Arrhythmia

Overview

An arrhythmia is a problem with the rhythm of your heartbeat. Your heart might beat too fast, too slow, or unevenly. These changes happen when the electrical signals that control your heartbeat don't work properly. Many arrhythmias are harmless, but some can be serious or even life-threatening.

Yes, arrhythmias are very common. Almost everyone has a harmless skipped beat now and then. Some types are more common as you get older.

Arrhythmias can affect people of all ages, including children. You are more likely to develop one if you have heart disease, high blood pressure, diabetes, or a family history of heart rhythm problems.

Symptoms

Common symptoms

• Palpitations (a feeling that your heart is skipping, fluttering, or racing)
• A slow heartbeat
• Dizziness or lightheadedness
• Shortness of breath
• Chest discomfort or pressure
• Fatigue or weakness

Symptoms in children

• Irritability or feeding difficulty in babies
• Complaints of a racing or skipping heartbeat
• Episodes of fainting or passing out
• Lack of energy during physical activity

Symptoms in older adults

• Confusion or memory problems
• Falls or unsteadiness
• Fainting or blackouts
• Breathlessness during light activity
• Chest pain or pressure

Causes

Main causes

• Abnormal electrical signals in the heart
• Damage to the heart muscle from a previous heart attack
• High blood pressure or coronary artery disease
• Abnormal electrical pathways in the heart that are present at birth
• Imbalances in electrolytes such as potassium, magnesium, or calcium in the blood

Risk factors

• Getting older
• Having heart disease or a history of heart attack
• High blood pressure
• Diabetes
• Overactive thyroid (hyperthyroidism)
• Sleep apnea
• Smoking
• Drinking heavy amounts of alcohol
• Using too much caffeine

When to see a doctor

See a doctor urgently if:

• If you have repeated or lasting heart palpitations
• If you feel dizzy, faint, or pass out
• If you have chest pain or pressure
• If you feel breathless with light activity

Book a routine appointment if:

• If you notice occasional palpitations and want to know if they are harmless
• If you have a family history of heart rhythm problems and are concerned
• If you are getting ready to start a new exercise routine and have heart risk factors

Diagnosis

Your doctor will start by asking about your symptoms and medical history, and by checking your blood pressure and heart sounds. If they think you may have an arrhythmia, they will suggest tests to record your heart's electrical activity.

Tests that may be done

• Electrocardiogram (ECG) — a quick test that records the heart's electrical signals
• Holter monitor — a small portable device you wear for 24 to 48 hours to record your heart continuously
• Event monitor — a device you wear for a few weeks and press a button when you feel symptoms
• Stress test — records your heart while you exercise on a treadmill or stationary bike
• Echocardiogram — an ultrasound picture of your heart
• Blood tests — to check for thyroid problems or electrolyte imbalances

What to expect at your appointment

The tests are usually painless. You may need to wear a monitor for a few days. Depending on your results, your doctor may ask a heart specialist (cardiac electrophysiologist) for advice.

Treatment

Treatment depends on the type of arrhythmia you have, how often it happens, and how much it affects your life. Many people need no treatment at all. Others may need medicine, a simple procedure, or changes in daily habits.

Self-care at home

• Avoid things that trigger your symptoms, such as too much caffeine or alcohol
• Quit smoking, if you smoke
• Find healthy ways to manage stress, like breathing exercises or mindfulness
• Get regular, moderate exercise, with your doctor's okay
• Stick to a heart-healthy diet

Medical treatments

If arrhythmia needs treatment, doctors may prescribe medicines to slow down or steady the heartbeat, or to thin the blood and reduce the risk of stroke. Some people benefit from a procedure called cardioversion, which uses a controlled electric shock to restore a normal rhythm. Another option is catheter ablation, a procedure that uses heat or cold to correct the small areas of heart tissue that are causing the rhythm problem. Your doctor will explain which option fits your situation.

When is surgery considered?

For more serious arrhythmias, a doctor may recommend implanting a small device under the skin, such as a pacemaker to keep the heartbeat steady or an implantable defibrillator to reset the rhythm if it becomes dangerous. Surgery is only used when medicines and other procedures are not enough.

Living with this condition

Most people with arrhythmia live full, active lives. The key is to learn your own heart's signals, take any medicines as directed, and keep your regular appointments with your doctor.

Lifestyle tips

• Keep a diary of your symptoms and what you were doing when they happened
• Take your medicines exactly as your provider tells you
• Get enough sleep and avoid staying up too late
• Limit alcohol and caffeine
• Tell your doctor about any over-the-counter medicines or supplements you take

Diet and exercise

Eat a balanced diet rich in vegetables, fruits, whole grains, and lean proteins. Cut back on salt and processed foods. Exercise is good for most people with arrhythmia, but check with your doctor first. If you have a condition that raises your risk, you may need to avoid very intense sports.

Mental health and emotional wellbeing

Living with an irregular heartbeat can make you anxious, and anxiety can sometimes make palpitations worse. It's normal to feel worried. Talking to a counsellor or a support group can help. If you feel overwhelmed or hopeless, reach out to a mental health professional or helpline.

Prevention

You can't always prevent arrhythmia, especially when it runs in families. But you can lower your risk by keeping your heart healthy: control blood pressure, keep diabetes under control, avoid excessive alcohol, don't smoke, and exercise regularly.

Complications

If left untreated

• If a serious arrhythmia isn't treated, it can raise your risk of blood clots, stroke, heart failure, or sudden cardiac arrest.
• However, most arrhythmias are not dangerous and many can be treated effectively.

Long-term outlook

The outlook for arrhythmia is generally good. Many people live with irregular rhythms for years without problems. Even serious forms of arrhythmia can be managed with modern treatments that let you stay active and independent. Your doctor and heart team will work with you to find the best approach.

Find support

Local organisations

• British Heart Foundation ↗ · United Kingdom
• Arrhythmia Alliance ↗ · United Kingdom

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