Understanding Abnormal Heartbeats (Arrhythmias)

Introduction

An abnormal heartbeat, medically referred to as an arrhythmia, occurs when the heart beats too fast, too slow, or irregularly. While some arrhythmias are harmless, others can indicate serious conditions that require medical attention.

How the Heart Beats Normally

The heart has its own electrical system that controls the rhythm of its beats. This system starts in the sinoatrial (SA) node, which acts as the heart’s natural pacemaker. Electrical signals travel through the heart, coordinating contractions and ensuring a steady rhythm.

Types of Arrhythmias

  1. Tachycardia (Fast Heart Rate) – More than 100 beats per minute (bpm)

    • Supraventricular Tachycardia (SVT) – Rapid heartbeats originating from above the ventricles
    • Atrial Fibrillation (AFib) – An irregular, chaotic rhythm in the upper chambers (atria)
    • Ventricular Tachycardia (VT) – A fast rhythm originating from the lower chambers (ventricles), which can be life-threatening
  2. Bradycardia (Slow Heart Rate) – Fewer than 60 bpm

    • Sinus Bradycardia – A naturally slow heartbeat, often seen in athletes
    • Heart Block – A problem with electrical signaling between the atria and ventricles
  3. Irregular Heartbeats

    • Atrial Flutter – A milder form of atrial fibrillation with a more organized rhythm
    • Premature Ventricular Contractions (PVCs) – Extra heartbeats that disrupt the regular rhythm

Causes of Arrhythmias

  • Heart disease (e.g., coronary artery disease, heart attack)
  • High blood pressure
  • Electrolyte imbalances (potassium, sodium, calcium)
  • Too much caffeine, alcohol, or smoking
  • Certain medications (e.g., beta-blockers, decongestants)
  • Stress and anxiety
  • Genetic predisposition

Symptoms to Watch For

  • Palpitations (a fluttering or pounding feeling in the chest)
  • Dizziness or fainting
  • Shortness of breath
  • Chest pain or discomfort
  • Fatigue or weakness

Diagnosis

Doctors use the following tests to diagnose arrhythmias:

  • Electrocardiogram (ECG or EKG) – A test that records the electrical signals of the heart
  • Holter Monitor – A portable ECG worn for 24-48 hours
  • Echocardiogram – An ultrasound scan of the heart
  • Stress Test – Monitoring heart activity during exercise
  • Electrophysiological Study (EPS) – A detailed study of heart rhythms using a catheter

Treatment Options

  • Lifestyle Changes: Reducing stress, avoiding caffeine, quitting smoking
  • Medications: Beta-blockers, antiarrhythmic drugs, blood thinners (for AFib)
  • Pacemakers: To regulate slow heart rates
  • Implantable Cardioverter-Defibrillators (ICD): For life-threatening arrhythmias
  • Catheter Ablation: Destroying abnormal electrical pathways in the heart

Prevention and Outlook

While some arrhythmias are harmless, others require treatment to prevent complications such as stroke or heart failure. Managing risk factors like hypertension, diabetes, and high cholesterol is essential for heart health.

If you experience palpitations or symptoms of irregular heartbeats, consult a cardiologist for evaluation.

Source recommendations

1. American Heart Association Guidelines on Arrhythmias

  1. https://www.heart.org/en/health-topics/arrhythmia
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
  3. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia
  4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000549
  5. https://pubmed.ncbi.nlm.nih.gov/29084733/

2. European Society of Cardiology Guidelines on Arrhythmias

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Supraventricular-Tachycardia
  4. https://pubmed.ncbi.nlm.nih.gov/36017572/
  5. https://www.ahajournals.org/doi/10.1161/01.cir.0000091380.04100.84

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