Heart arrhythmia

Heart arrhythmias may not cause any signs or symptoms. A doctor may notice the irregular heartbeat when examining you for another health reason.

In general, signs and symptoms of arrhythmias may include:

• A fluttering in the chest
• A racing heartbeat (tachycardia)
• A slow heartbeat (bradycardia)
• Chest pain
• Shortness of breath

Other symptoms may include:

• Anxiety
• Fatigue
• Lightheadedness or dizziness
• Sweating
• Fainting (syncope) or near fainting

When to see a doctor

If you feel like your heart is beating too fast or too slowly, or it's skipping a beat, make an appointment to see a doctor. Seek immediate medical help if you have shortness of breath, weakness, dizziness, lightheadedness, fainting or near fainting, and chest pain or discomfort.

A type of arrhythmia called ventricular fibrillation can cause a dramatic drop in blood pressure. Collapse can occur within seconds and soon the person's breathing and pulse will stop. If this occurs, follow these steps:

• Call 911 or the emergency number in your area.
• If there's no one nearby trained in cardiopulmonary resuscitation (CPR), provide hands-only CPR. Push hard and fast on the center of the chest at a rate of 100 to 120 compressions a minute until paramedics arrive. You don't need to do rescue breathing.
• If you or someone nearby knows CPR, start CPR. CPR can help maintain blood flow to the organs until an electrical shock (defibrillation) can be given.
• If an automated external defibrillator (AED) is available nearby, have someone get the device and follow the instructions. An AED is a portable defibrillation device that can deliver a shock that may restart heartbeats. No training is required to operate an AED. The AED will tell you what to do. It's programmed to allow a shock only when appropriate.

To understand the cause of heart arrhythmias, it may be helpful to know how the heart typically works.

How does the heart beat?

The heart is made of four chambers — two upper chambers (atria) and two lower chambers (ventricles).

The heart's rhythm is normally controlled by a natural pacemaker (the sinus node) in the right upper chamber (atrium). The sinus node sends electrical signals that normally start each heartbeat. These electrical signals move across the atria, causing the heart muscles to squeeze (contract) and pump blood into the ventricles.

Next, the signals arrive at a cluster of cells called the AV node, where they slow down. This slight delay allows the ventricles to fill with blood. When the electrical signals reach the ventricles, the chambers contract and pump blood to the lungs or to the rest of the body.

In a healthy heart, this heart signaling process usually goes smoothly, resulting in a normal resting heart rate of 60 to 100 beats a minute.

Things that can cause an irregular heartbeat (arrhythmia) include:

• Current heart attack or scarring from a previous heart attack
• Blocked arteries in the heart (coronary artery disease)
• Changes to the heart's structure, such as from cardiomyopathy
• Diabetes
• High blood pressure
• Infection with COVID-19
• Overactive thyroid gland (hyperthyroidism)
• Sleep apnea
• Underactive thyroid gland (hypothyroidism)
• Certain medications, including cold and allergy drugs bought without a prescription
• Drinking too much alcohol or caffeine
• Drug abuse
• Genetics
• Smoking
• Stress or anxiety

Things that may increase the risk of heart arrhythmias include:

• Coronary artery disease, other heart problems and previous heart surgery. Narrowed heart arteries, a heart attack, abnormal heart valves, prior heart surgery, heart failure, cardiomyopathy and other heart damage are risk factors for almost any kind of arrhythmia.
• High blood pressure. This condition increases the risk of developing coronary artery disease. It may also cause the walls of the left lower heart chamber (left ventricle) to become stiff and thick, which can change how electrical signals travel through the heart.
• Congenital heart disease. Being born with a heart condition may affect the heart's rhythm.
• Thyroid disease. Having an overactive or underactive thyroid gland can raise the risk of irregular heartbeats.
• Obstructive sleep apnea. This condition causes pauses in breathing during sleep. It can lead to a slow heartbeat (bradycardia) and irregular heartbeats, including atrial fibrillation.
• Electrolyte imbalance. Substances in the blood called electrolytes — such as potassium, sodium, calcium and magnesium — help trigger and send electrical impulses in the heart. An imbalance in electrolytes — for example, if they are too low or too high — can interfere with heart signaling and lead to irregular heartbeats.
• Certain drugs and supplements. Some prescription drugs and certain cough and cold medications bought without a prescription can cause arrhythmias.
• Excessive alcohol. Drinking too much alcohol can affect the electrical impulses in your heart and can increase the chance of developing atrial fibrillation.
• Caffeine, nicotine or illegal drug use. Caffeine, nicotine and other stimulants can cause your heart to beat faster and may lead to the development of more-serious arrhythmias. Illegal drugs, such as amphetamines and cocaine, may greatly affect the heart and cause many types of arrhythmias or sudden death due to ventricular fibrillation.

Complications depend on the type of arrhythmia. In general, complications of heart arrhythmias may include stroke, sudden death and heart failure.

Heart arrhythmias are associated with an increased risk of blood clots. If a clot breaks loose, it can travel from the heart to the brain, causing a stroke. Blood thinners can lower the risk of stroke related to atrial fibrillation and other arrhythmias. Your doctor will determine if a blood-thinning medication is right for you.

If an arrhythmia is causing heart failure symptoms, methods to control the heart rate may improve heart function.

Lifestyle changes to reduce the risk of heart disease may help prevent heart arrhythmias. A heart-healthy lifestyle includes:

• Eating a heart-healthy diet
• Staying physically active
• Maintaining a healthy weight
• Not smoking
• Limiting or avoiding caffeine and alcohol
• Reducing stress, as intense stress and anger can cause heart rhythm problems
• Using medications as directed and telling your doctor about all the medicines you take, including those bought without a prescription

To diagnose a heart arrhythmia, the doctor will usually do a physical exam and ask questions about your medical history and symptoms. Tests may be done to confirm an irregular heartbeat and look for conditions that can cause arrhythmias, such as heart disease or thyroid disease.

Tests to diagnose heart arrhythmias may include:

• Electrocardiogram (ECG or EKG). During an ECG, sensors (electrodes) that can detect the electrical activity of the heart are attached to the chest and sometimes to the arms or legs. An ECG measures the timing and duration of each electrical phase in the heartbeat.
• Holter monitor. This portable ECG device can be worn for a day or more to record your heart's activity as you go about your routine.
• Event recorder. This wearable ECG device is used to detect sporadic arrhythmias. You press a button when symptoms occur. An event recorder may be worn for a longer period of time (up to 30 days or until you have an arrhythmia or typical symptoms).
• Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on the chest uses sound waves to produce images of the heart's size, structure and motion.
• Implantable loop recorder. If symptoms are very infrequent, an event recorder may be implanted under the skin in the chest area to continually record the heart's electrical activity and detect irregular heart rhythms.

If your doctor doesn't find an arrhythmia during those tests, he or she may try to trigger the arrhythmia with other tests, which may include:

• Stress test. Some arrhythmias are triggered or worsened by exercise. During a stress test, the heart's activity is monitored while you ride on a stationary bicycle or walk on a treadmill. If you have difficulty exercising, a drug may be given to stimulate the heart in a way that's similar to exercise.
• Tilt table test. A doctor may recommend this test if you've had fainting spells. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up. The doctor observes how your heart and the nervous system that controls it respond to the change in angle.

• Electrophysiological testing and mapping. In this test, also called an EP study, a doctor threads thin, flexible tubes (catheters) tipped with electrodes through the blood vessels to different areas within the heart. Once in place, the electrodes can map the spread of electrical impulses through the heart.

  Sometimes, a heart doctor (cardiologist) uses the electrodes to stimulate the heart to beat at rates that may trigger — or stop — an arrhythmia. Doing this helps the doctor determine the location of the arrhythmia, its possible causes and the best treatment options. This test may also be done to determine if a person with certain health conditions is at risk of developing heart arrhythmias.

If you have heart disease or a heart condition, your doctor will likely recommend making lifestyle changes to keep your heart as healthy as possible.

Examples of heart-healthy lifestyle changes are:

• Eat heart-healthy foods. Eat a healthy diet that's low in salt and solid fats and rich in fruits, vegetables and whole grains.
• Exercise regularly. Aim to exercise for at least 30 minutes on most days.
• Quit smoking. If you smoke and can't quit on your own, talk to your doctor about strategies or programs to help you break a smoking habit.
• Maintain a healthy weight. Being overweight increases the risk of developing heart disease.
• Keep blood pressure and cholesterol levels under control. Make lifestyle changes and take medications as prescribed to manage high blood pressure or high cholesterol.
• Drink alcohol in moderation. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
• Maintain follow-up care. Take your medications as prescribed and have regular follow-up appointments with a doctor. Tell your doctor if your symptoms worsen.

Managing stress is an important step in keeping the heart healthy. Stress-relief techniques might also help prevent or reduce heart arrhythmias. Some ways to reduce stress include:

• Yoga
• Meditation or mindfulness
• Relaxation techniques

Some research suggests that acupuncture may help reduce irregular heartbeats in people with persistent arrhythmias, but further research is needed.

If you think you may have a heart arrhythmia, make an appointment with your doctor. If a heart arrhythmia is found early, treatment may be easier and more effective. You may be referred to a doctor trained in heart conditions (cardiologist).

If a heart arrhythmia persists for more than a few minutes or is accompanied by fainting, shortness of breath or chest pain, call 911 or your local emergency number or have someone drive you to the nearest emergency room.

Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. You may need to do this if your doctor orders any blood tests.
• Write down any symptoms you're having, including any that may seem unrelated to heart arrhythmia.
• Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
• Make a list of all medications, including vitamins or supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For heart arrhythmias, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests will I need? Do I need to do anything to prepare for these tests?
• What's the most appropriate treatment?
• Are there any foods or drinks that you recommend I avoid? Is there anything you suggest that I add to my diet?
• What's an appropriate level of physical activity?
• How often should I be screened for heart disease or other complications of an arrhythmia?
• I have other health conditions. How can I best manage these conditions together?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or do they come and go?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Is there a family history of arrhythmia?