What Is an Arrhythmia and When Is It a Concern?

An arrhythmia is an abnormal heart rhythm. It may happen when the heart beats too fast, too slowly, irregularly, or in an unusual pattern. Some arrhythmias are brief and may not cause major symptoms, while others may need medical assessment, monitoring, or treatment.

Patients may describe arrhythmia symptoms as palpitations, skipped beats, fluttering, pounding, dizziness, breathlessness, chest discomfort, tiredness, or fainting. In some cases, an arrhythmia is found during a routine ECG or heart screening even when the patient has no symptoms.

What Is an Arrhythmia?

The heart has an electrical system that controls when and how the heart beats. An arrhythmia occurs when this electrical activity becomes abnormal.

An arrhythmia may cause the heart to beat:

• Too fast
• Too slowly
• Irregularly
• With extra beats
• With skipped beats
• In a pattern that starts and stops suddenly

Not every irregular heartbeat is dangerous. Some people experience occasional extra beats that may be harmless. However, arrhythmias should be assessed if they are frequent, persistent, associated with symptoms, or occur in someone with known heart disease.

What Does an Arrhythmia Feel Like?

Symptoms can vary. Some patients feel obvious palpitations, while others feel only mild discomfort or no symptoms at all.

Possible symptoms include:

• Fluttering in the chest
• Pounding heartbeat
• Racing heartbeat
• Skipped beats
• Irregular heartbeat
• Chest discomfort
• Shortness of breath
• Dizziness
• Light-headedness
• Fainting
• Tiredness
• Reduced exercise tolerance
• Anxiety during episodes

Symptoms alone cannot always show whether an arrhythmia is mild or concerning. Some serious rhythm problems may cause few symptoms, while some noticeable palpitations may be less concerning after assessment.

What Causes Arrhythmia?

Arrhythmias may occur for many reasons. Some are related to the heart, while others are linked to lifestyle factors, medication, hormones, or other medical conditions.

Possible causes or triggers include:

• Coronary artery disease
• Previous heart attack
• Heart failure
• Heart valve disease
• Cardiomyopathy
• High blood pressure
• Thyroid problems
• Electrolyte imbalance
• Diabetes
• Sleep apnoea
• Fever or infection
• Anaemia
• Dehydration
• Stress or anxiety
• Caffeine or stimulant use
• Alcohol intake
• Smoking
• Certain medication or supplements
• Previous heart surgery

A heart doctor may assess whether the arrhythmia is caused by a heart condition or another contributing factor.

Common Types of Arrhythmia

There are many types of arrhythmia. The treatment and level of concern depend on the rhythm type, symptoms, medical history and risk factors.

1. Atrial Fibrillation

Atrial fibrillation is an irregular heart rhythm that starts in the upper chambers of the heart. The heartbeat may feel fast, irregular, or fluttering.

Some patients with atrial fibrillation have palpitations, breathlessness, tiredness, dizziness, or reduced exercise tolerance. Others may have no symptoms.

Atrial fibrillation is important because it can increase the risk of stroke in selected patients. A cardiologist may assess stroke risk, bleeding risk, heart function and treatment options.

Management may include heart rate control, rhythm control, blood thinning medication where suitable, cardioversion, catheter ablation in selected cases, and risk factor management.

2. Supraventricular Tachycardia

Supraventricular tachycardia refers to a fast heart rhythm that starts above the lower chambers of the heart. It may start and stop suddenly.

Symptoms may include:

• Sudden racing heartbeat
• Palpitations
• Chest discomfort
• Dizziness
• Breathlessness
• Anxiety during episodes

Some episodes may stop on their own. Others may need medical treatment. A cardiologist may discuss medication, monitoring, or catheter ablation depending on the pattern and severity.

3. Premature Beats

Premature beats are extra heartbeats that occur earlier than expected. They may feel like skipped beats, thumps, pauses, or brief fluttering.

They may be triggered by stress, caffeine, lack of sleep, alcohol, dehydration, or other factors. In some patients, they may occur with underlying heart disease.

Assessment may involve ECG, Holter monitoring, blood tests, and echocardiogram depending on symptoms and risk factors.

4. Bradycardia

Bradycardia means a slow heart rhythm. A slow heart rate may be normal in some people, especially those who are physically active. However, it may be concerning if the heart rate is too slow for the body’s needs.

Symptoms may include:

• Dizziness
• Fainting
• Tiredness
• Weakness
• Shortness of breath
• Confusion
• Reduced exercise tolerance

Causes may include ageing-related electrical system changes, medication effects, heart block, thyroid problems, or other medical conditions. Some patients may need medication changes or a pacemaker depending on the cause.

5. Ventricular Arrhythmia

Ventricular arrhythmias start in the lower chambers of the heart. Some can be more concerning, especially in people with structural heart disease, previous heart attack, heart failure, or inherited rhythm conditions.

Symptoms may include palpitations, dizziness, fainting, chest discomfort, or sudden collapse.

Patients with fainting, sudden severe palpitations, chest pain, or known heart disease should seek prompt medical assessment.

When Is Arrhythmia a Concern?

An arrhythmia may be more concerning when it is associated with warning symptoms, occurs frequently, lasts longer, or happens in someone with heart disease or risk factors.

Seek medical advice if palpitations or irregular heartbeat:

• Happen repeatedly
• Last longer than usual
• Occur with chest discomfort
• Occur with shortness of breath
• Occur with dizziness or fainting
• Occur during exercise
• Cause reduced exercise tolerance
• Are associated with leg swelling or fatigue
• Occur after a heart attack
• Occur in someone with known heart disease
• Are linked to a family history of sudden cardiac death
• Are new or worsening

Some symptoms need urgent medical care rather than a routine appointment.

When to Seek Urgent Medical Care

Seek urgent medical attention if there is:

• Chest pain or tightness
• Severe shortness of breath
• Fainting or sudden collapse
• Severe dizziness
• Palpitations with chest pain
• Palpitations with breathlessness
• Sudden weakness or numbness
• Stroke symptoms
• Confusion
• Blue lips
• Very fast heartbeat that does not settle
• Irregular heartbeat after a recent heart attack

Patients should not wait for a scheduled cardiology appointment if symptoms suggest an emergency.

How Is an Arrhythmia Diagnosed?

Diagnosis usually involves capturing the heart rhythm during symptoms or identifying rhythm changes through monitoring.

A cardiologist may recommend one or more tests depending on symptom frequency and risk factors.

1. Electrocardiogram

An electrocardiogram, or ECG, records the electrical activity of the heart. It may show abnormal rhythm, slow heartbeat, fast heartbeat, previous heart injury, or other electrical changes.

If symptoms are happening during the ECG, the rhythm may be captured immediately. If symptoms come and go, further monitoring may be needed.

2. Holter Monitoring

A Holter monitor records the heart rhythm continuously, often over 24 to 48 hours. It may be recommended if symptoms occur daily or frequently.

Patients may be asked to note symptoms, activities, sleep, medication, or triggers during the monitoring period. The doctor can then compare symptoms with the recorded rhythm.

3. Event Monitor or Longer Rhythm Monitoring

If symptoms happen less often, longer rhythm monitoring may be needed. An event monitor or patch monitor may be used for a longer period depending on the clinic’s available options and the patient’s symptoms.

This can help detect arrhythmias that do not occur every day.

4. Echocardiogram

An echocardiogram is an ultrasound scan of the heart. It does not diagnose every rhythm problem directly, but it can assess heart structure and function.

It may be recommended if the doctor wants to check for:

• Heart chamber enlargement
• Heart pumping function
• Heart valve disease
• Cardiomyopathy
• Structural heart concerns
• Effects of long-standing arrhythmia

5. Blood Tests

Blood tests may be used to check for conditions that can contribute to arrhythmia.

These may include:

• Thyroid function
• Electrolyte levels
• Kidney function
• Full blood count
• Blood sugar
• Other tests based on symptoms

6. Stress Test or Other Cardiac Tests

A stress test may be recommended if symptoms occur during exertion or if coronary artery disease needs to be assessed. Other tests, such as cardiac imaging or coronary artery assessment, may be discussed depending on symptoms and risk factors.

Treatment Options for Arrhythmia

Treatment depends on the type of arrhythmia, symptoms, stroke risk, heart function, age, other medical conditions and patient preferences.

Some arrhythmias may only need monitoring and trigger management. Others may need medication or procedures.

Possible treatment options include:

• Lifestyle and trigger management
• Treatment of underlying conditions
• Medication to control heart rate
• Medication to control rhythm
• Blood thinning medication for selected patients
• Cardioversion
• Catheter ablation
• Pacemaker for selected slow rhythms
• Implantable cardioverter defibrillator in selected cases
• Follow-up monitoring

Patients should ask why a treatment is recommended, what risks apply, what alternatives exist and how treatment response will be monitored.

Lifestyle and Trigger Management

Some arrhythmias or palpitations may be affected by lifestyle triggers. Patients may be advised to review habits that can affect the heart rhythm.

Possible steps include:

• Limiting caffeine if it triggers symptoms
• Avoiding stimulant products unless cleared by a doctor
• Reducing alcohol intake
• Stopping smoking
• Staying hydrated
• Managing stress
• Getting enough sleep
• Treating sleep apnoea where present
• Managing blood pressure
• Managing cholesterol and diabetes
• Taking medication as prescribed

Lifestyle changes should be guided by the doctor, especially if the patient has known heart disease.

Living with Arrhythmia

Some patients live with arrhythmia that requires long-term monitoring or medication. Follow-up care may involve symptom review, medication adjustment, blood tests, repeat ECG, rhythm monitoring, or echocardiogram.

Patients should keep track of:

• Symptom frequency
• Triggers
• Heart rate readings, if advised
• Medication side effects
• Bleeding symptoms if on blood thinners
• Exercise tolerance
• Dizziness or fainting episodes
• Chest discomfort
• Breathlessness

Patients should not stop heart rhythm medication or blood thinning medication without medical advice.

An arrhythmia is an abnormal heart rhythm. It may cause a heartbeat that is too fast, too slow, irregular, or unusually patterned. Some arrhythmias are occasional and may not require major treatment, while others can increase the risk of stroke, heart failure, fainting, or sudden collapse.

Arrhythmia becomes more concerning when it is persistent, recurrent, worsening, associated with chest pain, breathlessness, dizziness, fainting, or occurs in someone with known heart disease. Diagnosis may involve ECG, Holter monitoring, longer rhythm monitoring, echocardiogram, blood tests, and other heart tests where needed.

Patients should seek urgent care for chest pain, severe breathlessness, fainting, sudden collapse, stroke symptoms, or palpitations with severe dizziness or chest discomfort. For recurring palpitations or irregular heartbeat, a cardiology assessment can help identify the rhythm problem and guide suitable treatment.

FAQ

What does arrhythmia feel like?

It may feel like fluttering, pounding, racing, skipped beats, irregular heartbeat, dizziness, breathlessness, chest discomfort, tiredness, or fainting. Some people have no symptoms.

When is arrhythmia dangerous?

An arrhythmia may be concerning if it occurs with chest pain, breathlessness, fainting, severe dizziness, stroke symptoms, or known heart disease. Some arrhythmias also increase stroke or heart failure risk.

How is arrhythmia diagnosed?

Diagnosis may involve ECG, Holter monitoring, longer rhythm monitoring, echocardiogram, blood tests, stress testing, or other cardiac tests depending on symptoms and risk factors.

Can arrhythmia be treated?

Yes. Treatment depends on the type of arrhythmia and may include lifestyle changes, medication, blood thinners in selected cases, cardioversion, catheter ablation, pacemaker, or other procedures.

Should I see a cardiologist for palpitations?

You may consider seeing a cardiologist if palpitations are recurrent, prolonged, worsening, associated with dizziness, chest discomfort, breathlessness, fainting, or if you have known heart disease.

This article is for general information only and should not replace medical advice from a qualified healthcare professional.