Arrhythmia (irregular heartbeat)

Arrhythmia, commonly known as an irregular heartbeat, is a problem with the rate the heart is beating, the way the heart is beating (the rhythm), or both.

Most arrhythmias are not dangerous, and they are nothing to worry about. They can be annoying and can take you by surprise, but they shouldn’t hurt you or lead to any long-term health effects. But some can be very serious and may even cause your heart to stop pumping blood effectively or stop beating completely.

If your heart doesn’t pump blood throughout your body effectively, you can suffer from damage to your brain and other organs. Learn about the different types of arrhythmias.

Why do arrhythmias occur?

The heart beats because nerve cells in the body send electrical signals to the chambers of the heart telling them to contract. If the electrical signals don't work properly or can't get to where they need to go, an arrhythmia can occur.

When do arrhythmias occur?

Arrhythmias can happen any time to anyone, but there are some things that can trigger them. For example:

  • A heart attack
  • Medical conditions, including:
    • High blood pressure
    • Coronary artery disease (heart disease)
    • Heart failure
    • Thyroid disease (both hypothyroidism and hyperthyroidism)
    • Rheumatic fever
  • Genetic heart defects, such as:
    • Wolff-Parkinson-White syndrome (also known as WPW)
  • Stress
  • Lifestyle choices, like:
    • Smoking
    • Excessive consumption of alcohol
    • Some types of drugs, such as amphetamines or cocaine
    • Excessive caffeine or other stimulants
  • Prescription and over-the-counter medication

Some arrhythmias have no known cause.

How can you tell if you’re having an arrhythmia?

Not all arrhythmias cause noticeable symptoms. Those that do often cause people to experience:

  • Feeling like your heart is not beating normally; it might feel:
    • Too fast
    • Too slow
    • Too hard
    • Like the beat isn’t regular
    • Like a flutter in the chest
    • Like a skipped beat
  • Some people also experience:
    • Dizziness, lightheadedness or feeling faint
    • Shortness of breath
    • Fatigue or lack of energy
    • Sweating
    • Hot flashes
    • Chest pain, pressure, tightness or discomfort in your chest
    • Anxiety
    • Trouble with everyday activities or exercise
    • Increased urination (using the bathroom more often)

What to do if you think you experience arrhythmias

Many arrhythmias are not dangerous, but you should still have them checked by a doctor who can diagnose your arrhythmias and treat them if necessary. Talk to your doctor and ask for a referral to an electrophysiologist (a doctor who specializes in heart rhythm disorders). He or she will talk to you about your symptoms, take a medical history, talk about your family history of heart disease and arrhythmia, and perform a physical exam. Your doctor may also do an EKG and order other tests or heart monitors.

If you have any signs or symptoms of a heart attack, call 911 or seek medical attention right away. Not everyone who is having a heart attack has these symptoms, and most people don’t have all of them, so if you’re ever in doubt, seek medical care right away. Some of the signs and symptoms of a heart attack are:

  • Chest pain, pressure, or discomfort, usually in the center of the chest
  • Pain or discomfort in one or both arms, the back, the neck, the jaw, or the stomach area
  • Shortness of breath (even without chest pain)
  • Nausea
  • Cold sweats
  • Lightheadedness or dizziness

Tests to diagnose arrhythmias

Arrhythmias can be difficult to diagnose because they often pass quickly, so some tests and physical exams may not catch them.

Some of the tests used to diagnose arrhythmias are:

  • Electrocardiogram (ECG or EKG): a snapshot of your heart's electrical activity. Electrodes are attached to your chest, arms and legs. These electrodes measure the rate and rhythm of your heart.
  • Portable monitors:
    • Holter monitor: portable ECG that attaches to your chest and may be worn for a day or up to two weeks at a time
    • Event monitor: portable rhythm monitors for patients who have an irregular heart rhythm less frequently. You may wear the monitor always and activate it when you feel symptoms or you may connect to the monitor when you feel symptoms.
    • Mobile cardiac monitor: worn up to 30 days, records your heart's beat when it is in normal and abnormal rhythm; results are sent automatically to your physician.
    • Insertable loop recorder: injected under the skin and can automatically record abnormal rhythm patterns for a period of three years
  • Chest x-rays: takes images of your chest to find out if your heart is enlarged
  • Echocardiogram: uses sound waves to produce images of your heart. This test allows your doctor to see how your heart muscle is moving and pumping blood. You may have one of several types of echocardiograms:
    • Transthoracic echocardiogram, TTE: non-invasive echocardiogram that gives your doctor a picture of your beating heart; technician uses an imaging device to look at sound waves of your heart
    • Transesophageal echocardiogram, TEE: non-invasive echocardiogram that helps get a good picture of the back of the heart; technician uses an imaging device and places it down your esophagus because the esophagus passes behind your heart. 
  • Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI): allows technicians to get a three-dimensional image of the heart and chest when it is beating
  • Electrophysiology studies (EPS): measures the electrical activity in the heart. They are used to help diagnose the underlying cause of arrhythmias. During the test, tiny catheters are put into a vein or artery. These catheters are electrodes that can stimulate the heart and record the electrical activity. If the doctor finds an accessory pathway that is causing the arrhythmias, he or she can also perform a cardiac ablation at the same time. 
  • Tilt table testing: test used to help determine causes of syncope (fall in blood pressure of temporary loss of consciousness)

You can help your doctor by keeping track of your diet and exercise routine and when you have arrhythmias. If you have intermittent arrhythmias, analyzing this information will help you and your doctor understand what may bring on your arrhythmias.