Cardiac Arrhythmia 101: Everything You Need to Know About Heart Rhythm Disorders

Table of contents

  • Introduction
  • What is arrhythmia?
  • What are the types of arrhythmias?
  • How serious is a heart arrhythmia?
  • What are its symptoms and causes?
  • What are the risk factors for arrhythmia?
  • How common is arrhythmia?
  • Diagnosis and Tests
  • Management and Treatment
  • Prevention
  • FAQs
  • Conclusion 
Key Takeaways

1. Cardiac arrhythmia is characterised by irregular heartbeats, where the heart may beat too fast, too slow, or in an erratic pattern.

2. Some arrhythmias can be dangerous. Seek medical help if you suspect or are diagnosed with cardiac arrhythmia.

3. Lifestyle changes, along with medications, procedures or implant devices can help effectively manage arrhythmia. 

Introduction

Ever wondered how and why your heart beats?

Your heart has a natural pacemaker known as the sinoatrial (SA) node. The SA node generates electrical impulses, which cause the heart to beat rhythmically. Your heartbeat normally increases during exercise and decreases during resting or sleep. Your heart needs to beat in rhythm because it needs to pump blood with nutrients and oxygen to all parts of the body efficiently.

Cardiac arrhythmia which impacts your heartbeat, is often a silent condition. Arrhythmias can be benign (harmless) or malignant (dangerous).

An image showing arrhythmia ECG reading along with a heart 

What is arrhythmia?

Cardiac arrhythmia is a heart condition characterised by irregular heartbeats. 

Arrhythmias can arise from abnormalities either in the generation of electrical impulses, their conduction through the heart, or a combination of both factors. 

  • Abnormal Impulse Generation: Arrhythmias can occur due to the generation of abnormal electrical impulses within the heart. This can be caused by cells outside the normal pacemaker regions (like the SA node) firing spontaneously or by certain triggers initiating irregular electrical activity. 
  • Conduction Disturbances: Arrhythmias may also occur when the generated electrical impulse is not transmitted normally within the heart, either due to abnormal electrical circuit formation or delays in the transmission of electrical impulses. 

What are the types of arrhythmias?

In a normal healthy adult, the heart rate is about 60 to 100 beats per minute in the resting stage. Deviations from this range, either above or below, may indicate arrhythmia. 

Cardiac arrhythmias can be broadly classified as:

  • Tachycardia is when the heart rate is more than 100 beats a minute.
  • Bradycardia is when the heart rate is less than 60 beats a minute.
  • An extra or premature heartbeat is where the electrical signal to beat comes before it is expected.

Arrhythmias can also be classified into two types, based on their origin:

  • Supraventricular arrhythmias (SVT)
    • Such arrhythmias begin above the ventricles (lower chambers of the heart), usually in the atria (upper chambers).
    • They mostly cause the heart to beat too fast.
    • SVTs are generally not life-threatening.
    • Examples of such arrhythmia include atrial flutter, atrial fibrillation, Atrioventricular nodal re-entrant tachycardia, and sinus tachycardia.
  • Ventricular arrhythmias (VT)
    • Such arrhythmias originate in the ventricles, the two lower chambers of the heart.
    • VTs pose a greater risk of causing serious harm as they can reduce the flow of oxygen-rich blood to the heart.
    • VTs are more unstable, increasing the likelihood of sudden cardiac death.
    • Examples include ventricular tachycardia and ventricular fibrillation.

How serious is a heart arrhythmia?

Your doctor is the best person to understand if you are having any serious cardiac rhythm issues.  

Some arrhythmia types are harmless and do not require any treatment. 

However, many other types of cardiovascular arrhythmia if left untreated can become life-threatening. It can lead to serious complications such as 

  • Blood clots, causing strokes (blood supply to the brain is disrupted)
  • Weakening of the heart’s muscle and failure of its pumping abilities lead to conditions such as heart failure and sudden cardiac death

What are its symptoms and causes?

In some patients, arrhythmias do not show any symptoms at all. Others may complain of

  • A faster or a slower heartbeat
  • Racing feeling in the heart
  • Difficulty in breathing
  • Anxiety
  • Chest pain
  • Sweating
  • Tiredness
  • Dizziness
  • Fainting

Arrhythmias usually happen when there is a problem with the heart's structures, namely its arteries, valves, or muscles. Other arrhythmia causes may include

  • Heart issues such as blocked arteries, high blood pressure, injury post heart attacks, diabetes, etc
  • Genetics
  • Mineral imbalances of the blood
  • Post heart surgery
  • Other medical conditions 

What are the risk factors for arrhythmia?

The most common risk factors include

  • Progressing age
  • Family history or genetics
  • Previous heart surgeries or heart problems
  • Heart problems present at birth
  • Hypertension
  • Excessive alcohol or illicit drug use
  • Smoking
  • Stress or anxiety
  • Electrolyte imbalances
  • Thyroid, lung or kidney issues 
  • Sleep apnoea
  • Obesity
  • Viral infections such as COVID-19
  • Some medications such as those prescribed for cough and cold

How common is arrhythmia?

Arrhythmia impacts about 1.5 to 5% of the world’s population. According to the Global Burden of Disease study 2019, atrial fibrillation, the most common type of cardiac arrhythmia affects about 3.3 crores people worldwide.

How are arrhythmias diagnosed?

Your doctor will ask you about your past medical history and symptoms.  He/she will also carry out a thorough physical examination, including checking your heart, listening for irregularities and observing symptoms. The doctor may order one or more of the following tests to determine the best course of action for your care.

  • Blood tests to check for electrolyte imbalance or genetic issues.
  • An electrocardiogram (EKG or ECG) that records your heart's electrical activity.
  • Holter Monitor, a portable device for continuous EKG monitoring over 24 to 48 hours.
  • Event Monitor to record the heart activity when you experience symptoms.
  • An echocardiogram uses sound waves to create a detailed image of the heart.
  • Stress Test to measure the heart function during physical activity.
  • Electrophysiology Study (EPS) is an invasive test to study the heart's electrical system.

How are arrhythmias treated?

Your treatment plan will depend on the type of arrhythmia, its severity, and your overall health. Your doctor will guide you on the most suitable approach for your situation. Treatment may consist of: 

  • Lifestyle changes such as managing blood pressure, maintaining ideal weight, quitting alcohol and smoking, etc.
  • Medications to control the heart rate, prevent arrhythmias and reduce the chances of blood clotting.
  • Therapies to improve your heart's rhythm.
    • Cardioversion: Uses electrical impulses to restore normal heart rhythm.
    • Catheter Ablation: High-frequency electrical energy is used to destroy the tissues causing abnormal rhythm.
    • Pulmonary Vein Isolation: Creates scar rings around the pulmonary veins entering the heart. This blocks abnormal electrical signals.
  • Implant devices that work to keep your heart beating normally.
    • Permanent Pacemaker: Sends tiny electrical signals to keep your heart beating regularly and at the right speed.
    • Implantable Cardioverter Defibrillator (ICD): Monitors your heart rhythm and fixes fast or irregular rhythms, especially those that can be life-threatening.
    • Biventricular Pacemakers and Defibrillators (CRT): Helps coordinate the contraction of your heart's left side.
Implantable Cardioverter Defibrillator 
  • Surgery
    • To fix heart issues causing the rhythm problem.
    • To correct arrhythmias that do not get better with medicines or other treatments.
    • To place implant devices.

Can you lower your risk of arrhythmia? 

You can lower your risk of cardiovascular arrhythmias by:

  • Managing your blood glucose and pressure within normal range
  • Maintain a healthy weight
  • Treating sleep apnoea
  • Stopping smoking and drinking alcohol
  • Avoiding caffeine 
  • Using cough medications cautiously 

FAQs

How can I count my heartbeat?

Several smartwatches or mobile apps are available that can help you measure your heartbeat. Alternatively, you can check your heartbeat rate by palpating your pulse. To count your heartbeat, place your index and middle fingers on your wrist (radial artery) or neck (carotid artery). Feel for the pulse and count the number of beats you feel in one minute. 

What situations may trigger arrhythmias, especially for individuals with risk?

Arrhythmias can be triggered by certain situations, especially if you have risk factors. Triggers may involve:

  • High or low blood sugar levels 
  • Caffeine, illegal drugs and certain medications 
  • Dehydration
  • Low levels of electrolytes like potassium, magnesium, or calcium
  • Physical activity
  • Intense emotional stress, anxiety, anger, pain, or sudden surprises
  • Vomiting or coughing

What is atrial fibrillation? 

Atrial fibrillation is one of the most common types of arrhythmias where the upper chambers of the heart (atria) beat irregularly and too fast. It increases the risk of complications such as stroke, so it requires medical attention and management.

What is CPR? How can it help in arrhythmia? 

CPR, or Cardiopulmonary Resuscitation, is a life-saving technique. It involves chest compressions and rescue breaths to maintain blood circulation and provide oxygen to the body when a person's heart has stopped beating suddenly due to a severe arrhythmia. CPR helps to buy time during a heart emergency, increasing the chances of survival until medical help is available.

Can I exercise if I have arrhythmia? 

Exercise is good for your heart. However, it is important to ensure that your workout plan is safe and appropriate for your condition. Always seek your doctor’s advice to determine the most appropriate exercise plan suitable for you. Your doctor may also recommend monitoring your heart rate during exercise.

Conclusion

Understanding and managing cardiac arrhythmias is crucial for proper heart functioning. Remember, if you or someone you know experiences symptoms, seek prompt medical attention. Additionally, embracing a heart-healthy lifestyle and monitoring your risk factors, plays a significant role in managing arrhythmias. 

Download our Aware Health app today to monitor and manage your heart health effortlessly. Your heart deserves the best care, and it starts with being aware.

About the Author
Dr. Satish Madiraju, a renowned cardiologist is passionate about consumer heart health and is on a mission to prevent a million heart attacks. He shares his expertise not only on heart health but also on leadership, digital health, and improving patient experience.
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