The heart should work in a regular, steady pattern. Arrhythmias are breaks in the pattern. It may happen in a short burst or last over long periods of time.
Types of arrhythmias:
- Very slow heart rate— bradycardia
- Very fast heart rate— tachycardia
- Irregular rhythm
- Skipped contractions (beats) of the heart
Most will not affect overall health. Some arrhythmias can slow the flow of blood to the body or increase the risk of other health problems such as stroke.
The action of the heart is controlled by an electrical signal. The signal starts in a group of cells called the sinoatrial (SA) node and moves from the top to the bottom of the heart. The heart will contract first in the upper areas of the heart called the atria and then the lower areas of the heart called the ventricles. Arrhythmias may occur if:
- The sinus node is damaged and cannot send normal electrical signals
- The electrical signal cannot travel smoothly through the heart
- Other influences like hormones or drugs make the SA node overreact
- Other areas of the heart start an action that does not match the pattern of the SA node
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Factors that may increase your chances of arrhythmias:
- Excess caffeine, stress, smoking, alcohol use disorder, or cocaine abuse
- Certain medicine, such as diet pills, decongestants, and antidepressants
- Heart-related conditions, such as:
- Medical conditions, such as anemia, high blood pressure, diabetes, liver disease, endocrine disorders (thyroid or adrenal gland problems), or typhoid fever
- Accidents or injuries such as electric shock or lightening strike, near-drowning, or hypothermia
Not all arrhythmias will cause symptoms. Some arrhythmias may be felt as a fluttering in the chest, skipped heartbeat, or fast heartbeat.
Arrhythmias that slow the flow of blood through the heart will also slow the flow of blood to the body. If the flow is slowed enough it can lead to:
- Shortness of breath
- Chest pain
The doctor will ask about your symptoms, past health, and family history. A physical exam will be done. The electrical activity of the heart can be checked with one of the following:
- ECG —Records the heart's activity for a period of time.
- Holter monitor —An ECG that records heart activity over 24 to 48 hours. It can help find arrhythmias that do not occur in a regular pattern.
- Exercise stress test —An ECG that is taken while you do a physical activity. It can help find arrhythmias that only appear with physical stress.
- Electrophysiological study —Wires are passed through blood vessels to the heart. The wire sends electrical signals to the heart to try to start an arrhythmia. This will help to find where the arrhythmias is starting in the heart.
To help find what may be causing problems or to look for problems of the heart structure the doctor may also order:
Not all arrhythmias need to be treated. Many are harmless and will not cause problems.
Treatment may be needed for arrhythmias that affect daily life or increase the risk of other problems like stroke. In this case, the goal of treatment is to return your heart to a normal rhythm. The type of treatment will depend on the arrhythmia and overall health. It may include:
- Medicine—to slow down or speed up your heart rate or treat the cause.
- Cardioversion—send an electrical signal to reset the pattern of the heart.
- Medical device implantation—placed by the heart to track and correct the heart's activity. Types of devices include:
- Changing tissue in small areas of the heart. The area will block the flow of bad electrical signals. It can also stop some signals from starting.
Not all arrhythmias can be prevented. To help reduce your chances of certain arrhythmias:
- Follow care plan for other heart or medical issues.
- Avoid substances that trigger arrhythmia or make it worse. This includes caffeine, alcohol, or tobacco.
- Follow general advice for a healthy heart:
American Heart Association
Heart Rhythm Society
Canadian Heart Rhythm Society
Heart and Stroke Foundation of Canada
Arrhythmias. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Arrhythmia/Arrhythmia_UCM_002013_SubHomePage.jsp. Accessed November 28, 2020.
Arrhythmia. Texas Heart Institute website. Available at: http://www.texasheart.org/HIC/Topics/Cond/Arrhythmia.cfm. Accessed November 28, 2020.
Atrial fibrillation. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T115288/Atrial-fibrillation. Accessed November 28, 2020.
Explore arrhythmia. National Heart, Lung, and Blood website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/arr. Accessed November 28, 2020.
Sick sinus syndrome. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T113692/Sick-sinus-syndrome. Accessed November 28, 2020.
Ventricular arrhythmias. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T909129/Ventricular-arrhythmias. Accessed November 28, 2020.
Last reviewed November 2020 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC Last Updated: 12/20/2020