Arrhythmia

What are the symptoms of arrhythmia?

Some arrhythmias cause no symptoms at all and are only picked up during a routine check. When symptoms do occur, they commonly include:

• palpitations, a thumping, fluttering or racing sensation in your chest, or a feeling that your heart has skipped a beat
• dizziness or feeling light-headed
• feeling as though you might faint, or actually fainting
• shortness of breath, or a sense that you can't get enough air
• chest discomfort or pain
• tiredness or weakness.

Experiencing these on their own doesn't necessarily mean you have arrhythmia, but they're worth getting checked out.

What are the causes of arrhythmia and who is at risk?

Arrhythmia happens when there's a problem with the electrical signals that keep your heart beating in time, whether that's a delay, a blockage, or another part of your heart taking over the job of pacing it.

Several underlying heart conditions can trigger this, including:

• coronary artery disease and other problems with your heart's arteries
• high blood pressure
• a weakened or enlarged heart muscle (cardiomyopathy)
• problems with your heart valves
• damage from a previous heart attack, or while recovering from heart surgery
• inherited conditions present from birth that disrupt your heart's electrical system, among them Brugada syndrome, long QT syndrome or CPVT.

Everyday triggers can also set off an arrhythmia or make one more likely, such as:

• drinking too much caffeine or alcohol
• smoking or using recreational drugs
• viral illnesses, including flu or the common cold
• certain medicines, including some over-the-counter ones
• an imbalance of salts (electrolytes) in your blood
• stress, poor sleep, dehydration or an overactive or underactive thyroid.

If a family member has an inherited arrhythmia condition, your doctor may suggest other relatives are tested too, since these conditions can run in families.

Are there different types of arrhythmia?

Arrhythmias are broadly grouped by how fast or slow they are causing the heart to beat. A resting heart rate above 100 beats a minute is called tachycardia, while one that drops below 60 is called bradycardia. A third broad group covers heartbeats that are simply uneven, whatever the speed.

Some of the more specific named types include:

• atrial fibrillation, diagnosed more often than any other type, where the upper chambers of your heart quiver instead of beating properly, raising your risk of blood clots and stroke
• supraventricular tachycardia (SVT), sudden bursts of a very fast heartbeat starting in the upper chambers
• atrial flutter, where the upper chambers race even faster than in atrial fibrillation, reaching as high as 300 beats a minute in some cases.
• ventricular tachycardia and ventricular fibrillation, faster and potentially more dangerous rhythms starting in the heart's lower chambers, which can require emergency treatment
• heart block, a delay or blockage between the upper and lower chambers that slows the heart down
• tachybrady syndrome, where the heart alternates between racing ahead and lagging behind because its electrical system isn't working as it should.

Not every fast or slow heartbeat is a cause for concern. A heart that simply beats faster or slower than average, but still in a regular pattern, doesn't necessarily mean something is wrong, though your doctor may still want to check for an underlying cause.

How is arrhythmia diagnosed?

A doctor will usually start by feeling your pulse and using a stethoscope to check your heartbeat, alongside asking about your symptoms and medical history. From there, you may be referred for further tests, sometimes to a specialist in heart rhythm problems. Common tests include:

• an ECG (electrocardiogram), which records your heart's electrical activity over a short period
• a longer wearable heart monitor (such as a 24-hour Holter monitor or implantable loop recorder), to catch rhythm problems that come and go
• an echocardiogram, which uses ultrasound to look at your heart's structure and how well it's working
• an exercise or stress test, to see how your heart responds to physical activity
• an electrophysiology study, a more detailed test that maps the electrical signals inside your heart.

How is arrhythmia treated?

Which treatment suits you best hinges on which type of arrhythmia you have and the effect it's having on you. Many people need no treatment beyond regular monitoring, especially if their arrhythmia is mild or harmless. Where treatment is needed, options include:

• medicines to control your heart's rate or rhythm, or blood-thinning medicines to cut your chances of clots and stroke
• cardioversion, which uses a controlled electric shock to reset your heart back into a normal rhythm
• catheter ablation, where a thin tube is guided to the exact area inside your heart causing the abnormal signal, then uses heat or cold to disconnect it
• having a pacemaker fitted, a small device under your skin that helps keep your heart beating at a steady rate
• an implantable cardioverter defibrillator (ICD), which monitors your rhythm continuously and delivers a shock if it detects a dangerous one
• surgery, such as heart valve surgery, a bypass, or a specific procedure called a maze operation, usually reserved for cases linked to another heart condition or that haven't responded to other treatments.

Alongside any medical treatment, cutting back on caffeine and alcohol, stopping smoking, managing stress, and staying physically active can all help reduce how often arrhythmias happen.

When should I see a doctor?

Call 999 or get yourself to A&E without delay if you have palpitations alongside any of the following: chest pain, breathlessness, or feeling faint, dizzy or like you're about to pass out. Ask someone else to take you rather than driving yourself, or dial for an ambulance.

Where those symptoms have already eased off by the time you read this, get in touch with your GP practice and ask to be seen urgently, or call 111.

For less urgent concerns, book a routine GP appointment if you think you might have arrhythmia, or if you keep getting palpitations that aren't improving or seem to be getting worse.