A cardiac arrhythmia happens when your heart is beating (or contracting) in an irregular pattern. At one time or another, you’ve probably learned to place your fingers gently against your carotid artery in your neck to feel your pulse or heart beating. Usually, you can feel a steady pattern of beats as you count. But if you have an arrhythmia, the pulse or rhythm of your heart may be unpredictable or too fast or too slow.
There are many kinds of arrhythmias, but I’d like to explain a very common and typically benign kind we often see patients for: premature heartbeats. Premature heartbeats are just that – a contraction that comes early and breaks the steady rhythm of the heart. It causes the succeeding heartbeat to be stronger, and it’s this beat (or beats) that people suddenly feel.
The sensation can be alarming. We get calls and see people for a variety of symptoms: they may feel just a single, occasional beat or a series of running beats. Usually, the beats come quickly and they’re gone, even though the feeling – a thumping, fluttering or even a quick pain – can be scary indeed!
Having premature heartbeats is actually quite common, especially for women and particularly so around menopause. There’s no known link to family history that helps predict who will experience them. Power boost drinks seem to cause a rise in arrhythmias, as caffeine in general can be a trigger along with nicotine, anxiety and hot flashes; keep in mind, though, that there’s not always an obvious cause.
If you should experience these sensations, we like to have you come in so we can listen to your heart and perhaps perform an EKG to check from where the irregular beats are originating, either the atria, the two upper chambers of the heart, or the ventricles, the two lower chambers of the heart. As EKGs only measure a short moment in time of your heart’s activity, sometimes we may also outfit you with a holter monitor that records your heart’s rhythm for 24 or 48 hours.
Once we know what kind of heartbeats you’re having, we can determine what our next step should be. If we find it’s just a few beats here or there from the atrium, we usually won’t do anything since this is not dangerous. It’s still worthwhile to be evaluated, however, as sometimes the anxiety of the sensation can trigger more, so peace of mind is important. I did have one patient recently who could feel a number of extra beats over several minutes that were finally measured on a holter monitor. Even though the beats originated in the atrium, there were enough of them to warrant medication to slow down that part of the heart. The patient feels much better now, and the symptoms have gone away.
We are more concerned when premature beats come from the ventricles. If the arrhythmia originates in the ventricles and if there are just a few here and there, there may be no cause for concern or for additional treatment such as medication. However, if you experience long runs of extra beats in the ventricles, it will most likely affect how you feel – dizzy spells, even fainting, tightness in the chest and shortness of breath – and your overall health, as the ventricles are pushing out blood to the body, and if that process is disrupted, your body’s nourishment supply is also getting disrupted.
If I have a patient in the office who is experiencing a run of ventricular beats and I can see them on an EKG, I have the additional option here at Harvard Vanguard to call a cardiologist in addition to the patient’s primary care doctor to assess what our next move should be in treating that patient.
So what should you do if you feel these heartbeats? First, check your pulse. If you feel an occasional skip, it’s probably okay, but if your heart is going through long periods where you cannot predict a steady pattern of beats, it’s probably best to be evaluated. Remember, though: regardless of what you can measure in terms of beats, the most important criterion is how you feel. Dizzy spells, chest pain or tightness, or shortness of breath are all reasons to call your health care provider immediately.
If you are getting panicky and having anxiety about the sensations you are having, you probably don’t feel well either. I tell people to do the modern version of “breathing into a paper bag” by breathing into their shirt or sweater. It will help you slow down your breathing and calm down to better evaluate the source of your symptoms.
Some of my patients have asked me if arrhythmias lead to a heart attack. The answer is “not really.” Sometimes they are an indicator of an enlarged heart or a valve or structural problem of the heart that could lead to a heart attack if left untreated. Therefore, arrhythmias may be a symptom of a greater problem and a good early warning system to be evaluated.