As a cardiac electrophysiologist — a physician who deals with the electrical system that controls the heart’s rhythm — I work with a lot of patients who are experiencing irregular heartbeats, also called heart arrhythmias.
Some kinds of heart arrhythmias are harmless. Others can be serious or potentially life-threatening if left untreated, as was the case with Danish soccer player Christian Eriksen, who suffered a cardiac arrest on the field during a match in the summer of 2021. Thankfully, Eriksen’s life was saved, and he ultimately received the care he needed, including a surgical placement of a cardiac defibrillator, to help manage his condition.
While that was an extreme arrhythmia case, I tell my patients it’s important to have some insight into which arrhythmias are nothing to worry about, versus those that might need treatment or close monitoring. I think it’s helpful to first understand the basics of arrhythmias.
What is a heart arrhythmia?
A heart arrhythmia occurs when the heart beats too fast, too slow, or with an irregular rhythm. The electrical impulse that “kick-starts” each heartbeat comes from the sinoatrial (SA) node. This node is sometimes called the heart’s natural pacemaker. When this impulse misbehaves or is disrupted, it can cause an arrhythmia, which affects how well your heart pumps blood to your body.
Many experience some of the following symptoms:
- A pounding or fluttering sensation in their chest (known as palpitations)
- Lightheadedness or feeling faint
- Shortness of breath
However, some of my patients with arrhythmias have few or no symptoms. Their arrhythmias may have been found incidentally during testing for other medical conditions.
What causes an arrhythmia?
In some cases, people are born with heart defects that may show up as arrhythmias. In my practice, I see patients of all ages with arrhythmias — from teens to people in their 100s. Risk factors for arrhythmias depend on the type of arrhythmia but may include aging, having high blood pressure, being overweight, smoking, drinking too much alcohol, having other diseases or conditions that weaken the heart, or a family history of arrhythmia.
Which arrhythmias require medical attention?
As I mentioned before, there are different types of arrhythmias, and not all of them require a doctor’s care. I generally break them down into three categories:
1. Arrhythmias that are usually not serious
Your heart “skipping a beat.” We’ve all had the feeling that our heart skipped a beat. These “butterflies” are usually nothing to worry about when they happen now and then, and usually last a few seconds at most. It can be the result of something as simple as drinking too much coffee or feeling stressed or anxious, or with no behavioral explanation at all – it just happened.
But signs or symptoms that might need to be evaluated and monitored by a physician include:
- Palpitations or other arrhythmia symptoms that occur often or last longer than a few seconds
- Any symptom of an arrhythmia in a person with a known heart problem
The bottom line is this: If you have any palpitations that concern you, let your doctor know. We are here to help. Chances are, your fleeting palpitations are normal, and you might gain the peace of mind that comes with knowing that. That is part of caring for you as your doctor.
2. Arrhythmias that need to be monitored.
Some other kinds of arrhythmias should be monitored more closely. I advise patients with these kinds of irregular heartbeats to see their doctor on a regular basis, in case their condition needs to be treated.
Premature ventricular contractions (PVCs)
PVCs happen when the bottom of your heart has an early beat. Like other fleeting palpitations mentioned above, they usually aren’t cause for alarm. However, they can cause symptoms, or when you have a lot of them, can even cause reversible damage to your heart – so they should not be ignored, and expert consultation should be sought.
This is when your heart beats too fast. Heart rates can differ depending on your age and overall health. A heart rate over 100 beats per minute is technically referred to as “tachycardia”, but really, an increase from your normal heart rate, particularly associated with symptoms, may indicate an arrhythmia. Some common types of tachycardia are:
- Sinus tachycardia. This is generally caused by things like stress, anxiety, fever, or strenuous exercise. It happens when the SA node sends out electrical signals too quickly. This is absolutely normal behavior, and is not an arrhythmia.
- Supraventricular tachycardia. This occurs when electricity from the top of the heart misbehaves. This can happen to anyone, but the risk factors depend on the specific type of tachycardia. Generally, symptoms are disruptive and uncomfortable, but the arrhythmia is typically not dangerous.
In this type of arrhythmia, the heart beats too slowly. Surprisingly, some of my patients who are younger or physically fit have resting heart rates that are quite low, and in these cases, it’s a sign of a healthy heart. The actual heart rate is far less important than how you feel when your heart rate is low – the number itself is no cause for alarm.
Sometimes, these arrhythmias do not require treatment, but it’s worth finding that out from an expert and gaining that reassurance. Our job is not just to prescribe medicines or perform procedures, nor is it only to uncover bad news — sometimes, after collecting the relevant data, our job is to provide knowledge that is reassuring. It’s good to know that you may not need any treatment, but if needed, there are treatments that can improve your symptoms and your quality of life.
Simple massage techniques on the neck or breathing maneuvers that your doctor can teach you can sometimes help with supraventricular tachycardia, specifically. And lifestyle changes — like weight loss, treating sleep disorders, and cutting back on alcohol — are almost always helpful with arrhythmias in general.
But, further treatments depends on the type of arrhythmia and severity, but it can include medications, such as antiarrhythmic drugs; minimally-invasive cardiac ablation procedures that use radiofrequency energy to destroy small areas of abnormal heart tissue; defibrillators, which provide emergency therapy to save your life from lethal arrhythmias, if needed; and pacemakers, to correct the slow heartbeats of bradycardia.
3. Arrhythmias that should be treated as soon as possible.
People with AFib experience irregular heartbeats that affect how well the heart pumps blood. I see many patients with AFib, which is more common in men, older people, and people with other heart conditions. If left untreated, AFib only becomes harder and harder to treat, and it increases the risk of stroke.
How I manage AFib is patient-specific. The best treatment depends on multiple factors. I prescribe beta-blockers and antiarrhythmic medications for some of my patients. Others may need an ablation procedure. Many people with AFib also need blood thinners or an implanted device to reduce their risk of stroke.
My patients with AFib often have other medical issues that are best treated in collaboration with other heart specialists, like interventional cardiologists or heart failure specialists. That’s why it’s great to be treated at a place like Temple, where we have all the experts you need working collaboratively to support you. You can even see us all on the same day.
Ventricular tachycardia, or VT
This arrhythmia is a fast arrhythmia from the lower chambers of the heart. It can be very brief and resolve on its own, but if it persists, it is serious, and can cause cardiac arrest. Heart conditions like heart failure, a prior heart attack, and certain cardiomyopathies — which reflect abnormal heart muscle and function — are among the risk factors. The treatment for ventricular tachycardia is often multi-pronged: an implanted cardioverter defibrillator (ICD) to terminate an event of VT and save your life as needed, and sometimes a medication or ablation procedure to prevent this arrhythmia from recurring.
Ventricular fibrillation, or VFib
This is another serious kind of arrhythmia and can lead to cardiac arrest and sudden death. VFib can be treated with an ICD – which, just as in VT, provides a shock to correct the arrhythmia and save your life — and sometimes with medications. Because VFib is so serious, if a patient is at high risk, a patient may be offered an ICD even if they have never had a VFib event – just in case. On average, in certain patients, this has been shown to prolong life. The most common scenario is in patients with heart failure. It’s worth asking if you should consider an ICD if you had a previous heart attack, heart failure, cardiac sarcoidosis. others in your family have had cardiac arrest, or if you have certain conditions that may increase your risk of cardiac arrest.
Monitor your heart health and get expert care
Arrhythmias can affect your quality of life, and sometimes they’re evidence of another, underlying heart problem. That’s why I tell my patients to pay close attention to how their heart feels and acts on a daily basis. Being able to recognize changes earlier rather than later can be the key to getting the expert help you need when you need it – even if that help is simply reassurance.
Our team uses advanced diagnostic tools — including heart monitors, imaging tests, and tests that track the electrical activity of the heart — to quickly and accurately diagnose arrhythmias.
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