An arrhythmia is an abnormal heart rhythm or heartbeat. It may feel like a fluttering or racing of the heart.

There are two basic types of arrhythmias:

  • Bradycardia The heartbeat is too slow, resulting in a heart rate of less than 60 beats per minute
  • Tachycardia The heartbeat is too fast, resulting in a heart rate greater than 100 beats per minute
Atrial fibrillation, sometimes called afib, is the most common type of arrhythmia. It is an irregular heartbeat that sometimes feels like quivering or fluttering in the chest.

Some arrhythmias are harmless and may have no noticeable symptoms.

Others can be serious or life-threatening. In some instances, abnormal or irregular heart rhythms can cause the heart to stop beating. This is called cardiac arrest.

Signs and Symptoms of Arrhythmia

Many arrhythmias don’t have any symptoms.

If they do, common signs and symptoms of an arrhythmia may include:

  • Palpitations (may feel like fluttering in your chest, like your heart is skipping a beat, or like it is beating too hard or too fast)
  • Feeling pauses between heartbeats or an irregular pattern
  • Fatigue, weakness, light-headedness
  • A slow heartbeat

Some arrhythmias are medical emergencies. During an arrhythmia, the heart may not be able to pump enough blood to the body and may stop working.

If you experience the following symptoms, call 911:

  • Significant weakness, dizziness, or light-headedness
  • Fainting
  • Shortness of breath
  • Chest pain
  • Blurred vision

Causes and Risk Factors of Arrhythmias

Arrhythmias happen when the electrical signals that control your heartbeat don’t work properly.

This can happen if the specialized heart cells that send the electrical signals are damaged or if the electrical signals don’t travel properly through the heart.

A normal heartbeat can also be disrupted if the heart produces too many electrical signals.

Sometimes the cause of an arrhythmia is unknown.

Arrhythmias are common in older adults, who are more likely to have heart disease, high blood pressure, and other health conditions that can cause arrhythmias.

Some medications can also cause arrhythmias as a side effect, including tricyclic antidepressants (TCAs), antihistamines, and beta-blockers.

Additionally, illegal drugs, such as cocaine, methamphetamines, and stimulants like caffeine and nicotine can cause arrhythmias.

How Is Arrhythmia Diagnosed?

A number of tests and devices are used to detect an arrhythmia.

Diagnosis usually requires recording the heart’s electrical activity using an electrocardiogram, or ECG.

A Holter monitor — a portable, 24- or 48-hour ECG — may also be used if your doctor wants to see your heartbeat over a longer period.

During an ECG, small patches or stickers called electrodes are stuck to several spots on your chest and body.

These electrodes will generate a picture of your heart’s electrical activity so doctors can see where any irregularities may occur.

An echocardiogram — a type of ultrasound that uses sound waves to produce images of your heart — may also be used to diagnose heart problems that can lead to arrhythmias.

Stress tests, which use physical exertion (such as running on a treadmill) or drugs to simulate exercise, can trigger an arrhythmia and help a doctor make an accurate diagnosis.

Cardiac catheterization, a procedure in which a tiny tube is threaded through a vein or artery and into the heart, can help your doctor measure pressures in the heart or evaluate for potential blockage of the coronary arteries.

Your doctor may also order a chest X-ray to see if your heart is larger than normal and blood tests to check your thyroid levels. This can help determine if you have a thyroid issue that may be causing an arrhythmia. A sleep study could help determine if sleep apnea is the culprit.

Duration of Arrhythmia

The frequency and duration of arrhythmia depends on the cause. For example, when an arrhythmia is caused by a treatable condition, like an overactive thyroid, the irregular heartbeat may go away when the thyroid problem is treated.

Arrhythmias caused by progressive or permanent damage to the heart, however, tend to be long-term issues and may need to be managed with medications or treated with surgery.

Treatment and Medication Options for Arrhythmia

Arrhythmias can be treated with lifestyle modification, medications, or medical procedures/surgery.

Medication Options

Medications can slow down a heartbeat that is too fast. They can also be used to even out or stabilize an abnormal heart rhythm.

Drugs used to treat arrhythmias include:

  • Adenosine slows a racing heart by slowing its electrical signals.
  • Atropine temporarily treats a slow heart rate.
  • Beta-blockers work by slowing the heart rate and decreasing the effects of adrenaline on the heart, thereby lowering blood pressure.
  • Anticoagulants, or blood thinners, work by making it more difficult for blood to clot. These medications do not dissolve existing blood clots, but rather prevent new ones from forming or existing ones from growing bigger. Anticoagulants are commonly prescribed to people who are at risk of blood clots, such as those with atrial fibrillation.
  • Calcium channel blockers, or “calcium antagonists,” interrupt the movement of calcium into the heart and can slow the heart rate.
  • Digitalis helps slow the heart rate and can help the heart strengthen its contractions when its pumping function has been weakened.

Medical Procedures

Some arrhythmias, including heartbeats that are too slow, can be treated with a pacemaker.

A pacemaker is a medical device that’s placed under the skin on your chest. The device electronically monitors and, by sending electrical impulses to your heart, moderates your heartbeat.
If an arrhythmia is life-threatening, such as ventricular tachycardia or ventricular fibrillation, your doctor may recommend an implantable cardioverter defibrillator (ICD). An ICD is a battery-powered device that is placed under the skin and is connected to the heart by thin wires to keep track of your heart rate. If the device detects an abnormal heartbeat, it will deliver an electric shock to the heart to restore a normal heart rhythm.

Another option might be a minimally invasive surgical procedure known as a catheter ablation. In this approach, a surgeon uses a catheter to create small scars in the heart tissue where the arrhythmia is occurring. The goal is to purposely destroy the abnormal tissue that is causing irregular rhythms and restore proper function. Catheter ablation is often considered if medication options are not effective,

Alternative and Complementary Therapies

Regardless of any medical interventions that are recommended for treating arrhythmia, your doctor may also advise common-sense lifestyle changes, including:

  • A healthy, low-fat, low-sodium diet
  • Regular exercise
  • Smoking cessation
  • Weight loss to avoid obesity

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