When Should I Be Worried About an Irregular Heartbeat?

Reviewed on 1/24/2022
An electrocardiogram showing an irregular heartbeat
You should see a doctor right away if you have an irregular heartbeat (arrhythmia) and lightheadedness/fainting, chest pain, difficulty breathing, dizziness, swelling in your leg, symptoms persist or frequently return, coronary artery disease, congestive heart failure, family history of heart disease, high blood pressure, or diabetes.

Irregular heartbeat (arrhythmia) refers to a change in the heart’s sequence of electrical impulses. Types of arrhythmias include:

  • Palpitations: heart rate is irregular
  • Tachycardia: heart rate is too fast (in adults, more than 100 beats per minute)
  • Bradycardia: heart rate is too slow (in adults, less than 60 beats per minute)
  • Atrial fibrillation (AFib): upper heart chambers contract irregularly
  • Ventricular fibrillation (VFib):  disorganized contraction of the lower chambers of the heart
  • Conduction disorders: heart does not beat normally
  • Premature contraction (PACs and PVCs): early heart beat

Complications of irregular heartbeat include: 

See a doctor right away if you have an irregular heartbeat and:

What Are Symptoms of Irregular Heartbeat?

Irregular heartbeat (arrhythmia) may not cause any symptoms or only minor symptoms such as feeling as if you skipped a heartbeat or feeling of fluttering in the chest or neck. 

When symptoms of irregular heartbeat occur, they may include:

  • Fatigue 
  • Weakness 
  • Dizziness 
  • Lightheadedness, fainting, or near-fainting spells 
  • Rapid heartbeat or pounding in the chest 
  • Shortness of breath 
  • Anxiety 
  • Chest pain or pressure 
  • In severe cases, collapse and sudden cardiac arrest 
    • Cardiac arrest is a serious medical emergency and can be fatal. 
    • If someone you know is experiencing any symptoms listed below call 911 and get to a hospital’s emergency department immediately. 
      • Sudden loss of responsiveness 
      • No normal breathing (not breathing at all or gasping for air)

What Causes Irregular Heartbeat?

Irregular heartbeat (arrhythmia) may be caused by:

  • Heart attack
  • Heart changes with age
  • Congenital abnormality of the heart’s electrical system
  • Inherited heart disease
  • Electrolyte abnormalities 

How Is Irregular Heartbeat Diagnosed?

Tests to diagnose the cause and type of irregular heartbeat (arrhythmia) include: 

  • Electrocardiogram (“ECG”) 
  • Stress test (treadmill test)
  • Echocardiogram (“echo”)
  • Electrophysiology test (EP study)
  • Esophageal electrophysiologic procedure
  • Tilt table test
  • Diagnostic monitors
    • Holter monitor
    • Transtelephonic monitor
  • Cardiac catheterization (“cardiac cath”) 
  • Magnetic resonance imaging (MRI) scan of the heart 
  • Computed tomography (CT) scan of the heart
  • Blood tests: brain natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) 

What Is the Treatment for Irregular Heartbeat?

Treatment for irregular heartbeat (arrhythmia) includes:

  • Medications  
    • Antiarrhythmics
      • Class I (fast sodium channel blockers) 
      • Class II (beta-blockers)
      • Class III (potassium channel-blockers)
      • Class IV (calcium channel blockers)
      • Class V (other)
    • Anticoagulants (blood thinners) such as warfarin
  • Ablation
  • Cardioversion
  • Implantable devices

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Reviewed on 1/24/2022
Image Source: iStock Images