On this page:BasicsTypesCausesRisk FactorsSymptomsDiagnosisTreatmentLifestyle ChangesLife With Arrhythmia
When your heart beats normally, you probably dont give it a second thought. But when that steady thump-thump changes, it could be a sign that something more is going on. There are numerous conditions that can cause your heart rate to speed up, slow down, or lose its regular rhythm. Some are nothing more than an annoyance. Others can be much more serious. We'll help you sort through the differences so you can get the treatment you need.
Weve all heard the sayings my heart skipped a beat and my heart was pounding out of my chest! Maybe thats why so many of us think of irregular heart rhythms as occasional episodes that are triggered by unusual levels of happiness, fear, or excitementand its true, they sometimes can be. But for people who live with irregular heartbeats, called arrhythmias, their symptoms occur for a variety of reasons, often triggered by a combination of factors, including genetics, underlying physical conditions, stimulants like cigarettes and alcohol, and/or those external stressors or high emotions.
So, lets get to the details. Arrhythmias are abnormal heartbeats that interfere with your hearts ability to pump blood efficiently and effectively. They can make your heart beat much faster or slower than it should, and sometimes it beats in an out-of-sync manner.
Most arrhythmias wont harm you, but the more serious types can prevent your brain, heart, and other organs from getting the blood and oxygen they need to survive and thrive. Some arrhythmias can be fatal.
For example, one type of arrhythmia, called atrial fibrillation, can cause blood clots to form. Such clots can travel to your brain and trigger a stroke, or, less commonly, cause a pulmonary embolism, a blockage in one of the arteries in your lungs. As scary as this is, these conditions can be treated when they're detected in time.
Before we dive into the details, though, lets start with how your heart beats when its doing its job the way its supposed to:
You know that your heart is a pump, and each beat or contraction moves blood through the body.
It has four chambers: On top are the left and right atria. On the bottom are the left and right ventricles.
To keep your blood flowing at a rate necessary to meet your bodys needs, the walls of each chamber contract and relax in a steady rhythm.
Thats your heart beating. It gets faster when you exercise or move around, as the demand for oxygen grows, and it slows down while youre at rest.
What controls this complex process? The heart has its own pacemaker. Called the sinus node, it's located at the top of the right atrium. It sends electrical signals to each part of your heart telling it what to do and when. Here's how it works:
First, the signal instructs the atria to contract, which pushes blood into the ventricles.
Next, it pauses at the atrioventricular (AV) node, which is med-speak for the electrical connection between atria and the ventricles. That little time-out gives the ventricles a sec to fill up.
Finally, the signal tells the ventricles to contract. Blood in the right ventricle heads over to the lungs to pick up oxygen. Blood on the left flows out to the rest of the body.
This whole signaling system works thanks to your autonomic nervous system, which also controls your liver, kidneys, and other bodily organs. They all function without any input from you (imagine if you literally had to think through every heart beat!). When all works as it should, your heart will beat approximately 60 to 100 times each minute.
Arrhythmias can be grouped in a couple of different ways, including where in the heart they occur and how they affect your beat.
Now, lets break it down even further.
Lets go back to the saying, My heart skipped a beat! Youve probably had one of these before. In fact, nearly everyone experiences them on occasion. This can occur spontaneously or with stress, excessive exercise, smoking, or too many cups of coffee rather than from an underlying heart condition.
These types of arrhythmias, officially called premature atrial contractions (PACs) or premature ventricular contractions (PVCs), are the most common types and are rarely cause for concern. They can originate in either the atria or ventricles. Theyre often found in children and teenagers. But if they happen frequently or they bother you, talk to your doctor. Its rare, but they can be a sign of an underlying heart problem, such as injury to the heart, according to the American Heart Association (AHA).
This type of arrhythmia, which can sometimes be life-threatening, starts in the atria. When it occurs, your heart can beat faster than 100 beats per minute at rest (which is another way of saying youre experiencing tachycardia).
Supraventricular arrhythmias include:
Atrial fibrillation (afib): This is the most common type of arrhythmia that requires medical intervention. Afib causes an erratic and often rapid heartbeat. During an episode, your heart cant pump as well as it does normally, and blood may pool in your left atrium. Clots can form there, and if one gets into your bloodstream, it can travel to your brain and cause a stroke. Afib can also lead to heart failure.
Most people who develop afib already have underlying heart disease and are 65 or older, though this condition can occur in young, healthy people as well. Episodes tend to be short and infrequent at first, coming and going on their own. However, as the disease progresses, episodes happen more often and will eventually require medical intervention to stop. For example, your doctor may have to shock your heart to correct its beating.
People with afib commonly take medications to prevent stroke, such as blood thinners. Other drugs and procedures may be needed to correct the hearts rhythm and rate. The Centers for Disease Control and Prevention (CDC) estimate that between about 3 and 6 million people in the U.S. have atrial fibrillation.
Atrial flutter: Similar to atrial fibrillation but rarer, it causes a super-fast heartbeatsometimes more than 300 beats per minutethats regular rather than erratic. Because the same type of pooling and clotting can occur, atrial flutter can also lead to a stroke or heart failure. However, such complications can usually be avoided with proper treatment.
Paroxysmal supraventricular tachycardia (PSVT): This is another very rapid heartbeat (up to 250 beats per minute) that starts and stops suddenly. Its often not dangerous. However, some PSVTs are cause for concern. People with Wolff-Parkinson-White syndrome, for example, are born with an extra electrical pathway that connects the hearts upper and lower chambers. While this PSVT only rarely causes cardiac arrest, it can cause fainting.
These arrhythmias, which can also cause fast and irregular heartbeats, start in the ventricles, your hearts lower chambers. While they can be life-threatening without treatment, there are procedures and medications available that restore a normal heart rate when it occurs.
Ventricular tachycardia: This type of rapid heartbeatoften greater than 170 beats per minutedisrupts the ventricles ability to fill and pump properly. When this type of arrhythmia lasts only a handful of heartbeats, it does not cause problems; however, if it lasts longer, it can cause dizziness, shortness of breath, fainting or, in extreme cases, cardiac arrest.
Ventricular fibrillation: The most serious of the arrhythmias, ventricular fibrillation is a medical emergency requiring an immediate call to 911. When this arrhythmia strikes, it causes the lower chambers (venticles) to quiver instead of contract, which stops the heart from pumping blood. If the heartbeat is not corrected within minutes, ventricular fibrillation leads to cardiac arrest and death.
This type of arrhythmia causes your heart to beat too slowly. For the average adult, that means under 60 heart beats a minute at rest or while doing non-strenuous activities (although a slowed rate during sleep is not unusual or always cause for alarm, according to the American Heart Association).
Your heart's natural pacemaker (remember, it's called the sinus node), is located in the right atrium. It sends electrical impulses across the atria, triggering them to pump blood into the ventricles. Bradyarrhythmias occur when those signals are blocked. This slowing or blockage can be caused by tissue damage from aging, previous heart procedures, inflammatory diseases, birth defects, and more.
In some people, slow heartbeats are perfectly normal. Athletes, for example, are very physically fit and therefore have hearts that work super efficiently, both when theyre working out and, say, sitting behind a desk. Thats because people who are in top physical condition can pump sufficient blood with fewer heart beats at restas few as 50 each minute.
Still, for regular Joes and Janes who are not daily gym bunnies or Olympic track stars, when the heart beats too slowly to meet the body and brains needs, there is a risk of passing out. The lack of oxygen may also cause confusion and shortness of breath. In extreme cases, cardiac arrest can occur.
This arrhythmia compromises the ability of your hearts pacemaker, or sinus node, to properly control your heart rate, causing it to swing from too slow to too fast or to wildly erratic. It can lead to stroke, heart failure, and cardiac arrest.
Your hearts electrical signals travel a route from their origin in the sinus node to their destination, such as your ventricles. If the route gets blocked, the signals may slow down, causing a dip in your heart rate.
Most arrhythmias occur in people who already have some form of heart disease. They can also occur in people who possess structurally normal hearts with no sign of disease, but rather have issues with how the electrical pathways in their hearts are working.
Having had a heart attack, for example, can increase your odds of an arrhythmia because the scarring that results can form along the path that the electrical signals interfering with transmission. Arrhythmias can also occur during a heart attack, as cells die off and scar tissue develops.
Specifically, the heart disease-related causes of arrhythmia include:
This buildup of plaque narrows and stiffens the heart's arteries. As blood flow and oxygen to the heart is reduced, the way it responds to electrical signals may change. This can cause atrial fibrillation.
CAD also frequently leads to heart attack, and the scarring can increase your risk of both ventricular tachycardia and ventricular fibrillation. Both can both also occur during a heart attack due to the sudden loss of blood flow in the heart.
This disease weakens your heart and alters the way electrical signals travel through your heart, setting you up for arrhythmias including atrial fibrillation, atrial flutter, sick sinus syndrome, and ventricular tachycardia.
When your hearts system of valves does not work properly, it can put extra strain on your heart. That causes the heartyour most important muscleto enlarge and stiffen. Heart-valve disorders are among the most common causes of atrial fibrillation. They can also trigger ventricular tachycardia.
Rheumatoid arthritis, lupus, and other autoimmune disorders often affect the heart and can cause arrhythmias, likely due to the chronic inflammation that occurs in such diseases. For example, lupus raises the risk of faster than normal heartbeats (above 100 beats per minute) as well as atrial fibrillation. Atrial fibrillation is the most common arrhythmia in people with rheumatoid arthritis.
In addition to these causes, many risk factorssome in your control, others notup your odds of developing an arrhythmia. Many of them also increase your risk of heart disease more broadly. They include:
Hypertension makes your heart work harder. As a result, your left ventricle grows thick and stiffens, which interferes with your hearts electrical wiring. Electrical signals can no longer move as easily, which increases your risk of atrial fibrillation.
This disease significantly boosts your odds of developing HBP and CAD, and people with diabetes have as much as 40% higher risk of atrial fibrillation. Inflammation associated with diabetes is once again the likely culprit.
Excess weight makes the heart work harder, and that extra strain can cause the heart to enlarge, making it more susceptible to atrial fibrillation. Obesity also often accompanies other arrhythmia risk factors, such as HBP, sleep apnea, and diabetes.
When your breathing is repeatedly interrupted during sleep, your heart gets less oxygen. Left untreated, sleep apnea can lead to atrial fibrillation and other usually less serious arrhythmias, including premature contraction.
If your body produces too much thyroid hormone, your heart may beat harder and faster. When left untreated, this can trigger afib.
As we get older, our hearts internal pacemaker loses cells, which causes it to slow down. Age-related heart changes can also affect the pathways that electricity follows. And with age we become more prone to diseases that affect the heart, like CAD, heart failure, and diabetes. Arrhythmias among the elderly include atrial fibrillation, bradycardias (slow heart beats), sick sinus syndrome, and other atrial and ventricular arrhythmias.
You can be born with structural abnormalities of the heart that affect the way it conducts electricity, leading to atrial tachycardias as well as life-threatening ventricular arrhythmias.
The genes that you inherit from your parents play a role in the development of some types of arrhythmias, called cardiac channelopathies. They can cause your heart to beat too fast, too slow, or irregularly whether or not you have other forms or heart disease.
The most common inherited arrhythmia is long QT syndrome, in which the lower chambers of the heart develop a rapid and irregular rhythm that can lead to ventricular fibrillation, a life-threating arrhythmia. Many people have no symptoms until they experience fainting, seizure, or even sudden cardiac arrest. Most first epsiodes occur before age 40. If you have a family history of this heart condition, ask your doctor for screening tests, which may include genetic testing, wearing event montoring devices, and an electrocardiogram (ECG).
Other examples of arrhythmias that you can be born with include:
Will you feel your heart speed up or slow down? Not always. Arrhythmias cause a variety of symptoms, but you may have no symptoms at all. Often, people learn they have an arrhythmia such as atrial fibrillation by chance.
Maybe you get a required heart exam prior to knee surgery, for example, and your doctor discovers a problem. Or a diagnosis of atrial fibrillation may come after youve already had a stroke. For others, a rapidly beating or erratic heartbeat is both noticeable and uncomfortable. Every person is different.
Something else to keep in mind: Having mild symptoms or no symptoms does not indicate that you have a less serious arrhythmia. And the opposite is also true. You could have severe symptoms but have a harmless arrhythmia. Here are some of the common symptoms:
These can feel differently for different people, but you may experience a pounding sensation in your chest, or you may feel like your hearts racing that famous mile a minute.
Remember from above: Some arrhythmias can cause your heart to beat to more than 100 times each minuteand sometimes much faster than that. You may also feel like your heart has skipped a beat or a beat has come earlier than usual. Again, though, that you may not feel any abnormal beating during an episode of arrhythmia.
Some or all of these can occur when your heart rates off and your heart cant pump blood efficiently. That can reduce the amount of oxygen your heart delivers to the rest of your body, resulting in shortness of breath. Both fast and slow heartbeats can cause these symptoms, according to the AHA.
People can faint from dehydration, emotional distress, or even standing up a little too quickly, and then quickly recover. Fainting from an arrhythmia, however, is caused when your blood pressure dropssometimes to dangerously low levels. Such drops in blood pressure are medical emergencies, so if you have a history of arrhythmias, be sure to carry or wear a medical ID card, necklace, or bracelet so others know to call 911.
You likely will see an electrophysiologist, a specialized type of cardiologist who focuses on heart-rhythm disorders. Early treatment may lead to better treatment outcomes. This is particularly true of atrial fibrillation, which may cause a stroke if left untreated.
In addition to a physical exam and a discussion of your family health history, your doctor will record your hearts electrical activity with an electrocardiogram (ECG or EKG), a painless test that lasts about ten minutes. It will reveal any abnormalities with your hearts electrical wiring that take place during the test.
However, arrhythmias often come and go, and yours may not occur during your ECG at your doctors office. If that happens, there are options:
These wearable devices will monitor your hearts activity while you go about your normal daily routine. If you are given an event recorder, you will turn it on when your symptoms begin, and it will start recording your hearts activity. Holter monitors, on the other hand, are worn 24/7 (except when youre in the shower), for anywhere from a few days to a few weeks. These smart-phone-sized devices automatically begin recording as soon as a change is detected. Theyre considered to be more effective because they capture irregularity during its first stages.
If your arrhythmia most often occurs during physical exertion, your doctor may order a stress test, in which you will get your heart rate going on a treadmill or exercise bike (or with medication if you cant exercise).
During this invasive surgical procedure, a catheter, or thin wire, is inserted through a vein, often in your groin, and threaded to your heart. Electrodes at the catheters tip stimulate the heart so that your doctor can evaluate its electrical function. This test helps find the cause of your arrhythmia and also helps guide treatment decisions. You will be awake but sedated for this one- to four-hour test. Often, youll go home the same day, but your doctor may decide to monitor you overnight.
Strapped onto a table in a horizontal position, you are slowly raised until you are vertical. This shows how your blood and heart rhythm respond to gravity and changes in position. This test is often done to trigger symptoms like lightheadedness, which can be caused by a heartbeat thats too slow or too fast.
A wide variety of treatments exist to help you manage your arrhythmia. Your doctor will determine which therapeutic approach is best for you depending on your specific symptoms.
For some arrhythmias, medications can be used to restore your heart beat to normal. They include:
Beta blockers, calcium channel blockers, and digitalis
These medications slow the heart and may be prescribed if your arrhythmia causes your heart to race.
Anticoagulants and antiplatelets
These include drugs such as warfarin and aspirin. They prevent clots and reduce your risk of stroke.
Antiarrhythmics
These medications help correct your heart beat and to keep your heart beating normally. If your doctor prescribes one of these, you may start it in the hospital, where you can be observed to be sure its effective and safe for you at the prescribed dose. They include:
Nexterone and Pacerone (Amiodarone): One of the most commonly prescribe drugs for arrhythmia, its often taken for atrial fibrillation. It can also treat other arrhythmias, including dangerous ventricular arrhythmias like ventricular fibrillation.
Tambocor (Flecainide): Used for irregular heartbeats, to slow a fast heart rate, and to maintain a normal rhythm, it works by relaxing the heart to improve how well it pumps blood. Its used to treat some types of supraventricular tachycardia as well as atrial fibrillation and atrial flutter. It also may be used for dangerous arrhythmias called sustained ventricular tachycardias, which are too-fast rhythms that require medical intervention to restore a normal heartbeat.
Betapace, Betapace AF, Sorine, and Sotylize (Solatol): Prescribed for atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation, this medication, which comes in various brands names, is used primarily in patients with life-threatening arrhythmias.
When medications cant do the job, your doctor may recommend a procedure.
Catheter Ablation
A catheter is threaded to your heart via the groin. Once there, your doctor will apply heat or extreme cold to small areas of your heart, creating tiny scars. These block the pathway of the electrical signal thats causing your arrhythmia. Most often, its used to treat supraventricular tachycardia, but it can also treat both atrial fibrillation and atrial flutter.
Cardioversion
When your heart beats irregularly or too fast, your doctor may have to shock it in order to get it back to normal. While sedated, two paddlesone on your chest, the other on your backdeliver brief electrical shocks to right your heart. The procedure takes about 30 minutes.
Implantable Devices
If your arrhythmia cant be managed sufficiently with medication and/or procedures, you may require a different kind of solution: a device that helps control the electrical signaling of your heart.
Pacemaker: A small device is implanted under your skin below one of your collarbones. Wires from the device run through a vein and attach to the heart. They deliver signals that tell your heart to beat faster and are used for bradycardias, or arrhythmias that slow your heart beat. Some pacemakers connect directly to your heart without the need for wires.
Cardioverter-defibrillator: Implanted like a pacemaker but slightly larger, this device monitors your heart constantly. It can sense when a life-threatening arrhythmia, such as ventricular fibrillation or ventricular tachycardia, occurs. It shocks the heart to restore a normal heartbeat.
In addition to sticking with your treatment planif your arrhythmia requires treatment, that isyoull need to focus on a healthy lifestyle to protect your heart and help prevent symptoms.
That means:
Eat well: Focus on foods that support heart health, such as fruits and vegetables, whole grains, legumes, lean meats, and fish. Avoid foods with saturated and trans fats, limit red meat, and choose whole foods over highly processed foods, which are often loaded with sodium and sugar.
Exercise: After getting your doctors OK, your goal should be 30 minutes a day five days a week. You and your doctor can discuss the right workout for you. To start, it may be something as mild as a daily walk around your neighborhood.
Weight loss: If youre overweight or obese, slimming down will help your heart. Losing weight can lower blood pressure, which reduces the risk of stroke.
Limit alcohol: Booze can stress your heart and make it beat faster. It can also trigger arrhythmias. Your doctor can help you decide if you need to cut it out altogether.
Quit smoking: Your hearts health will improve dramatically, and youll be less likely to have an arrhythmia if you break this habit. Visit the American Heart Association to get help to stop smoking today.
Sleep well: If you have sleep apnea, which disturbs your breathing constantly as you sleep, you will likely benefit from a device known as a C-PAP, which helps open your airways during the night and keeps you breathing normally. Good sleep will also help improve your blood pressure.
Tackle stress: Too much worry and anxiety can up blood pressure, boost cortisol levels, and increase your risk for arrhythmias. Try daily mediation, a walk with a loved one or friend outside, or focusing on doing the things you love to better manage stress.
Pay attention to side effects: Monitoring how you feel while on a medication is super importantit might not be the best medication for you, and in some cases, medication can actually trigger an arrhythmia. You may need a dose adjustment or a different medication altogether. Share all your symptoms with your doctor.
Theres no doubt that living with an abnormal heartbeat can be stressful, even frightening. Fortunately, theres plenty that you can do to help ease your worries, which is especially important because stress can be a trigger for an episode of arrhythmia.
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Heart Arrhythmias: Types, Treatment, Signs, and Symptoms - HealthCentral.com
