Arrhythmias

What is an arrhythmia?

An arrhythmia is an abnormal rate or rhythm in your heartbeat. It can feel like a fluttering in your chest or a pounding. When the heart beats normally, an electrical signal that starts near the top of the heart makes its way down towards the bottom in a very specific chain of events. Any break in this chain can cause an arrhythmia.

Arrhythmias can be when the heart beats too fast, called tachycardia, or too slow, called bradycardia. There are different types that start in various places in the heart. Three common arrhythmias are atrial fibrillation, atrial flutter, and sinus bradycardia.

Arrhythmias can be treated with medications or procedures, such as implanting a device to regulate the irregular heartbeat.

Most common symptoms

Since there are so many types of arrhythmias, there are also many possible symptoms. One of the most common is a faster-than-normal heartbeat and a feeling of fluttering in the chest, called palpitations. Also common is a feeling of “pounding” in the chest.

Main symptoms

• Palpitations (fluttering in the chest)
• Pounding heartbeat
• Feeling lightheaded
• Dizziness
• Fatigue
• Weakness
• Chest pain
• Shortness of breath
• Loss of consciousness

Other symptoms you may have

• Sweating
• Anxiety
• Neck pain

Next steps

If you or a family member have an abnormal heartbeat with chest pain, difficulty breathing, or loss of consciousness, it’s an emergency. Call 911. For symptoms that are less of an emergency, see your primary care doctor.

Arrhythmias are typically diagnosed with an electrocardiogram (EKG), an in-office test that involves attaching a number of electrical leads to stickers on your chest. The EKG provides a printout of the electrical activity in your heart at that time. An EKG can be done while you are resting. Or it can be done while you are walking fast on a treadmill or pedaling a stationary bike, called a stress test.

If the EKG doesn’t show anything, the doctor might ask you to wear an ambulatory monitor. This is a small EKG machine that you wear for several days to a few weeks to collect more information for the doctor.

Can arrhythmias be cured?

There are various treatments to manage the arrhythmias, and they’re based on the type of arrhythmia you have. It may be a medication or a procedure.

Your doctor may also suggest that you stop using drugs, tobacco, and alcohol, cut down on caffeine, and change or stop medications that can cause arrhythmias.

Pregnant women with arrhythmias need careful treatment because they cannot take some of the usual arrhythmia medications.

Medications

• Medications, such as beta blockers, can help control the heart rate and prevent it from going too fast in tachycardic arrhythmias.
• Blood thinners are often prescribed to treat other arrhythmias, such as atrial fibrillation or atrial flutter, to decrease the risk of stroke.

Surgeries and procedures

• Pacemaker: This device is implanted into the chest wall to treat a slow heartbeat. It uses electrical pulses to prompt the heart to beat at a normal rate.
• Defibrillator: Fast heart rhythms, which can be fatal, are often treated by implanting a defibrillator, which can shock the heart back to a normal beat.
• Electrical cardioversion is when an electric shock is delivered to the chest in an attempt to restore normal heart rhythm.
• Catheter ablation is when the heart’s electrical system is mapped, and heat or extreme cold is delivered through a tube to the point where the arrhythmia started.
• Cardiac surgery can also be considered if these other treatments don’t work, though it is less common.

What causes heart arrhythmias?

The most common cause by far is aging. As people get older, the heart’s electrical system starts to decline. That can lead to an arrhythmia.

Heart disease and heart failure can significantly increase a person's risk of developing arrhythmias. When the heart is damaged or weakened by conditions like coronary artery disease or heart failure, it becomes more susceptible to irregular heartbeats.

In heart disease, the buildup of plaque in the arteries can disrupt the heart's normal electrical signals, leading to arrhythmias. For example, a heart attack can cause scarring in the heart muscle, which may become a site for abnormal electrical signals and trigger ventricular tachycardia, a dangerous type of fast heart rhythm.

Heart failure, where the heart cannot pump blood effectively, can also set the stage for arrhythmias. As the heart weakens, it may enlarge and change shape, interfering with its electrical system. This can lead to various types of arrhythmias, including atrial fibrillation, the most common arrhythmia in heart failure patients.

Both heart disease and heart failure can create a cycle where arrhythmias and the underlying condition worsen each other. For instance, atrial fibrillation can further reduce the heart's pumping efficiency, potentially worsening heart failure symptoms. This complex relationship underscores the importance of managing both the underlying heart condition and any resulting arrhythmias to improve overall heart health.

Some causes are related to heart valve disease, heart attack, congestive heart failure, or high blood pressure.

Other triggers include side effects of certain medications, imbalances of electrolytes (abnormal levels of certain minerals), substance abuse (including tobacco), too much caffeine, or physical or emotional stress. But sometimes there is no clear reason.

Children and arrhythmias

Arrhythmias can affect any person at any age, including seemingly healthy children and young adults.

Kids can develop arrhythmias due to congenital heart conditions, which are heart problems they have had since birth. (These defects may or may not have been noticed or diagnosed.) Children can also have inherited conditions.

Symptoms in children are similar to the symptoms in adults, and treatment is focused on the specific type of arrhythmia.

Follow up

If you have an arrhythmia, follow up with your doctor regularly. They’ll want to monitor how effective your medications are at controlling the arrhythmia. You may need routine blood tests depending on the medications you’re taking.

Preventative tips

The best prevention is to eliminate or at least minimize any potential triggers.

• Maintain a healthy diet and exercise regularly to lower your risk of heart disease.
• Avoiding drinking excessive amounts of alcohol, particularly binge drinking
• Don’t smoke or take drugs.
• Limit caffeine.
• Stop taking medications with known arrhythmic side effects, but only after speaking with your doctor about alternatives.