'll let someone medical weigh in on the indications...
 

Loke1997

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I googled "chronic arrhythmia" and that certainly seems to be a thing. But I'll let someone medical weigh in on the indications...

Yes, exactly, I've been looking at all the official medical websites I can see, but none of them seem to clarify if you can definitely have it throughout your entire life, and definitely don't want my doctor to say it's fine to have when it's really not. That's dangerous.

I did not know what 'chronic' meant though, thank you! Shows you how little I know right now.
 

AW Admin

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My mom's had it since early childhood. Was medicated for it as an adult, and then, in her 80s, got a pacemaker.

She managed to work full time in a strenuous job, travel the world, and have three kids. (In large part because she was willing to keep pushing herself).

There are different kinds of arrhythmia, in part, tied to which of the four heart valves is not functioning. Sometimes the valve is not right at birth for genetic reasons; sometimes disease (strep for one) can damage the valve.
 

P.K. Torrens

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Hi team,

I'm a doctor so here's the DL.

Arrhythmias are common. They are a class of disorders and not a disorder itself. For example, cancer is a class of diseases and there are multiple types e.g. prostate.

The most common type of arrhythmia is atrial fibrillation (AF). It's super fricking common. Lots and lots of people, especially older, have it. Basically, it's caused by a faulty atrial pacemaker and instead of firing regularly from one spot, the atria fire at random times from random spots.
This gives you an irregularly irregular heart rhythm (as opposed to regularly irregular e.g. with types of complete heart block).

ANYWAY, patients with AF usually need medication. They either get rate or rhythm controlled. But this is quite complicated so it depends on how much info you want.
Most commonly, they go onto anticoagulants - the oldest and most common med being warfarin and the newer ones being dabigatran etc.

Let me know what specifics you need. PM me if you reply here so I don't miss it.
 
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P.K. Torrens

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And yes, you can lead a healthy life.

AF has nothing to do (usually - they are caveats to this) with coronary artery disease - so yes, you can live a relatively normal life with no heart attacks. Remember, heart attacks (MI) have nothing to do with heart rhythm and all to do with coronary artery disease (think big macs, not heart rate).

Exercise tolerance is usually limited but not noticeable for most people as they usually aren't runners at the age they get AF anyway :)
 

P.K. Torrens

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Gosh, I just keep adding posts - sorry.

Chronic just means "long term" or that it has been around for a long time, and chronic is the opposite to acute.

Googling this stuff is useless because the search terms people use are incorrect. You end up looking at non-expert information and it is 9/10 flawed in a scientific sense.
 

Kitkitdizzi

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<-- Not a medical expert

My niece has Wolff–Parkinson–White syndrome, which can cause tachycardia due to having an extra electrical pathway in the heart. She was born with it. Her heartbeat was normal most of the time, but she did have instances where it would go over 200 beats/minute. She had to wear a special vest that monitored her heart rate when she wasn't at home. When she was about 14 she had a catheter ablation to remove the extra pathway. She just started college and is a volleyball player now, but before her surgery she wasn't allowed to play sports/participate in PE because the doctors were afraid of triggering the tachycardia.
 

Blinkk

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I have no medical training, but my SO has atrial fibrillation. My SO was involved in a clinical study 3 years ago, where did they an experimental new surgery on his heart to try and fix the condition. They said his condition might come back in 20 years or so, but this far after the surgery, he's had no issues with his heart (yay!)

My SO's had it since childhood. Since he was a kiddo, about once a month his heart will go absolutely nuts. It'll beat really hard and jump out of his chest for about 5 minutes at a time. Then it chills and everything goes back to normal. He actually didn't know it was a medical condition. It never bothered him his whole life until his 40's. In his 40's it began to happen more frequently. Slowly, it increased to episodes about once a week. It would also start to last longer than 5 minute spans.

At its worst, it reached a point where his heart would beat fast for hours. The first time it reached 30 minutes of nonstop beating, we went to the hospital. Got diagnosed and began looking at treatment options. During really bad episodes I remember putting my hand on his chest and his whole chest was pulsing somewhere around 180-200 BPM. I remember that really well because of how scary it was; his whole chest was jumping up and down. Never seen anything like that. Very scary.

As for physical activities, my SO is pretty cool. He is Japanese so he practices tai chi, kendo, and does casual jo staff in the backyard. He's never had a heart attack, but he's also doesn't run or do action-movie-style fighting. His kendo is for health not combat, so it's focused, yet a chill pace. I was actually never aware this condition was life threatening until reading this thread. The docs never told us that. They told him to stop exercising while we were talking about treatment options, but once we got it handled he could go right back to that stuff.
 

MaeZe

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And yes, you can lead a healthy life.

AF has nothing to do (usually - they are caveats to this) with coronary artery disease - so yes, you can live a relatively normal life with no heart attacks. Remember, heart attacks (MI) have nothing to do with heart rhythm and all to do with coronary artery disease (think big macs, not heart rate).

Exercise tolerance is usually limited but not noticeable for most people as they usually aren't runners at the age they get AF anyway :)
Everything you posted was great and clearly you know your stuff. But I think you might have confused people here. MI or myocardial infarction indeed has to do with losing cardiac tissue due to a loss of blood supply. But here in the US, lay persons often refer to a fatal (or near fatal) arrhythmia and an MI both as heart attacks.
 
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P.K. Torrens

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Ah, okay. I didn't realise that was the case in the USA.

The colloquial term, "heart attack" should refer only to myocardial infarction but I have seen people use it for cardiac arrest in New Zealand too.

Anyway, Kitkit raises a good point. WPW is a good condition if the OP needs a heart condition to be present from a young age but the arrythmia won't be present all the time. However, the character can "flip" into nasties like torsades pointes etc.

So, it's all up to what the OP needs for plot/character


Everything you posted was great and clearly you know your stuff. But I think you might have confused people here. MI or myocardial infarction indeed has to do with losing cardiac tissue due to a loss of blood supply. But here in the US, lay persons often refer to a fatal (or near fatal) arrhythmia and an MI both as heart attacks.
 

P.K. Torrens

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Please don't take this as medical advice - rather a discussion.

AF can be life threatening in the way that it allows for blood to clot in the atrial chambers. Then, when a clot dislodges, it can ping up into brain and result in a stroke. But, if it's treated then obviously not.

I'm glad your SO is well :)

I have no medical training, but my SO has atrial fibrillation. My SO was involved in a clinical study 3 years ago, where did they an experimental new surgery on his heart to try and fix the condition. They said his condition might come back in 20 years or so, but this far after the surgery, he's had no issues with his heart (yay!)

My SO's had it since childhood. Since he was a kiddo, about once a month his heart will go absolutely nuts. It'll beat really hard and jump out of his chest for about 5 minutes at a time. Then it chills and everything goes back to normal. He actually didn't know it was a medical condition. It never bothered him his whole life until his 40's. In his 40's it began to happen more frequently. Slowly, it increased to episodes about once a week. It would also start to last longer than 5 minute spans.

At its worst, it reached a point where his heart would beat fast for hours. The first time it reached 30 minutes of nonstop beating, we went to the hospital. Got diagnosed and began looking at treatment options. During really bad episodes I remember putting my hand on his chest and his whole chest was pulsing somewhere around 180-200 BPM. I remember that really well because of how scary it was; his whole chest was jumping up and down. Never seen anything like that. Very scary.

As for physical activities, my SO is pretty cool. He is Japanese so he practices tai chi, kendo, and does casual jo staff in the backyard. He's never had a heart attack, but he's also doesn't run or do action-movie-style fighting. His kendo is for health not combat, so it's focused, yet a chill pace. I was actually never aware this condition was life threatening until reading this thread. The docs never told us that. They told him to stop exercising while we were talking about treatment options, but once we got it handled he could go right back to that stuff.
 

Loke1997

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Whoa, thanks for the amazing advice! I was in no way expecting so much information from professionals and so many useful anecdotes from people who have experienced the condition in real life and its effects. I think I'll go with AF, like Torrens and Blinkk said. WPW is very interesting, but I think it's not quite what I'm looking for.

I have no medical training, but my SO has atrial fibrillation. My SO was involved in a clinical study 3 years ago, where did they an experimental new surgery on his heart to try and fix the condition. They said his condition might come back in 20 years or so, but this far after the surgery, he's had no issues with his heart (yay!)

My SO's had it since childhood. Since he was a kiddo, about once a month his heart will go absolutely nuts. It'll beat really hard and jump out of his chest for about 5 minutes at a time. Then it chills and everything goes back to normal. He actually didn't know it was a medical condition. It never bothered him his whole life until his 40's. In his 40's it began to happen more frequently. Slowly, it increased to episodes about once a week. It would also start to last longer than 5 minute spans.

At its worst, it reached a point where his heart would beat fast for hours. The first time it reached 30 minutes of nonstop beating, we went to the hospital. Got diagnosed and began looking at treatment options. During really bad episodes I remember putting my hand on his chest and his whole chest was pulsing somewhere around 180-200 BPM. I remember that really well because of how scary it was; his whole chest was jumping up and down. Never seen anything like that. Very scary.

As for physical activities, my SO is pretty cool. He is Japanese so he practices tai chi, kendo, and does casual jo staff in the backyard. He's never had a heart attack, but he's also doesn't run or do action-movie-style fighting. His kendo is for health not combat, so it's focused, yet a chill pace. I was actually never aware this condition was life threatening until reading this thread. The docs never told us that. They told him to stop exercising while we were talking about treatment options, but once we got it handled he could go right back to that stuff.

If your SO has it and can do sports like Kendo, I think it's the right choice for my character. Ideally, I want the condition to be as non-life threatening as possible, and as continuous as possible. So I suppose I'll just say she has a very mild form of AF?


Hi team,

I'm a doctor so here's the DL.

Arrhythmias are common. They are a class of disorders and not a disorder itself. For example, cancer is a class of diseases and there are multiple types e.g. prostate.

The most common type of arrhythmia is atrial fibrillation (AF). It's super fricking common. Lots and lots of people, especially older, have it. Basically, it's caused by a faulty atrial pacemaker and instead of firing regularly from one spot, the atria fire at random times from random spots.
This gives you an irregularly irregular heart rhythm (as opposed to regularly irregular e.g. with types of complete heart block).

ANYWAY, patients with AF usually need medication. They either get rate or rhythm controlled. But this is quite complicated so it depends on how much info you want.
Most commonly, they go onto anticoagulants - the oldest and most common med being warfarin and the newer ones being dabigatran etc.

Let me know what specifics you need. PM me if you reply here so I don't miss it.


So just for clarity: is it the case that the average heartbeat, for the average person with no condition, is usually very regular? Like, most people usually have the same average number of beats per second (i.e. 1 beat per second, 1 beat per second, 1 beat per second, and so on)? I think AF would work for my character, but it sounds like it means a regular heartbeat most of the time, and then just a very extreme heartbeat sometimes. Ideally, I want my character to have a heartrate which varies with time, like, for example, 1 beat per second, then 2 beats per second, then 1.5 beats per second, etc, or is this not possible?

So instead of like, da-dunk, da-dunk, da-dunk, da-dunk, it's like, da-dunk . . . da-da-dank, da-dank, da-dunk, etc. I'm sorry if this isn't clear, it feels ridiculous typing this out, lmao. Is this AF?
 

P.K. Torrens

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Your post is awesome.

AF is exactly what you are looking for. It’s irregularly irregular, meaning the rate varies from beat to beat. So you may have a beat then a 0.5s pause then a beat then a 1s pause etc. Random.

You can have AF that’s present all the time or paroxysmal AF which comes on at times and then goes away.

AF that’s present all the time is more common. Usually, people take meds to slow down their heart rate (beta blockers) and an anticoagulant. We do try and cardiovert people too (to see if their rhythm will go back into sinus/normal).

Let me know if that’s not clear - eek!
 

Loke1997

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Your post is awesome.

AF is exactly what you are looking for. It’s irregularly irregular, meaning the rate varies from beat to beat. So you may have a beat then a 0.5s pause then a beat then a 1s pause etc. Random.

You can have AF that’s present all the time or paroxysmal AF which comes on at times and then goes away.

AF that’s present all the time is more common. Usually, people take meds to slow down their heart rate (beta blockers) and an anticoagulant. We do try and cardiovert people too (to see if their rhythm will go back into sinus/normal).

Let me know if that’s not clear - eek!

Thank you! I gave her AF. So glad the condition I thought up was a real thing. I'm glad I can describe it with at least some idea of how it works, properly.