Irregular Heartbeat: When To Seek Help

The medical term for an irregular heartbeat is arrhythmia. It means the heart is beating too fast, too slow, or with an irregular rhythm. 

Some changes in the heartbeat are harmless. For example, it is normal for the heart to beat faster when you’re exercising, anxious, or have a fever. It’s also normal for your heart to slow down when resting or asleep. 

However, some types of changes in heart rhythm can be more serious and life-threatening. They can cause complications such as blood clots, heart failure, or sudden cardiac death if left untreated.

The Science Behind Heart Rhythms

The human heart pumps blood to every part of the body throughout a person’s lifetime. In adults, the normal resting heart rate is 60 to 100 beats per minute. Therefore, your heart beats around 100,000 times per day. 

An electrical system controls the pumping action of the heart muscle and maintains a normal heart rhythm called the sinus rhythm. The name comes from a part of the heart tissue called the sinus node, which functions as a natural pacemaker.

A heartbeat starts when the sinus node fires off an electrical signal. This electrical impulse spreads to all the cells in the atria (the heart’s upper chambers), causing them to contract. A fraction of a second later, the electrical signal spreads through the atrioventricular node (AV node) to the ventricles (the heart’s lower chambers).

For the heart to pump enough blood to the body, all the cells in the heart must contract in a coordinated manner with a normal rhythm. A heart arrhythmia occurs if the cells contract too fast, too slow, or out of rhythm with each other, thereby disrupting the heart’s regular rhythm.

Common Causes of Irregular Heartbeats 

Possible causes or risk factors for an irregular heart rhythm include:

• Scarring in the heart muscle from a previous heart attack

• Coronary artery disease (blocked arteries)

• Damage to the heart from heart disease

• High blood pressure

• Diabetes

• Thyroid disorders

• Sleep apnea

• Electrolyte imbalance

• Infections such as COVID-19.

• Excessive use of alcohol or caffeine

• Drug abuse

• Certain medications

• Smoking

• Anxiety

• Family history and genetics

Types of Irregular Heartbeats

Irregular heartbeats are broadly classified into:

• Fast heartbeat (tachycardia)

  • Heart rate more than 100 beats per minute

• Slow heartbeat (bradycardia)

  • Heart rate less than 60 beats per minute

Types of arrhythmias that are too fast: 

• Atrial fibrillation (AFib)

• Atrial flutter

• Supraventricular tachycardia

• Ventricular fibrillation

• Ventricular tachycardia

Types of arrhythmias that are too slow: 

• Sick sinus syndrome

• Conduction block

Can you have an irregular heartbeat and be OK?

You can have an irregular heartbeat and be OK. For example, premature heartbeats are extra beats that occur alternating with the regular heartbeat. They can occur either sporadically or in patterns. Extra heartbeats originating in the heart's upper chambers are called premature atrial contractions (PACs), and those in the bottom chambers are called premature ventricular contractions (PVCs).

Premature heartbeats can occur at rest, after strenuous exercise, or using stimulants like caffeine or nicotine. They often feel like a skipped beat or fluttering in the chest. 

Premature heartbeats are usually not concerning and are rarely a symptom of a serious condition. However, sometimes premature beats can trigger worse arrhythmias or lead to weakening of the heart muscle, especially in people with underlying heart disease. 

What is a 3-beat heart arrhythmia?

There are two main types of PVCs: a trigeminy and a bigeminy. A trigeminy consists of two normal heartbeats followed by an extra heartbeat, and a bigeminy is when one normal heartbeat is followed by one extra beat. This type of arrhythmia feels like a skipped heartbeat or a fluttering sensation in your chest. 

Symptoms of Irregular Heartbeats

Common Symptoms of Irregular Heartbeats

Not all arrhythmias cause symptoms. But when present, the symptoms of a cardiac arrhythmia may include:

• Fast or slow heartbeat

• A sensation of pounding, racing, or fluttering in the chest

Other arrhythmia symptoms include:

• Shortness of breath

• Chest pain

• Lightheadedness or dizziness

• Tiredness

• Anxiety

• Sweating

• Fainting

When Should You Worry About An Irregular Heartbeat? 

You should worry about an irregular heartbeat if it hasn’t been evaluated by a doctor. Only a healthcare provider can tell the difference between normal palpitations and a more serious cardiac arrhythmia. 

Call your doctor if you feel your heart is beating too fast or too slow or if you feel like your heart is skipping. Your primary care provider may refer you to a cardiologist (specialist in heart diseases) or cardiac electrophysiologist (cardiologist who specializes in heart rhythm disorders).

It is especially important to contact your healthcare provider without delay if you have:

• More than 6 extra heartbeats per minute or extra heartbeats that come in groups of 3 or more.

• A history of heart disease. 

• Risk factors for heart disease, like high blood pressure, high cholesterol, or diabetes.

• New or different heart palpitations.

• A pulse rate above 100 beats per minute (that cannot be explained by fever, anxiety, or exercise).

• A pulse rate below 60 beats per minute (unless you are physically fit and have a low resting heart rate).

When should you go to the ER for an irregular heartbeat?

Call 911 or go to the nearest emergency room if you think you are having a heart attack. 

You should seek immediate medical care for the following serious symptoms:

• Chest pain

• Difficulty breathing

• Shortness of breath

• Fainting or loss of consciousness

Is an irregular heart rate an emergency?

Some types of irregular heart rhythms are emergencies. For example, ventricular fibrillation, a type of arrhythmia, is the most common cause of sudden cardiac arrest. It causes a dangerous drop in blood pressure that can cause a person to collapse (fall to the ground) within seconds. Fainting is typically followed by the stoppage of the pulse and breathing. 

Ventricular fibrillation is an emergency that requires immediate medical help. If this happens, you should call 911, perform CPR, and use an AED (automated external defibrillator) if one is available. 

Diagnosing Irregular Heartbeats

Doctors can diagnose heart arrhythmias based on your symptoms, medical history, and test results. Some of the tests that are done to diagnose a heart arrhythmia include: 

• An electrocardiogram (ECG or EKG) to check the heart's electrical activity. 

• Echocardiogram to see pictures of the heart using sound waves.

• Holter monitor or event recorder (portable ECG device) to check heart activity during daily activities.

• Stress test to check the heart’s response to exercise.

• Tilt table test to test the heart’s response to changes in position.

• Electrophysiological (EP) study to find the location of faulty signaling in the heart.

Treating Irregular Heartbeats

You may or may not need treatment for a heart arrhythmia, depending on the cause and type. The best treatment for your arrhythmia will depend on the type of faulty electrical signals in your heart and other coexisting medical conditions. When treatment is necessary, it may consist of: 

Medications for Heart Arrhythmias

• Anticoagulants and antiplatelets (aspirin, warfarin) to lower the risk of blood clots.

• Beta-blockers (atenolol, metoprolol, carvedilol, others) or calcium channel blockers (diltiazem, verapamil) to slow the heart rate.

• Antiarrhythmic drugs (flecainide, amiodarone, sotalol, others) to control abnormal heart rhythms.

Other Types of Heart Arrhythmia Treatment

• Vagal maneuvers (coughing, having a bowel movement, bearing down, putting ice on the face) to slow the heart rate.

• Cardioversion or cardiac resynchronization therapy to reset the heart rhythm with an electrical shock. 

Surgical Procedures for Heart Arrhythmias

• Catheter ablation is used to block irregular heart signals using high-frequency electrical energy to scar abnormal heart tissue.

• Pacemaker implantation to control the heartbeat.

• An implantable cardioverter-defibrillator (ICD) is used to identify and reset an abnormal heart rhythm.

• The Cox maze procedure to create scar tissue in the heart muscle and to block abnormal electrical signals.

• Coronary artery bypass graft (CABG or heart bypass surgery) to improve blood flow around a blocked artery.

Lifestyle Changes and Home Remedies

The following lifestyle changes can help with the prevention and management of an abnormal heart rhythm:

• Eat a heart-healthy diet (low-salt, low-fat diet).

• Get regular exercise.

• Maintain a healthy body weight.

• Take the prescribed treatment for high blood pressure, high cholesterol, and diabetes if you have these conditions.

• Stop smoking if you smoke.

• Limit caffeine and alcohol intake.

• Get enough restful sleep every night.

• Manage stress with meditation, mindfulness, deep breathing, and support groups.