If you think you might have a heart arrhythmia, you’re not alone as it’s one of the most common issues that bring people in to see their doctor. Simply put, an arrhythmia refers to an irregular heart rhythm, which can also be noted as an irregular pulse or heart rate. Essentially, the heartbeat goes off cadence and this irregularity may or may not be felt in your body.
Many people are aware of their skipping, strongly palpitating or rapid heartbeats. Others have no idea they have an arrhythmia until it is caught during a doctor visit or shows up on an electrocardiogram (EKG).
Symptoms of a Heart Arrhythmia
While an arrhythmia can present without symptoms, you may feel one or more of the following signs and symptoms:
- Fluttering sensation in the chest
- Chest pain
- Heart palpitations
- Slow heart rate
- Shortness of breath
If you suspect you have an arrhythmia, it’s imperative that you see a doctor who can accurately assess the problem. An evaluation by a cardiologist would be ideal, but it’s also okay to begin with your primary care physician.
How Is an Arrhythmia Diagnosed?
Heart testing should begin with a baseline EKG and a Holter monitor evaluation. These are basic, noninvasive heart tests typically covered by insurance.
If you’ve never had a Holter evaluation, you can think of it as a 24-hour EKG. You’ll be asked to wear several adhesive electrode pads on your chest, and wires will connect the pads to a small recorder worn on a belt or in a sling. At the same time, you will be asked to keep a diary of your activities and any symptoms you feel. Your doctor will then analyze your heart’s rhythm to determine the specific type of arrhythmia you have.
Types of Arrhythmias
There are several types of heart arrhythmias:
- Atrial Fibrillation (A-Fib): This is one of the most common types of arrhythmias and often develops with aging. A-Fib occurs when the atria (the upper chambers of your heart) don’t contract in a regular rhythm as they should. Instead of contracting, the atria "fibrillate," which is like twitching or quivering, so blood moves to the ventricles (lower chambers) when the valves open at varying intervals. You may feel A-Fib as a fluttering sensation in your chest, or you may not feel it at all. Because the atria do not contract fully, blood is not forcefully ejected into the ventricles. The loss of what is referred to as the "atrial kick" can cause physical symptoms including shortness of breath, dizziness or weakness, and flu-like symptoms.
- Ectopic Heartbeats: Ectopic heartbeats are generated outside the heart's normal conduction system and are the primary cause of cardiac arrhythimas. When an ectopic beat arrives early in sequence to disrupt the heart's regular rhythm, it may be felt as a "skip," or as an "extra" beat. After a kind of "resetting pause," the heart will return to its regular rhythm, which begins in the sino-atrial node, the heart's built-in pacemaker. This type of arrhythmia is usually benign, especially in an otherwise healthy heart. Although treatment is usually not necessary, you should get tested to make sure it’s not a sign of another underlying condition.
- Premature Ventricular Contractions (PVCs): PVCs occur when one of the two bottom chambers of the heart, the ventricles, contract prematurely. While anyone can develop PVCs, we often see them in women who have mitral valve prolapse.
- Premature Atrial Contractions (PACs): PACs occur when the atrium (one of the two top chambers of the heart) contracts prematurely. These irregularities are usually not a problem for healthy people.
- Ventricular Tachycardia (V-tach): V-tach (also VT) is a dangerously fast arrhythmia where the heart’s pumping mechanism loses traction, resulting in an erratic and intense racing of the heart. It’s dangerous because it can deteriorate rapidly into ventricular fibrillation (V-fib) or cardiac arrest. We use nasal oxygen and intravenous (IV) medication to prevent and treat these lethal arrhythmias during a heart attack, which is just one reason to get yourself to a hospital quickly if you suspect you’re having one.
You may also hear the term respiratory sinus arrhythmia, and while it contains the word “arrhythmia” it is quite normal and common to all of us. Simply put, a respiratory sinus arrhythmia is a gentle heart rate fluctuation where your heart rate varies slightly during the normal breathing cycle. When you breathe in, the heart rate may increase slightly and then slows backs down as you exhale.
I was first made aware of respiratory sinus arrhythmia while a medical student working at a summer camp for diabetic children. The pediatrician there familiarized me with pulse-taking of the kids at the camp, instructing me as to how obvious this heart rate variation is in healthy children.
Can Arrhythmias Be Deadly?
The “café coronary” has been documented in connection with fatty meals, alcohol, and stressful news. The combination can trigger a fatal series of rapid fired ventricular tachycardia. I remember having a patient who routinely overindulged on gin who ended up developing tachycardia. Obviously lacking good judgment, he would drive himself to the emergency room for treatment: dangerous for him and everyone else on the road!
Despite warnings, he indulged himself one too many times and died when the tachycardia turned into deadly fibrillation, as it often does. These situations are particularly dangerous among patients with congestive heart failure or who have cardiomyopathy, where the heart muscle becomes inflamed, dilated, and doesn’t pump well, or where the left ventricle is dilated.
What Causes Heart Arrhythmias?
Causes of heart arrhythmias can vary. They can occur as a natural part of aging or if there has been enlargement of the upper chambers of the heart. They can also be caused by heart attacks, high blood pressure, mitral valve prolapse, and angina. Women in menopause are also more susceptible to cardiac arrhythmias, as are healthy young women using birth control pills.
There are also several lifestyle habits that can trigger arrhythmias, including:
- Sensitivity to caffeine
- Excess sugar intake, which causes fluctuations in insulin and adrenaline
- Magnesium deficiency
- Electrolyte imbalances
- Cigarette smoking
- Certain drugs and medications
- Food additives, such as MSG
- Environmental toxins
Treatment for Cardiac Arrhythmias
For healthy people with occasional instances of arrhythmia, lifestyle changes may be enough to bring the heart back into rhythm, such as reducing stress and avoiding caffeine, alcohol, and sugar. For others, medications or surgical procedures may be needed.
Plus, there are several nutritional supplements that can help to support a healthy heartbeat: