Does Angina Cause Arrhythmia?

The human heart contracts and relaxes roughly 2.5 billion times throughout a typical lifespan. Amazingly, the heart performs a never-ending workload, supplying millions of gallons of blood that is nutrient- and oxygen-rich to every part of the body, including itself. 

Sometimes, this process is affected by various factors that impair the heart's fundamental operation and affect the heart and blood vessels, causing symptoms like chest pain (angina) and irregular heartbeats (arrhythmia). This, in turn, may give rise to the development of cardiovascular diseases in many people. Therefore, investigating early signs of irregular heart rhythm and chest discomfort could help to determine underlying heart issues.

What is Angina?

Angina, often known as angina pectoris, is a medical term for chest pain that occurs when there’s a restriction in blood flow and oxygen to the heart muscles. People define angina as a tight or heavy squeezing discomfort, often felt as a burning sensation and suffocation in the middle of the chest or behind the sternum.

Types

The types of angina vary depending on the cause of pain and the medical approaches required to relieve symptoms:

• Stable Angina: This is the most common type, usually triggered by any physical activity, due to a 70% narrowing of the arteries. Stable angina is mostly recovered with proper rest and medications.

• Unstable Angina: This is a type of chest pain that can occur during rest and lasts longer than stable angina. The episode of discomfort worsens over time and does not ease with medication. Unstable angina requires immediate medical attention.

• Variant Angina, also called Prinzmetal Angina, is caused by the spasm in the coronary arteries due to exposure to various stimuli (cold weather, stress, or medicine). Variant angina usually happens during sleeping hours. It is treatable with angina medication.

• Microvascular Angina, sometimes known as cardiac syndrome X, is chest pain that affects tiny vessels of the heart. It is more common in women and is usually treatable with medicine and lifestyle changes.

Causes

Angina is an underlying symptom of a heart problem rather than a disease itself. During angina attacks, the heart becomes suffocated due to a lack of oxygenated blood supply through the narrowed arteries, called cardiac ischemia. This causes a strain on the heart muscles and induces chest pain. Coronary artery disease (CAD) is the most common feature of disrupted blood flow. Tiny coronary vessels clog down because of plaque accumulation (arteriosclerosis). Usually, angina occurs when one or more arteries are blocked, reducing the heart’s ability to pump blood.

Symptoms

Angina symptoms vary from person to person and depend on the type of angina an individual has. The following are common symptoms:

• Pressure, tightness, dull or sharp pain behind the sternum.
• Difficulty breathing.
• Radiating pain in the jaw, neck, arm, and shoulder.
• Fatigue.
• Nausea.
• Lightheadedness.
• Unnecessary sweating.
• Heartburn.

Diagnosis

Healthcare providers may perform a physical test to evaluate the cause, risk factors, and symptoms of angina discomfort. Moreover, they may run a few diagnostic tests, which include:

• Blood tests.
• Electrocardiogram (ECG).
• Angiography.
• Stress test (Exercise electrocardiogram).
• Transesophageal echocardiogram (TEE).
• Cardiac catheterization.
• Thallium (or Cardiolite) scan.

What is Arrhythmia?

Arrhythmia or dysrhythmia is a medical term for an irregular heartbeat caused by a faulty electrical signal that disrupts heart rhythm. Irregular heartbeats may be too fast (tachycardia) or too slow (bradycardia). Approximately 2 million people in the UK experience arrhythmia. Most people with arrhythmia can lead a normal life if properly diagnosed and managed; however, some types of arrhythmia may be indicative of severe heart conditions. 

The most common type of arrhythmia is atrial fibrillation. Its prevalence has increased by 33% worldwide in the last 20 years, posing a global health challenge. A few studies have suggested that the prevalence might go over 60% by the year 2050.¹

Types

Generally, arrhythmia is categorised by the speed of heartbeat, such as:

• Tachycardia is a fast heart rhythm of over 100 beats per minute at rest.
• Bradycardia is a slow heart rhythm when the resting heart rate is less than 60 beats per minute.

The sub-types of tachycardia include:

• Atrial fibrillation (A-fib): the most common type of irregular heart rhythm occurring due to disorganised signalling. This happens when the upper two chambers of the heart, known as the atria, contract so quickly that the heart walls fibrillate, resulting in a loss of normal rhythm. If left untreated, A-fib can lead to major heart problems such as stroke and heart failure. According to a study, A-fib is a major cause of morbidity and mortality, with nearly 5 million global incidences.²
• Atrial flutter: similar to A-fib, the heart beats faster, but the rhythm is much more organised. Atrial flutter can also be associated with stroke complications.
• Supraventricular tachycardia (SVT): also known as proximal supraventricular tachycardia, is an irregular rapid palpitation that begins and may stop abruptly in the atria. Supraventricular means ‘’above the ventricles’’.
• Ventricular fibrillation (V-fib): a serious (read “life-threatening”) type of arrhythmia in which the ventricles twitch rapidly due to disorganised electrical activity. People with V-fib might have serious complications because of insufficient blood flow in the body.
• Ventricular tachycardia (V-tach): irregular signalling in the lower chambers of the heart, causing them to beat too fast to adequately pump oxygenated blood to the body. As a result, the heart is unable to supply blood to the body.

Types of bradycardia include:

• Sinus node dysfunction: also called sick sinus syndrome, a slow heartbeat caused by sinoatrial (SA) node dysfunction.
• Heart block: a delay or conduction blockage in the heart’s electrical pathway that triggers a slow heart rate and sometimes even stops it.
• Premature heartbeat: also called premature ventricular contractions, occurs when there are extra heartbeats in the lower chambers of the heart that disrupt the heart rhythm. PVC is common and often feels like skipping a heartbeat.

Symptoms

Common symptoms of an arrhythmia may include:

• Rapid palpitations.
• Pounding sensation in the chest.
• Dizziness.
• Shortness of breath.
• Chest discomfort.
• Unusual fatigue.
• Fainting (syncope).

Causes and Risk Factors

When the electrical impulses that coordinate the heart rhythm don’t work properly, it causes faulty signalling, which results in an abnormal heartbeat that is either too fast or too slow. The major causes and risk factors for arrhythmia may include:

• Coronary artery disease.
• Diabetes.
• High blood pressure.
• Cardiomyopathy.
• Inflammation of the heart muscles (myocarditis)
• COVID-19 infection.
• Valve disorders.
• Electrolyte imbalances such as sodium or potassium.
• Injury from a heart attack.
• Healing after heart surgery.
• Certain drugs or supplements.
• Smoking.
• Stress or anxiety.

Diagnosis

After physical examination, a cardiologist may perform a variety of diagnostic tests to confirm arrhythmia:

• Electrocardiogram.
• Echocardiogram.
• Cardiac catheterization.
• Ambulatory monitoring—Holter monitor.
• Electrophysiology study (EPS)
• Stress test.
• Tilt table test.

Angina and Arrhythmia

Having angina may be a sign of cardiovascular problems, such as blocked arteries causing restricted blood flow. Such discomfort and changes in the arterial wall might lead to irregular heart rhythm and may increase the risks of stroke or heart attack.

Does Angina Cause Arrhythmia?

Individuals with existing health problems like coronary artery disease (CAD) are particularly susceptible to angina, which might cause arrhythmia due to clot formation as a result of ruptured plaque. The clogged arteries in CAD restrict blood flow to the heart muscles. Such deprivation may lead to weakened muscular activity, resulting in an irregular heart rate. Recent studies have suggested that atrial fibrillation can be associated with multiple cardiovascular diseases, along with ischemic heart disease and chronic kidney problems.²

Can Arrhythmia Lead to a Heart Attack?

Although arrhythmia generally doesn’t cause a heart attack, people with pre-existing cardiovascular problems, such as arrhythmia, might experience a heart attack. 

According to a study, arrhythmia can lead to 10–20% reduced cardiac output due to the heart’s inability to supply blood, affecting vital body organs.³

A prospective study found that atrial fibrillation increases the chances of myocardial infarction (MI) by up to 70% in elderly patients.  Arrhythmia might act as a prognostic factor for a heart attack.⁴

When to Call a Doctor

Any slow or fast-paced arrhythmia experienced for more than a few minutes requires immediate medical attention. Make an appointment if symptoms of abnormal heart rate occur, such as dizziness, shortness of breath, chest pain, or near fainting. Evaluating unusual cardiac activity could prevent a life-threatening emergency.

Summary

Arrhythmia and angina can indicate life-threatening issues if not considered seriously.  A combination of proper medical care, lifestyle adjustments, and discussion of related changeable and non-modifiable risk factors with the healthcare professional may be beneficial. Additionally, people with cardiovascular problems who have arrhythmia tend to have a greater chance of heart attack or stroke. A thorough analysis of the major contributing factors could reduce angina and the prevalence of arrhythmia in the general population.