Double Condolences to Tim Robbins

Mary Robbins, singer and mother of Academy Award winning actor/director Tim Robbins has passed away. This is only 12 days after Tim’s father, Highwaymen singer Gil Robbins died of prostate cancer. Mary Robbins, who was 78 years old died at home of a heart arrhythmia. According to the Associated Press:

She successfully battled colon cancer through nutrition and alternative medicine, eventually earning a bachelor’s degree in holistic nutrition. She volunteered her services at a clinic near the couple’s Mexico home.

Robbins says his mother “had a calm and cheerful demeanor, a sharp wit, a gentle spirit and a generous and loving heart.” Of his father, he told the L.A. Times: “He was very charming, open and funny. He had a real strong moral center; he spoke up for what he believed in.”

An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.

A heartbeat that is too fast is called tachycardia. A heartbeat that is too slow is called bradycardia.

Most arrhythmias are harmless, but some can be serious or even life threatening. When the heart rate is too fast, too slow, or irregular, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.

To understand arrhythmias, it is important to understand the electrical activity of the heart. The heart’s electrical system controls all the events that occur when the heart pumps blood. The electrical system also is called the cardiac conduction system. If you’ve ever seen the heart test called an EKG (electrocardiogram), you’ve seen a graphical picture of the heart’s electrical activity.

The heart’s electrical system is made up of three main parts:

  • The sinoatrial (SA) node, located in the right atrium of your heart
  • The atrioventricular (AV) node, located on the interatrial septum close to the tricuspid valve
  • The His-Purkinje system, located along the walls of your heart’s ventricles

This is a short video about how these main components of the electrical system come together:

The four main types of arrhythmia are:

Premature (extra) beats– Premature beats are the most common type of arrhythmia.  Most of the time they are harmless and often don’t cause any symptoms. If symptoms do occur, they may feel like fluttering in the chest or a feeling of a skipped beat. Most of the time, premature beats need no treatment, especially in healthy people.

In most cases, premature beats occur naturally and are not due to any heart disease. Although certain heart diseases can cause premature beats, they also can happen because of stress, too much exercise, or too much caffeine or nicotine.

Supraventricular arrhythmias are tachycardias (fast heart rates) that start in the atria or the atrioventricular (AV) node. Types of supraventricular arrhythmias include atrial fibrillation (AF), atrial flutter, paroxysmal supraventricular tachycardia (PSVT), and Wolff-Parkinson-White (WPW) syndrome.

AF is the most common type of serious arrhythmia. It’s a very fast and irregular contraction of the atria. In AF, the heart’s electrical signal doesn’t begin in the SA node. Instead, the signal begins in another part of the atria and doesn’t travel through the normal pathways and it spreads throughout the atria in a fast and disorganized manner. This causes the walls of the atria to quiver very fast (fibrillate) instead of beating normally. As a result, the atria aren’t able to pump blood into the ventricles the way they should.

Ventricular arrhythmias start in the ventricles. They can be very dangerous and usually need medical attention right away.Ventricular arrhythmias include ventricular tachycardia and ventricular fibrillation (v-fib). Coronary heart disease, heart attack, weakened heart muscle, and other problems can cause ventricular arrhythmias.

Ventricular tachycardia is a fast, regular beating of the ventricles that may last for only a few seconds or for much longer.
V-fib occurs when disorganized electrical signals make the ventricles quiver instead of pump normally. Without the ventricles pumping blood out to the body, a person will lose consciousness within seconds and die within minutes if not treated.

To prevent death, the condition must be treated right away with an electric shock to the heart called defibrillation.
Bradyarrhythmias are arrhythmias in which the heart rate is slower than normal. If the heart rate is too slow, not enough blood reaches the brain. This can cause you to lose consciousness.

In adults, a heart rate slower than 60 beats per minute is considered a bradyarrhythmia. Some people normally have slow heart rates, especially people who are very physically fit. For them, a heartbeat slower than 60 beats per minute isn’t dangerous and doesn’t cause symptoms. But in other people, bradyarrhythmia can be due to a serious disease or other condition.

Bradyarrhythmias can be caused by:

  • Heart attack
  • Conditions that harm or change the heart’s electrical activity, such as an underactive thyroid gland or aging
  • An imbalance of chemicals or other substances, such as potassium, in the blood
  • Some medicines, such as beta blockers

Bradyarrhythmias also can happen as a result of severe bundle branch block. Bundle branch block is a condition in which an electrical signal traveling down either or both of the bundle branches is delayed or blocked.

When this happens, the ventricles don’t contract at exactly the same time, as they should. As a result, the heart has to work harder to pump blood to the body. The cause of bundle branch block often is an existing heart condition.

For more information about arrhythmias, click here to go to the Resounding Health Casebook on the topic.

Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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