A. When your heart is beating normally, about 60 to 80 times per minute, you don’t even feel it. But if it skips a beat, you’ll likely notice something. Heart rhythm problems (heart arrhythmias) occur when the electrical impulses in your heart that coordinate your heartbeats don't work properly, causing your heart to beat too fast, too slow or irregularly. An occasional skipped heartbeat poses no adverse consequences, says Dr. Emad Aziz, a cardiac electrophysiologist at St. Luke’s and Roosevelt Hospitals, but when that fluttering or irregularity lasts for a longer period of time or happens frequently, it may indicate a dangerous heart condition.
“A fast heartbeat is dangerous whether it’s originating in the upper chamber or lower chamber of the heart, but it’s more dangerous in the lower chamber because it could potentially deteriorate and become life-threatening,” Dr. Aziz says.
Q. What are some common types of irregular heartbeats?
A. Irregular heartbeats — arrhythmias (uh-RITH-me-uhs) — can be fast or slow, and rhythmic or with no rhythm. Even irregular heartbeats can be “regular” in terms of a pattern — for example, if you have a beat that repeats itself every third beat. Some people just have chaotic rhythms that have no patterns at all, which is called irregularly regular. But if a heartbeat becomes chaotic and beats out of rhythm, it’s known as an arrhythmia.
The most common arrhythmias are:
- Tachycardia, which is a heart rate that’s too fast, has two predominant types: supraventricular and ventricular. The most common type of supraventricular tachycardia is atrial fibrillation, or a-fib, which is a rapid and irregular chaotic electrical activity in the two upper chambers (atria) of the heart result in the muscle fibrillating (i.e., quivering). Ventricular tachycardia can turn into the deadly ventricular fibrillation, which is the top cause of sudden death.
- Bradycardia, or a heart rate that is too slow, could be caused by aging, medications or diseases that affect the electrical conduction system. A heart rate of less than 50 beats per minute could indicate insufficient blood flow through the body.
Q. What are the symptoms of an irregular heartbeat?
A. The most common symptom that people with irregular heartbeats have is feeling as if their hearts are racing, Dr. Aziz says. Some people have the feeling of a drum roll in their chests, while others feel the skipping of beats, breathlessness, weakness, fatigue, dizziness or even fainting. Some people, if they have lived with arrhythmia for long enough, stop noticing their symptoms or assume they are a normal part of aging. But they aren’t, so please see your doctor if you feel you may have an irregular heartbeat.
Q. How are irregular heartbeats typically diagnosed?
A. Patients sometimes get so uncomfortable after hours of an arrhythmia that they go to the emergency room or urgent care. But most of the time, people will bring their symptoms to their primary care doctor. In either place, patients can get an electrocardiogram, or an EKG, which identifies normal and abnormal rhythms. If rhythm abnormalities are found, patients then get referred to an electrophysiologist, who is an “electrician of the heart.”
Those who do not experience symptoms during the EKG can be given an external heart monitor, which is worn for many days in the hopes of capturing incidents of arrhythmia.
Q. What are the treatments for arrhythmias?
A. There are many ways to manage heart arrhythmias, starting with lifestyle modifications including diet and exercise. Some of the conditions can be managed by medication to slow the heart rate, but some require stronger medications — with more side effects — called anti-arrhythmic drugs.
Patient that don’t tolerate those anti-arrhythmic drugs, can be offered an ablation procedure. “In an ablation procedure, we insert a special catheter through the vein in the leg, up to the heart, and find exactly where these abnormal short circuits are occurring. We then cauterize that tissue to eliminate that arrhythmia forever,” Dr. Aziz says. The success of these ablation procedure ranges from 70% to 99% depending on the rhythm problem and sometimes they have to be done multiple times to be effective. Patients with atrial fibrillation, which is the hardest arrhythmia to control, he adds, may need lifelong treatment.
Slow heart rate patients sometimes require a pacemaker implantation. A pacemaker is a small, battery-powered device that sends out small impulses to assist the heart muscle to contract. The pacemaker itself is the size of a silver dollar and implanted under the skin. A pacemaker consists of a pulse generator (battery) that creates the electrical impulses, and wires (leads) that transmit electricity to the heart.
If you think you have irregular heartbeats, contact a primary care physician or cardiologist who can identify a heart problem or condition. Call 1-855-411-LWNY (5969) or visit chpnyc.org.