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Did Your Heart Skip A Beat? All About Arrhythmias

All about Arrhythmias

Arrhythmias can be scary, and it’s important to know exactly what they mean. If you feel like there is something wrong with your heartbeat, or if you experience an arrhythmia that seems serious, unexpected, or accompanied by giddiness or chest pains, call emergency services or visit the A&E department.

Otherwise, read on for everything you need to know about irregular heartbeats.

What is an arrhythmia?

Usually, your heart beats at a regular rhythm, controlled by electrical activity in your body. The sinus node in your heart monitors how much blood your body needs, and sends electrical impulses that cause the chambers of your heart to contract at the correct pace for your body’s needs. Most people have a resting heart rate of 60 to 100 beats per minute, which speeds up during exercise or stressful situations. That’s completely normal. An arrhythmia is a change in this rhythm, when your heart beats too fast, too slow or at an irregular pace.

What are the different types of arrhythmia?

Arrhythmias are either ventricular (starting in the lower ventricles of the heart) or supraventricular (starting outside or above the ventricles, usually in the atria, the upper chambers of the heart). Common types of arrhythmia include:

Premature atrial contractions: Also known as PACs or APCs, these are extra beats in the heart’s upper chambers.

Premature ventricular contractions: Also known as PVCs, these are very common, and are ‘skipped’ heartbeats caused by the ventricles contracting too soon.

Supraventricular tachycardia or paroxysmal supraventricular tachycardia: Known as SVT or PSVT, where paroxysmal means occasional, this is a rapid heartbeat of 150 – 250 beats per minute, caused by electrical impulses in the atria.

Ventricular tachycardia: Known also as V-tach, this is a rapid heart rate starting from the lower heart, where the heart is unable to fill up with enough blood.

Atrial fibrillation: This is a fast, irregular heart rhythm where the muscles or fibres in your heart twitch and contract.

Ventricular fibrillation: This is a medical emergency where the heart’s lower chambers can’t contract to pump blood.

Atrial flutter: This is similar to atrial fibrillation, but more regular. The misfired electrical signals causing an irregular heartbeat and atrial flutter often lead to atrial fibrillation.

Accessory pathway tachycardia: This is a rapid heart rate due to an extra pathway between your heart’s chambers.

Bradyarrhythmia: This is a slow heart rhythm usually caused by issues with your body’s electrical system.

Heart block: This is a problem with the speed of the impulses being sent through your heart, and in some cases a block of the impulses altogether, causing irregular heartbeats.

Symptoms of an arrhythmia

Depending on the type of arrhythmia, you might experience the following symptoms:

  • Heart palpitations, which feel like fluttering, skipped or extra beats
  • A pounding sensation
  • Chest pain
  • Tightness in your chest
  • Shortness of breath
  • Fainting

Possible causes

Most people will experience the sensation of a missed heartbeat or a random extra heartbeat at some point without explanation, and without any real risk to their health. However, if this happens to you often, for an extended period of time, or in conjunction with other symptoms, there may be an underlying issue.

Arrhythmias can be caused by stress, an infection or fever, medication and other stimulants like drugs or alcohol, but they may also signal heart disease. You might be suffering from some of the previously mentioned electrical disorders, such as atrial fibrillation or heart block, alone or alongside other serious heart conditions. Some patients suffer from something known as long QT syndrome, an electrical disorder that is often inherited, and can trigger sudden and severe arrhythmias.

In other cases, it may be due to sick sinus syndrome, a group of symptoms that demonstrate the sinus node in your heart is not functioning correctly. Arrhythmias can also be caused by structural issues with your heart, or congenital heart defects. In some instances, they can also be caused by problems outside of the heart, such as:

  • High blood pressure
  • Thyroid disorders
  • Lung disease
  • Diabetes
  • Surgery
  • Other acute illnesses

Diagnosis of arrhythmias

It is vital to see a doctor if you are suffering from arrhythmias regularly. Your doctor will perform tests to find out why your heart is not performing as it should. You might undergo:

An echocardiogram: This is a type of ultrasound to look at the structure of your heart.

An electrocardiogram: Also known as an EKG or ECG, this test records any electrical activity occurring in your heart.

A stress test: Sometimes doctors will ask you to walk or run on a treadmill or exert yourself in some way while monitoring your heart rate.

At-home monitoring: Doctors may have you wear a heart monitor for a period of time to record how your heart performs day-to-day.

A cardiac catheterisation: This is the insertion of a catheter to inject dye into your heart, which is then viewed on an ultrasound.

It is important to remember that if you are suffering from an arrhythmia that seems severe or unexpected, or accompanied by dizziness or chest pains, you should not wait to visit a doctor. Instead, call emergency services or visit the A&E department.

Treatment for arrhythmias

The treatment your doctor prescribes for your arrhythmia will be specific to you and your condition. You may only require medication to control your symptoms, but in some cases more intervention may be necessary.

Doctors might perform electrical cardioversion, which is an electrical shock to the chest wall to rest your heart rhythm. If a more long-term solution is required, you might have a pacemaker fitted, which is a small device that sends electrical impulses to the heart to keep it regular. In extreme cases, you may require an implantable cardioverter defibrillator, which tracks your heart rate and delivers an electric shock to restore the heart’s rhythm when it beats too fast, too slow, or unevenly. Finally, doctors might decide that heart surgery is the best option to resolve your symptoms, but this is usually a last resort.

Keeping a healthy heart

It is important for everyone to keep their heart as healthy as possible, even if they are not experiencing heart problems. Getting plenty of moderate exercise, cutting out cigarettes, maintaining a healthy weight and eating a fresh balanced diet are all easy ways to keep your heart in top condition. Try to eat plenty of heart-healthy foods like whole grains, fruit and vegetables, legumes like black beans or chickpeas, and lean proteins. Avoid processed food or food high in trans fats. Looking after yourself will give you and your heart the best chance of preventing arrhythmias and heart disease.

Article reviewed by Dr Hsu Li Fern, cardiologist at Mount Elizabeth Novena Hospital


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