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Have you ever become aware of your heartbeat or felt a fluttering in your chest? Doctors call that a heart palpitation. Heart palpitations are common and they’re usually not a medical problem. They might occur after you finished a strenuous workout or if you’ve had a little too much caffeine. OK, or after you see your daughter in a wedding gown or your newborn grand-daughter for the first time!
However, sometimes palpitations are a symptom of an abnormal heart rhythm. That’s what we call a heart arrhythmia.
An arrhythmia is a problem with the heart’s electrical system that causes abnormal synchronization among the different parts of the heart’s pumping system and therefore blood might not flow effectively to other parts of the body.
Besides palpitations, other symptoms of an arrhythmia are dizziness, passing out, shortness of breath, chest pain, weakness or fatigue. If you experience these symptoms in addition to heart palpitations, you should see your doctor right away.
There are many types of arrhythmias; in one of the annoying but not dangerous ones, your heart produces occasional extra beats. In another, potentially more serious, the heart beats too slowly. Dangerous arrhythmias include those in which the upper or lower chambers of the heart beat too fast and out of coordination with the rest of the system. These are called tachyarrhythmias and include atrial fibrillation, where the upper chambers of the heart beat too fast and irregularly. In ventricular tachyarrhythmias, the lower chamber is involved and cardiac arrest is often the result. Your heart’s electrical signals are disorganized and pumping suffers in these situations.
Some arrhythmias present symptoms while others don’t—it’s possible to be diagnosed with an arrhythmia without ever feeling a fluttering in your heart.
If you think you might have an arrhythmia, you could be diagnosed several different ways.
Your primary care doctor may refer you to a cardiologist or a doctor who specializes in heart arrhythmias called an electrophysiologist.
The specialist may first ask you about your symptoms, your own medical history and whether you have a family history of heart disease, high blood pressure or arrhythmias. Then, the cardiologist or electrophysiologist will conduct a physical exam to listen to your heartbeat, test your pulse and check for signs of other disease.
Beyond just listening to your heartbeat and testing your pulse, we typically do one of several tests to diagnose an arrhythmia, depending on your symptoms and family history:
Electrocardiogram
An Electrocardiogram (EKG or ECG) measures the size and timing of your heart’s electrical signals as they move through the heart’s rhythm-setting system of specialized cells and fibers. During the test, small electrodes are placed on the body and electrical signals are recorded.
Many arrhythmias are intermittent and people don’t experience symptoms all the time. If you don’t have the arrhythmia while an EKG is being done, they can’t be recorded.
Wearable monitors
In this case, your doctor might recommend a long term recording of your EKG with a wearable device. One of these is called a Holter monitor, which is a small EKG monitor worn for a few days to continuously record the electrical signals of your heart. When I started in medicine these were clunky tape recorders carried in big pouches around your neck. Now some are tiny solid state devices as small as a large Band-Aid.
While you’re wearing a Holter monitor you should write down what’s happening when palpitations develop so your team can match symptoms with activities that might provoke or worsen the electrical issue. Knowing if you’re sitting, walking or exercising when things go wrong is a big help.
Electrophysiology study
If your doctor suspects you have a serious arrhythmia, she might want to conduct an electrophysiology (EP) study to map the electrical signals of your heart. During an EP study, small catheters are threaded through a vein in your groin up to your heart.
Once the catheters are in place, electrical impulses stimulate your heart and we monitor the way these signals are transmitted through the heart. This allows us to sort out the specific abnormalities involved with your arrhythmia. In some cases, your doctor will use anti-arrhythmia medicines during the study to see if they steady your heartbeat.
Echocardiogram
An echocardiogram uses sound waves to take a moving picture of your heart. During this test, your doctor can see the size and shape of your heart, as well as how it’s contracting and expanding and how blood flows from your heart.
Other tests
Depending on your symptoms and family history, your doctor may recommend blood tests or an X-ray to help diagnose your arrhythmia.
The type and severity of your arrhythmia determines how it should be treated. In some cases, medication to slow or regulate your heartbeat can be prescribed. Other medications like blood thinners can prevent blood from clotting inappropriately during the abnormal rhythms.
In other cases, an arrhythmia is treated with a pacemaker, with a jolt of electricity to the heart to resynchronize it or with catheter ablation, which is a heart treatment where the tissue that starts an arrhythmia is destroyed.
We’ll talk more about these marvels in the next few weeks.
