UPMC Electrophysiologist: When is an Irregular Heartbeat a Concern?

Our hearts are amazing organs, and we can often take them for granted. They steadily pump away, rhythmically beating life into our bodies. But what happens when your heartbeat becomes irregular, erratic, or even skips a beat? These incidents are called heart palpitations, and for most people, heart palpitations are a once-in-a-blue-moon occurrence. However, some may have dozens of these heart flutters a day, sometimes so intense that they are mistaken for a heart attack.

A recurring abnormal heartbeat is often due to an underlying abnormal heart rhythm known as an arrhythmia. It is therefore important to have heart palpitations evaluated by a medical professional. Most palpitations are caused by a harmless hiccup in the heart's rhythm. But these minor hiccups may be a sign of a problem in the heart or elsewhere in the body.

During an arrhythmia, the heart either beats too slow (bradycardia), too fast (tachycardia), or irregularly (atrial fibrillation). Almost everyone experiences an occasional skipped heartbeat, fluttering, or racing heartbeat. While most events are harmless, some people have arrhythmias that are bothersome and sometimes dangerous.

Diagnosis and Treatment
Palpitations and arrythmias can appear out of the blue and disappear just as suddenly. They can be linked with certain activities, events, or emotions and have various other triggers including dehydration, low blood sugar, and too much alcohol or caffeine. The problem with diagnosing palpitations or arrythmias is that the noticeable rhythm change and symptoms usually subside by the time you get to the doctor's office. One of the most helpful pieces of information is your story of how your heart palpitations feel, how often and when they strike, so be sure to record that information for your doctor.

A physical exam may reveal some signs as to what is causing your heart condition. Your doctor may hear a murmur or other sound when listening to your heart that suggests a problem with one of the heart's valves. Your doctor may also order blood tests if he or she suspects a thyroid imbalance, anemia, low potassium, or other problems that can cause or contribute to heart rhythm disorders.

An electrocardiogram (ECG) is a standard tool for evaluating the heart’s rhythm. This recording of your heart's electrical activity shows the heart's rhythm and any overt or subtle disturbances, but only over the course of 10 seconds or so. Your doctor may order additional testing to record your heart for longer periods of time using a mobile ECG called a Holter monitor. These units are battery powered and worn on the body for 24 to 48 hours, sometimes longer, so that your doctor can see and compare your heart activity throughout the period.

If your palpitations or arrythmia comes with chest pain, your doctor may want you to have an exercise stress test. An exercise stress test is used to determine how well your heart responds during times when it's working its hardest. During the test, you'll be asked to exercise — typically on a treadmill — while you're hooked up to an electrocardiogram (EKG) machine. This allows your doctor to monitor your heart rate.
 
With early intervention, you and your doctor may be able to reduce your risk for stroke, blood clots, and other heart-related complications due to heart rhythm disorders. Treatments come in a variety of forms depending on the cause and seriousness of your condition. Some people benefit from simple lifestyle modifications and at-home therapies such as deep breathing and meditation, while others may require medications, medical devices such as pacemakers or defibrillators, or surgical procedures.

Medicines can slow your heart rate or reduce the risk of clots. Cardioversion uses electricity to instantly shock the heart back into a normal rhythm, but the irregular heart rhythm may still return. An ablation is more invasive but often helps maintain a normal heart rhythm long term. This minimally invasive procedure uses a catheter to access the heart through a vein in your leg to burn (or freeze) the tissue that is causing the abnormal heart rhythm. Implanted devices, such as pacemakers, defibrillators, and the Watchman™, are also sometimes needed to treat arrhythmias.
 
Living with a Heart Rhythm Disorder
Lifestyle changes can make a significant difference in those living with heart rhythm disorders. Some tips for maintaining a heart healthy lifestyle include:

• Achieve a healthy weight. It may not be easy, but weight loss/maintaining an ideal body weight has been correlated to decreased episodes of A-Fib and other rhythm disorders. It also can increase effectiveness of treatment options and may prevent or improve other health conditions, like high blood pressure and diabetes.
• Exercise regularly. As always, speak with your doctor prior to starting any new workout program. Most light cardio exercises (Ex. walking, swimming, biking) are beneficial to your heart health.
• Adopt a heart healthy diet. Swap a burger for lean protein, white flour for whole grains, and sugar-filled desserts for fresh fruit. Reducing intake of sugar, saturated fat, trans fats, and salt may improve or prevent other health conditions such as high blood pressure, high cholesterol, and diabetes.
• Decrease caffeine intake. Caffeine is a stimulant that may make your heart race and can be a trigger. Limiting caffeine intake is important. Look for caffeine sources in your diet that can be decreased or eliminated, including coffee, tea, soda, energy drinks, and chocolate.
• Limit alcohol intake. Regular, moderate-to-heavy consumption of alcohol, including binge drinking, can trigger rhythm disorders. Additionally, significant alcohol consumption has been attributed to other health problems, including high blood pressure, sleep apnea, and weakened heart muscle (cardiomyopathy).
• Improve your sleeping habits. Undiagnosed or untreated sleep apnea may trigger A-Fib and other disorders and make treatment options less effective. A sleep study is often recommended in patients with rhythm disorders. If you don’t feel rested in the morning or have excessive daytime sleepiness, make an appointment with your health care provider.
• Manage stress. Although it may be impossible to eliminate stress from daily life, it can be managed more effectively. Walking, gentle yoga, deep breathing, and meditation are all ways to help decrease stress and anxiety. 

Don’t Delay When It’s a Matter of the Heart
Delaying care can have devastating consequences to your health, as time is one of the biggest factors with treating and potentially overcoming the effects of cardiovascular emergencies. If you are experiencing mild symptoms related to heart palpitations or arrythmia – racing heart, dizziness, or fainting – call your doctor. If you or a loved one are experiencing heart attack symptoms including shortness of breath, sharp pain in the chest or back, or a tingling sensation in your arm, don’t delay treatment – call 911 immediately. Even when the signs are subtle, the consequences can be deadly, especially if treatment is delayed. Recognizing the signs and symptoms of a heart attack and seeking care quickly go a long way to potentially improving your outcome.

Kashif Chaudhry, M.D., is an electrophysiologist with UPMC Heart and Vascular Institute and sees patients at the UPMC Health Innovation Center, 740 High St., Williamsport. To schedule an appointment with Dr. Chaudhry, call 570-321-2800. For more information, visit UPMC.com/HeartNCPA.