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Arrhythmia (palpitations)

Arrhythmia is a disturbance of your heart’s usual electrical rhythm. Arrhythmias can happen at any age and mostly they aren’t serious.

Your heart pumps oxygen-rich blood all around your body through a network of blood vessels (arteries) to tissues including organs, muscles and nerves.

The heartbeat

The usual pattern of a heartbeat starts when an electrical impulse is produced by part of your heart called the sinus node. The impulse is conducted to the top chambers of your heart (the left atrium and right atrium). This causes them to contract, pushing your blood into two lower, larger chambers (the left and right ventricles). The electrical impulse is then transmitted to the ventricles causing them to contract. This pushes the blood out of your heart to your lungs and the rest of your body.

Your heart will usually beat between 60 and 100 times a minute when you’re resting. There are certain times when it may beat faster or slower than this, for example if you’re exercising or depending on how fit you are.

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An image showing the chambers and electrical conducting system of the heart

Details

  • Types of arrhythmia Types of arrhythmia

    • Sinus tachycardia. This is when your heartbeat is still regular, but faster than it should be. It’s normal in certain situations, such as during exercise or if you have a fever, but may also occur at other times for no obvious reason. Conditions such as an overactive thyroid gland or anaemia may cause sinus tachycardia. Although normal heart rate can reach 100 beats per minute (bpm) when you’re at rest, you may feel some discomfort if the rate is faster than you’re used to for a particular level of activity.
    • Sinus bradycardia. This is when your heartbeat is still regular, but slower than usual (fewer than 60 bpm). Bradycardia is common in athletes but can also occur if you’re exposed to the cold and have a low body temperature or are resting or sleeping. If your heart rate is extremely slow, you may feel dizzy or faint.
    • Ectopic beats. These are extra heartbeats but they don’t result in any blood being pumped from your heart. You feel an ectopic heartbeat as a missed beat and the next beat is then more powerful – you feel this as a thump. You may get ectopic beats every few beats or even every beat – this results in a slow, thumping rhythm (bigeminy). Ectopic beats are very common and rarely mean that you have a heart problem. They are most noticeable when you’re resting. See our frequently asked questions for more information.

    There are a number of different types of arrhythmia. Most arrhythmias that come from the top of your heart (supraventricular or atrial) can cause symptoms but tend to be less serious. Arrhythmias that arise from your ventricles (ventricular) can cause severe symptoms and can sometimes be fatal.

    Atrial fibrillation

    Atrial fibrillation is the most common type of arrhythmia and happens when the electrical impulses in your atria become disorganised, which overrides your heart’s normal rate and rhythm. This causes your atria to contract in an irregular manner or ‘fibrillate’. You may notice that your heartbeat feels uneven and it may be faster than usual. Attacks of atrial fibrillation can last from a few seconds to over a week, and can cause symptoms including:

    • palpitations – an unpleasant awareness of your heartbeat, often described as a thumping in your chest
    • tiredness – not being able to do as much physical activity as usual
    • breathlessness
    • dizziness or fainting
    • chest pain

    Atrial fibrillation can potentially lead to a blood clot forming in your heart – this is because your blood isn’t able to flow through properly. If a clot forms, it may travel to your brain and cause a stroke.

    Supraventricular tachycardia

    There are different types of supraventricular tachycardia (SVT) and most are caused by one or more extra electrical pathways in your heart, between the atria and the ventricles. This allows electrical impulses to ‘short-circuit’ and re-enter your atria instead of going to your ventricles. This means that the impulses end up travelling around your heart in a circle.

    SVT can make your heart beat very quickly, possibly 250 beats per minute or more. Attacks of SVT may only last for a few seconds but can last for several hours or, rarely, days.

    Ventricular tachycardia

    In ventricular tachycardia, the electrical impulses fire too quickly from your ventricles, causing blood to be pumped out faster than usual. Your ventricles may not have enough time to fill up properly with blood and this can sometimes cause your heart to stop pumping blood around your body (cardiac arrest).

    If the attack lasts for 30 seconds or more, it’s called sustained ventricular tachycardia. Ventricular tachycardia can progress to a condition called ventricular fibrillation.

    Ventricular fibrillation

    In ventricular fibrillation, electrical impulses start firing from multiple sites in your ventricles, very rapidly and in an irregular rhythm. This means your heart can’t beat properly and little or no blood will be pumped. Ventricular fibrillation is a type of cardiac arrest, which can be fatal. You will lose consciousness and your pulse and breathing will stop. A cardiac arrest needs urgent medical treatment – it’s vital to get emergency cardiopulmonary resuscitation (CPR) straight away.

    Heart block

    If you have heart block, it means there is a problem affecting how the electrical impulses are transmitted from your atria to your ventricles. There are different types of heart block – it can occur in your atrioventricular (AV) node or in the muscle fibres that lead into your ventricles. Your AV node is found between the upper and lower chambers of your heart. The symptoms of heart block vary and you may or may not need treatment depending on how severe they are.

    Tachy-brady syndrome

    In tachy-brady syndrome (also called sick sinus syndrome), your sinus node doesn’t function properly and causes your heart to beat slowly and then fast and abnormally. This can cause you to feel dizzy or collapse.

  • Symptoms Symptoms of arrhythmia

    Your symptoms will depend on the type and severity of your arrhythmia. How often you get them will also vary, ranging from every day to very infrequently, once or twice a year for example. With some types of arrhythmia you may not get any symptoms, but general ones include:

    • palpitations
    • dizziness
    • fainting or collapsing
    • breathlessness
    • chest pain
    • tiredness

    These symptoms aren't always caused by arrhythmia but if you have them, see your GP.

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  • Diagnosis Diagnosis of arrhythmia

    Your doctor will ask about your symptoms and examine you. He or she may refer you to a cardiologist (a doctor who specialises in identifying and treating conditions of the heart and blood vessels).

    Your doctor may do tests including:

    • blood tests
    • an electrocardiogram (ECG) – this records the electrical activity of your heart to see how well it’s working
    • a 24-hour heart monitor (ambulatory ECG) – this records the electrical activity of your heart over 24 hours or longer
    • an electrophysiological study – this determines if you have any extra electrical pathways in your heart that are causing an abnormal heart rhythm
    • an echocardiogram – this uses ultrasound (sound waves) to look at your heart’s structure, valves and pumping action
    • an exercise ECG – this can check for other problems with your heart and may trigger abnormal heart rhythms
  • Treatment Treatment of arrhythmia

    Your treatment will depend on the type, cause and severity of the arrhythmia that you have.

    Self-help

    Sometimes, such as with ectopic beats, you may not need any treatment because your arrhythmia is unlikely to cause serious problems. Try to steer clear of any triggers of your arrhythmia that you know about, such as alcohol or caffeine. Ask your GP for advice about exercising.

    Medicines

    Your doctor may prescribe medicines to help control your heart rhythm. These can include medicines to slow down your heart rate, such as beta-blockers, or antiarrhythmic medicines, such as amiodarone and flecainide – these work in different ways to control your heartbeat.

    If you have atrial fibrillation, you may be advised to take blood-thinning medicines, such as warfarin, to reduce your risk of blood clots forming.

    Procedures

    If you need to have surgery, the exact procedure you have will depend on your condition. Your doctor will advise you which one is most suitable for you.

    Cardioversion

    This may be carried out if you have atrial fibrillation. In this procedure, your doctor will apply a controlled electric shock to your chest from a machine called a defibrillator. This aims to help restore your heart to its usual rhythm. Cardioversion is usually done under general anaesthetic, which means you will be asleep during the procedure, but it can sometimes be done using only a sedative – this relieves anxiety and helps you to relax.

    Pacemaker

    Your doctor may suggest having a pacemaker if you have heart block or sinus node disease. A pacemaker is a small device, usually implanted under your skin in the upper part of your chest. Electrical signals are sent from the pacemaker to your heart to stimulate it to beat at a specific rate. Your doctor will usually fit your pacemaker under local anaesthesia – this will block pain from your chest area and you will stay awake during the operation.

    Catheter ablation therapy

    You may have this procedure for atrial fibrillation, supraventricular tachycardia or ventricular tachycardia. In this procedure, your doctor identifies the abnormal areas in your heart and then inserts a catheter into your heart, via a large vein in your groin. Heat or freezing treatment is used destroy the area that is causing the abnormal rhythm. The procedure is usually done under local anaesthesia.

    Ablation of the AV node

    If you have atrial fibrillation, it’s possible that your doctor will use catheter ablation to destroy your AV node. You will probably have a pacemaker fitted before the procedure is carried out.

    Implantable cardioverter defibrillator

    An implantable cardioverter defibrillator (ICD) is similar to a pacemaker. If your doctor thinks you may be at risk of a ventricular arrhythmia, you may be fitted with an ICD. This can monitor your heart rhythm and deliver a small electric shock to correct your heartbeat if it detects a problem. ICDs are usually fitted under local anaesthetic in the same way as a pacemaker.

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  • Causes Causes of arrhythmia

    An arrhythmia can be caused by a number of things. This includes certain conditions such as:

    • heart failure
    • heart valve disease
    • inflammation of your heart (myocarditis)
    • thyroid disease
    • diabetes
    • high blood pressure
    • a heart attack
    • coronary heart disease
    • chronic obstructive pulmonary disease (COPD)
    • Wolff-Parkinson-White syndrome – an electrical abnormality in the heart that can cause SVT and atrial fibrillation

    The risk of developing an arrhythmia increases as you get older, and you may also be more at risk if you’re pregnant or recently had heart surgery. Some types of arrhythmia may be caused by particular triggers, such as alcohol, caffeine, smoking tobacco or cannabis, and certain medicines. See our frequently asked questions for more information.

    Often it may not be possible to find a cause for your arrhythmia. It’s important to remember that having an arrhythmia doesn’t necessarily mean that you have a serious heart problem.

  • FAQs FAQs

    Sometimes my heart skips a beat and thumps. What is this and do I need treatment?

    Answer

    Sometimes it may feel as though your heart has missed a beat or thumped suddenly. This is likely to be an ectopic heartbeat. Ectopic beats don’t usually cause problems but very occasionally they can be a sign of a more serious condition.

    Explanation

    Usually your heartbeat originates in the sinus node in your heart. An ectopic beat occurs when an extra beat starts somewhere else in your heart – this happens before the usual beat can come from the sinus node. Ectopic beats are generally completely harmless and don’t usually need treatment. However, if you do find the ectopic beats worrying, you can be treated with a beta-blocker or other type of medicine. If the ectopic beats are very troublesome, you may be able to have a procedure to destroy the abnormal area of heart tissue.

    Ectopic heartbeats are very common and you may not notice if you have one. However, if you have any other symptoms, such as chest pain, see your GP.

    Very rarely, ectopic beats can be caused by an underlying problem such as:

    • thyroid disease
    • inflammation of your heart caused by a virus (myocarditis)
    • a problem with your heart muscle (cardiomyopathy)
    • heart valve disease

    If your ectopic beats are very frequent, or if you have other signs of heart disease, your GP may refer you to a cardiologist (a doctor who specialises in identifying and treating conditions of the heart and blood vessels).

    I think my medicine is affecting my heart rate – should I stop taking it?

    Answer

    No. Don’t stop taking a prescription medicine without speaking to your GP first. If you’re taking an over-the-counter medicine, ask your pharmacist for advice.

    Explanation

    Everyone has some variation in their heartbeat and you may occasionally feel a palpitation. A palpitation is an awareness of your heartbeat, often described as a thumping in your chest.

    An arrhythmia is a disturbance of the usual electrical rhythm of your heart. You may get an arrhythmia regularly or just occasionally.

    Arrhythmias can be caused by taking certain medicines, such as those listed below.

    • Beta-blockers, which are used to treat some heart conditions, can cause a very slow heartbeat.
    • Some calcium-channel blockers (especially verapamil and diltiazem), which are mainly used to treat high blood pressure, slow down your heart rate and can lead to symptoms such as dizziness.
    • Levodopa, a medicine used to treat Parkinson’s disease, can cause sinus tachycardia.
    • Beta-2 agonists (such as salbutamol) that are used to treat asthma can cause tachycardia and arrhythmia.
    • Some over-the-counter cough and cold medicines that contain pseudoephedrine hydrochloride (for example Sudafed) can cause tachycardia. If you have a heart condition or blood pressure problems, be careful about using over-the-counter cold remedies. Always read the patient information that comes with your medicine and if you have any questions, ask your GP or pharmacist for advice.

    Often these medicines only cause arrhythmias if you already have a heart problem, such as having had a heart attack or previous arrhythmia. It’s rare that they cause arrhythmias in people who don’t have heart problems.

    It’s also possible that medicines that are prescribed to treat an arrhythmia can actually make it worse.

    Always read the patient information leaflet that comes with your medicine, and if you think your medicine is causing an arrhythmia, speak to your doctor or pharmacist for more advice.

    Can I drive a car or motorcycle if I have an arrhythmia?

    Answer

    The rules about whether or not you can drive if you have an arrhythmia are complicated and vary depending on what type you have. You will probably be able to drive a car or motorcycle as long as you don’t have any symptoms but it’s important to check. If you have a procedure to treat your arrhythmia, you will need to stop driving for a while. How long you have to wait before driving again will depend on the procedure and how well you recover.

    Explanation

    If you have an arrhythmia, it’s possible that you will be able to drive as long as you don’t have any symptoms that could distract you when you’re driving. You must stop driving if your arrhythmia causes any symptoms, such as dizziness or breathlessness. See your doctor for advice as you may need to change your treatment. Once your symptoms have been under control for at least four weeks you may be able start driving again, but you should discuss this with your doctor.

    If you have a procedure to treat your arrhythmia, you won’t be able to drive for some time depending on what treatment you had. How long you have to stop driving for can range from a week to several months, and will also vary according to how severe your condition is and whether or not you have other conditions that may prevent you from driving. Not driving until it’s confirmed that your arrhythmia is under control means that you won’t be putting yourself or other drivers in danger.

    The rules about driving if you have an arrhythmia are different if you drive a lorry or are responsible for passengers. If you’re in any doubt about driving, always follow your doctor’s advice and contact your motor insurer so that you’re aware of their recommendations.

  • Resources Resources

    Further information

    Sources

    • Know your pulse. Arrhythmia Alliance. www.heartrhythmcharity.org.uk, accessed 23 January 2013
    • Runge MS, Greganti MA. Netter’s Internal Medicine. 2nd ed. Philadelphia: Saunders; 2009
    • Bradycardia. Arrhythmia Alliance. www.heartrhythmcharity.org.uk, accessed 23 January 2012
    • Abnormal heart rhythms. British Heart Foundation. www.bhf.org.uk, accessed 23 January 2013
    • Categories of arrhythmias. Texas Heart Institute. www.texasheartinstitute.org, published August 2012
    • Atrial fibrillation. British Heart Foundation. www.bhf.org.uk, accessed 23 January 2013
    • Atrial fibrillation. Prodigy. www.prodigy.clarity.co.uk, published August 2009
    • Reentrant supraventricular tachycardias (SVT, PSVT). The Merck Manuals. www.merckmanuals.com, published November 2012
    • Colucci RA, Silver MJ, Shubrook J. Common types of supraventricular tachycardia: diagnosis and management. Am Fam Physician 2010; 82(8):942–52. www.aafp.org
    • Conditions. American Heart Association. www.heart.org, accessed January 2013
    • Ventricular tachycardia (VT). The Merck Manuals. www.merckmanuals.com, published July 2012
    • Ventricular fibrillation (VF). The Merck Manuals. www.merckmanuals.com, published July 2012
    • Sinus node dysfunction. The Merck Manuals. www.merckmanuals.com, published July 2012
    • Overview of arrhythmias. The Merck Manuals. www.merckmanuals.com, published November 2012
    • Abnormal heart rhythms. British Heart Foundation. www.bhf.org.uk, accessed 24 January 2013
    • For patients – arrhythmias. Scottish Intercollegiate Guidelines Network (SIGN), 2007. www.sign.ac.uk
    • Arrhythmia treatments. University of Maryland Medical Center. www.umm.edu, accessed 24 January 2013
    • Glossary of terms. AV node ablation (AVNA). University of Southern Carolina Keck School of Medicine. www.cts.usc.edu, accessed 24 January 2013
    • Ectopic heart beats. Atrial Fibrillation Assocation. www.atrialfibrillation.org.uk, published January 2010
    • Beta-blockers – blood pressure medication. Blood Pressure UK. www.bloodpressureuk.org, published May 2009
    • Your medicines explained. British Heart Foundation. www.bhf.org.uk, accessed 29 January 2013
    • Joint Formulary Committee. British National Formulary. 64th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012
    • For medical practitioners. At a glance guide to the current medical standards of fitness to drive. Drivers Medical Group. www.dft.gov.uk/dvla, published May 2012
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