Arrhythmias

Symptoms

When you have an arrhythmia, your heartbeat may be:

• Too slow (bradycardia)
• Too quick (tachycardia)
• Irregular, uneven, or skipping beats

An arrhythmia may be present all of the time or it may come and go. You may or may not feel symptoms when the arrhythmia is present. Or, you may only notice symptoms when you are more active.

Symptoms can be very mild, or they may be severe or even life threatening.

Common symptoms that may occur when the arrhythmia is present include:

• Chest pain
• Fainting
• Lightheadedness, dizziness
• Paleness
• Palpitations (feeling your heart beat fast or irregularly)
• Shortness of breath
• Sweating

Exams and Tests

The health care provider will listen to your heart with a stethoscope and feel your pulse. Your blood pressure may be low or normal.

An ECG will be the first test done.

Heart monitoring devices are often used to identify the rhythm problem, such as a:

• Holter monitor (where you wear a device that records and stores your heart rhythm for 24 hours)
• Event monitor or loop recorder (worn for 2 weeks or longer, where you record your heart rhythm when you feel an abnormal rhythm)

An echocardiogram is often ordered to examine the size or structure of your heart.

Coronary angiography to see how blood flows through the arteries in your heart.

A special test, called an electrophysiology study (EPS), is done to take a closer look at the heart's electrical system.

Treatment

When an arrhythmia is serious, you may need urgent treatment to restore a normal rhythm. This may include:

• Electrical "shock" therapy (defibrillation or cardioversion)
• Implanting a short-term heart pacemaker
• Medicines given through a vein or by mouth

Sometimes, better treatment for your angina or heart failure will lower your chance of having an arrhythmia.

Medicines called anti-arrhythmic drugs may be used:

• To prevent an arrhythmia from happening again
• To keep your heart rate from becoming too fast or too slow

Some of these medicines can have side effects. Take them as prescribed by your provider. DO NOT stop taking the medicine or change the dose without first talking to your provider.

Other treatments to prevent or treat abnormal heart rhythms include:

• Cardiac ablation, used to destroy areas in your heart that may be causing your heart rhythm problems
• An implantable cardiac defibrillator, placed in people who are at high risk of sudden cardiac death
• Permanent pacemaker, a device that senses when your heart is beating irregularly, too slowly, or too fast. It sends a signal to your heart that makes your heart beat at the correct pace.

Outlook (Prognosis)

The outcome depends on several factors:

• The kind of arrhythmia you have. (Some abnormal heart rhythms may be life threatening if not treated right away, or DO NOT respond well to treatment.)
• Whether you have coronary artery disease, heart failure, or valvular heart disease.

When to Contact a Medical Professional

Call your provider if:

• You develop any of the symptoms of a possible arrhythmia.
• You have been diagnosed with an arrhythmia and your symptoms worsen or DO NOT improve with treatment.

Prevention

Taking steps to prevent coronary artery disease may reduce your chance of developing an arrhythmia.

References

Olgin JE. Approach to the patient with suspected arrhythmia. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 62.

Rubart M, Zipes DP. Genesis of cardiac arrhythmias, electrophysiologic considerations. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 33.

Tracy CM, Epstein AE, Darbar D, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2012;60(14):1297-1313. PMID: 22975230 www.ncbi.nlm.nih.gov/pubmed/22975230.