Life is rhythm, that of the heart. Under normal conditions, this rhythm produced by the contraction of the atria and ventricles is called sinus and has a frequency between 60 and 100 beats per minute; in this situation the pumped blood is able to supply the whole organism. What if this rhythm changes? We talk about arrhythmia. We often learn about it from the breaking latest news of professional athletes forced to retire for this disease. As in the recent case of the Barcelona footballer Aguero which could leave calcium due to a malignant arrhythmia. “If it really were artimia maligna, we could say that Aguero was lucky because it often has fatal outcomes causing instant cardiac arrest “, explains Dr. Paolo Della Bella, chief physician of the Cardiac Arrhythmology and Electrophysiology Unit of the IRCCS San Raffaele Hospital in Milan.
There are numerous arrhythmias that can involve the heart. Most of these, atrial fibrillation (AF) or paroxysmal supraventricular tachycardia (TPSV), are treated and managed with the use of drugs or with electrical cardioversion; while in malignant arrhythmias we only intervene with early defibrillation and cardiac massage.
“In arrhythmias, frequency is not the only diagnostic and prognosis criterion. We also need to identify the type of rhythm. For example, malignant arrhythmias are caused by ventricular tachycardia / fibrillation potentially fatal because they generate exaggeratedly high frequencies in which the ventricles are no longer able to perform their mechanical work, that of supplying organs and tissues ”, continues Della Bella. Can they be predicted in some way? “Yes, very often they are predictable and our legislation is at the forefront in the protection of athletes who can count on the great professional quality of sports medicine operators and the protocols that are put in place to diagnose them, through ecg, echocardiogram or cardiac magnetic resonance. However, there is a very rare percentage of unpredictable malignant arrhythmias for which no one can be blamed. In any case, amateur and professional sportsmen are well protected by a specialist support network. Today any sports club has the user perform tests, stress tests, which even if less refined than those typical of sports medicine, can already detect anomalies, such as cardiomyopathies which in some cases represent an arrhythmogenic risk “. In all of this the athlete himself must play an active role. And he must do so, in the event of a diagnosis of this type, by agreeing to stop in time, even at the cost of giving up a career full of successes.
the causes of malignant arrhythmias are attributable to the development of some anomalies, such as arrhythmogenic dysplasias, dilated or hypertrophic heart disease which have a genetic basis and which can develop or manifest over the years in the form of malignant arrhythmia, detectable by the observation of an arrhythmologist, therefore a figure highly specialized. Can they be prevented in some way with lifestyle? “We have to consider the whole huge problem of coronary heart disease, and lifestyle certainly has a huge impact. So familiarity counts, but risk factors are smoking, high cholesterol levels, a sedentary lifestyle ”, continues Della Bella.
“Some unregulated eating habits can facilitate the onset of cardiovascular accidents up to – in the most extreme situations – serious episodes such as malignant arrhythmias ”, adds Dr. Rolando Alessio Bolognino, nutritionist and expert in sports nutrition, lecturer in Nutrition Sciences and Clinical Dietetics at the University of Rome – Unitelma La Sapienza. “People don’t always realize they have active atrial fibrillation, some experience unpleasant chest palpitations or a rapid, irregular heartbeat. And the intensity of the disturbance is also not unique. It should also be remembered that the heart and stomach are innervated by the same nerve plexus: the vagus nerve. Some recent studies link gastroesophageal reflux to an increase in vagal tone, that is, to a vagus nervous system not in sufficient balance. This can affect the health of the cardiovascular system with the possibility of causing arrhythmias and extrasystole. In addition, in case of strongly slowed digestion for food errors, prolonged intake of certain medications, enzyme deficiencies or reduced stomach acid, the blood stops longer in the intestine, slowing the blood flow to the heart. This can increase cardiac motility in an attempt to draw blood back into circulation. And too much caffeine, alcohol and tobacco can also be responsible for serious, sometimes fatal, arrhythmias. Let’s think about the exponential increase in the consumption of energy drink which has been seen in recent years, especially among young people. High doses of caffeine, associated with taurine and B vitamins, ingredients that characterize the preparation of these drinks, have been shown to lengthen the QT time (long QT syndrome that could lead to dangerous malignant arrhythmias, ed) even in cases in whose caffeine intake was within the defined safe limits (ie within 400 mg) ”, concludes Bolognino.
Finally, there is a misconception that could unintentionally be conveyed, that physical activity can be a risk factor. In fact, although it shouldn’t be stressed anymore, “moderate exercise is a terrific protection against life-threatening arrhythmias,” Della Bella emphatically states. The real risk is for those who do too much, while moderate activity “is even more essential in people who are affected by risk factors such as smoking, obesity, dyslipidemia. It is enough to do aerobic activity two to three times a week. Indeed, it should be almost an ‘obligation’ “.