Heart Arrhythmias And Palpitations

Overview

Your heart has its own natural electrical 'timer' that keeps it beating in a steady rhythm. An arrhythmia (say: ah-RITH-mee-ah) means that rhythm is off — the heart may beat too fast, too slow, or in an irregular way. A palpitation is the feeling you get when you notice your heartbeat: it might feel like fluttering, pounding, racing, thumping, or like a beat has been skipped. Lots of people feel palpitations at some point, and most of the time they are harmless. Some arrhythmias, though, need checking and treatment because they can affect how well your heart pumps blood or raise the risk of other problems.

Yes. Feeling your heartbeat now and then is extremely common, and irregular heart rhythms become more common as people get older. Atrial fibrillation — the most common lasting arrhythmia — affects millions of people worldwide and is seen more often in people over 65.

Anyone can have palpitations or an arrhythmia, including healthy young people and children. You are more likely to have one if you are older, have an existing heart condition, high blood pressure, thyroid problems, sleep apnoea (pauses in breathing during sleep) or diabetes, or if you drink a lot of caffeine or alcohol. Stress, pregnancy, dehydration and some medicines can also set them off.

Symptoms

Common symptoms

• A fluttering, pounding, racing or 'thumping' feeling in the chest
• A sense that your heart has skipped a beat or paused, then beat harder
• A heartbeat that feels faster than it should, even when you are resting
• Feeling your pulse in your neck or throat
• Mild light-headedness or a brief dizzy spell
• Shortness of breath, especially with fast rhythms
• Tiredness or low energy when the rhythm problem lasts
• Chest discomfort or a feeling of pressure (get this checked urgently)

Symptoms in children

• Young children often cannot describe palpitations — they may say their heart is 'beeping' or 'jumping', or just seem unsettled
• A racing heart with fever, crying, dehydration or illness is common and usually settles once the child is well
• Fainting or near-fainting during exercise or sport should always be checked by a doctor
• Some children are found to have an irregular rhythm during a routine check-up and feel completely well
• Children with a known heart condition, or a family history of sudden collapse at a young age, should be reviewed by a heart specialist

Symptoms in older adults

• Irregular rhythms are more common with age and may cause tiredness, breathlessness or reduced energy rather than obvious pounding
• Dizziness, unsteadiness or falls can be the main clue
• Sudden confusion, poor concentration or a general 'not myself' feeling can sometimes be caused by an irregular heartbeat
• Swelling of the ankles or worsening breathlessness may suggest the heart rhythm is affecting how well the heart works
• Older adults often take several medicines, so a medicine review with a doctor or pharmacist is a sensible part of checking palpitations

Causes

Main causes

• Normal 'extras' beats — an early beat from the upper or lower heart chambers that most people feel as a skipped or thumped beat
• Atrial fibrillation — a fast, irregular rhythm from the upper chambers, common in later life
• Fast rhythms that start suddenly in the upper chambers (often felt as a sudden racing heart that stops as quickly as it started)
• Anxiety, stress, panic or strong emotion, which speed up the heart through adrenaline
• Caffeine, energy drinks, alcohol and nicotine
• Some prescription medicines, decongestants and stimulant drugs
• An overactive thyroid, low iron (anaemia), dehydration or low salt levels in the blood
• Fever, infection or heavy bleeding
• Heart problems such as damaged valves, heart failure or scarring after a heart attack
• Inherited conditions that affect the heart's electrical system (these can run in families)
• Pregnancy, which increases heart rate and blood volume

Risk factors

• Getting older
• A close family member with an arrhythmia, sudden collapse or an inherited heart condition
• Existing heart disease, previous heart attack or heart failure
• High blood pressure, diabetes, obesity or sleep apnoea (pauses in breathing during sleep)
• Thyroid disease or kidney disease
• Drinking a lot of alcohol or caffeine, smoking, or using stimulant drugs
• High levels of ongoing stress or poorly managed anxiety
• Being dehydrated, over-exercising in heat, or having low salt levels
• Taking certain medicines, including some cold and flu remedies
• Being pregnant

When to see a doctor

See a doctor urgently if:

• Palpitations with chest pain, breathlessness, dizziness or feeling faint
• A racing heartbeat that will not settle after a few minutes of resting
• Any fainting or near-fainting, especially during exercise
• A new, clearly irregular pulse
• Palpitations in someone with a known heart condition or an implanted heart device

Book a routine appointment if:

• Palpitations that keep coming back over weeks, even if you feel otherwise well
• A fluttering feeling that wakes you at night or happens at rest
• Palpitations you can trigger with caffeine, alcohol or stress and want to understand
• A family history of arrhythmia, unexplained collapse or sudden death at a young age
• Feeling unusually tired, breathless or less able to exercise than before

Diagnosis

Your doctor will start by listening to your story: what the palpitations feel like, when they happen, how long they last, what brings them on and what else you feel at the time. They will check your pulse, listen to your heart, and probably check your blood pressure. Often the rhythm is normal by the time you are seen, so the tests are designed to catch it in the act. Your doctor may also ask about caffeine, alcohol, stress, medicines and family history.

Tests that may be done

• An ECG (electrocardiogram) — a quick, painless tracing of your heart's electrical signals
• A longer heart monitor worn for 24 hours or several days, to catch palpitations that come and go
• An event recorder or a small patch monitor you activate when symptoms start
• An implantable loop recorder — a tiny device placed under the skin for long-term monitoring, used in some cases
• Blood tests to check thyroid, iron, kidney function and salt levels
• An echocardiogram — an ultrasound scan of the heart to look at its structure and valves
• An exercise test on a treadmill or bike if symptoms happen mainly with activity
• A referral to a cardiologist (heart specialist) or an electrophysiologist (a specialist in heart rhythm)

What to expect at your appointment

Most of these tests are quick and painless. The ECG just involves sticky patches on your chest for a minute or two. Wearing a monitor means going about your normal day while it records. Results may take a few days to a couple of weeks, and often the answer is simply that your heart is healthy. If something is found, your doctor will explain what it means and what, if anything, needs doing.

Treatment

Treatment depends on what is causing the palpitations, how often they happen, and how much they affect you. Many people need nothing more than reassurance and a few lifestyle tweaks. If an underlying problem is found — such as an overactive thyroid or low iron — treating that usually settles the rhythm. If you have a lasting arrhythmia, your doctor will discuss options that suit your age, health and preferences.

Self-care at home

• Cut back on caffeine and energy drinks, and see whether your symptoms change
• Reduce or stop alcohol, and avoid nicotine
• Drink enough water, especially in hot weather or during exercise
• Try slow, steady breathing when you feel a flutter — it can help settle a fast heartbeat and ease anxiety
• Keep a simple symptom diary to spot triggers
• Protect your sleep — being overtired makes palpitations and stress worse
• Ask your pharmacist or doctor to review your medicines, including cold and flu remedies, to see if any could be contributing
• Stay physically active within what feels comfortable for you

Medical treatments

Where treatment is needed, doctors may use medicines that slow the heart rate or steady the rhythm, and — for some rhythms such as atrial fibrillation — medicines that lower the risk of stroke. Another approach is cardioversion, where a controlled electric shock is used to reset the heart's rhythm. Some people are offered catheter ablation: a procedure where thin tubes are passed through blood vessels to the heart to treat the small patch of tissue causing the problem. For slow rhythms, a pacemaker can keep the heart beating at a safe rate, and for dangerous rhythms an implanted defibrillator can correct them automatically. Your care team will explain which of these, if any, fits your situation — you will never be given a treatment without a clear explanation first.

When is surgery considered?

Open surgery is rarely needed for rhythm problems. When a procedure is appropriate, it is usually a keyhole catheter ablation or the fitting of a pacemaker or defibrillator, both of which are common and generally well tolerated. Your heart team will talk through the benefits, risks and what recovery involves before you decide.

Living with this condition

For most people, palpitations are an occasional annoyance rather than something that changes daily life. Knowing your triggers makes a big difference — many people find that cutting back on late-night coffee or alcohol, or building in time to unwind, reduces episodes a lot. If you have a diagnosed arrhythmia, keeping up with appointments and any prescribed treatment is the main thing. Ask your doctor whether there are any activities you should approach with care.

Lifestyle tips

• Keep a regular sleep routine
• Manage stress with breathing exercises, walking, or whatever helps you switch off
• Limit alcohol and avoid binge drinking
• Avoid stimulant drugs
• Stay hydrated and eat regular meals
• Build gentle exercise into your week — it is good for the heart in general
• Tell someone close to you about your symptoms, so they know what to do if you feel unwell

Diet and exercise

There is no special 'heart rhythm diet', but a balanced way of eating that is good for your heart and blood pressure is helpful — plenty of vegetables, fruit, wholegrains, beans and fish, and less salty and heavily processed food. Keep an eye on caffeine, including tea, coffee, cola and energy drinks. Regular moderate activity such as walking, swimming or cycling is encouraged for almost everyone with palpitations. If exercise reliably triggers symptoms, mention it to your doctor rather than simply stopping activity altogether.

Mental health and emotional wellbeing

Feeling your heart race can be frightening, and worry about it can become a cycle: anxiety speeds the heart, which causes more worry. That is very common and worth talking about. Slow breathing, learning about what is happening in your body, and a clear explanation from your doctor all help. If low mood, panic or constant worry is affecting your life, please tell your doctor — talking therapies are effective and widely available. If you ever feel you cannot cope, contact your local emergency number or a crisis line in your country straight away; you deserve support and you do not have to manage alone.

Prevention

Not all arrhythmias can be prevented — some are inherited or simply more likely with age. But you can lower your chances of the common triggers and of the heart conditions that make rhythms more likely. Looking after your blood pressure, not smoking, keeping active, limiting alcohol and caffeine, sleeping well and managing stress all help your heart's electrical system stay steady.

Vaccines

There is no vaccine for arrhythmias, but staying up to date with routine vaccinations — including flu and COVID-19 vaccines if offered to you — helps prevent infections that can stress the heart and set off palpitations.

Screening programmes

There is no general screening programme for arrhythmias in most countries. However, your pulse is usually checked at routine appointments, and anyone over 65 or with high blood pressure may be offered a simple pulse check or heart rhythm check. If you have a strong family history of arrhythmia or sudden collapse at a young age, ask your doctor whether a heart check or family screening is right for you.

Complications

If left untreated

• Stroke — particularly with atrial fibrillation, where blood can pool and clot in the heart
• Heart failure, if a fast rhythm goes untreated for a long time and weakens the heart muscle
• Fainting and injuries from falls
• In rare cases, dangerous rhythms can cause cardiac arrest
• Ongoing tiredness, breathlessness and reduced ability to exercise
• Anxiety and low mood related to worrying about symptoms

Long-term outlook

The outlook is good for most people. Many palpitations turn out to be harmless and need no treatment at all. Where an arrhythmia is found, modern treatment is very effective at controlling symptoms and lowering risks — people with well-managed rhythm problems usually live full, active lives. The important thing is to get symptoms checked rather than ignore them, and to keep up with any follow-up your doctor recommends.

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