Heart rhythm disorders (arrhythmia)
Disturbances in the heart's electrical rhythm — too fast, too slow, or irregular. Many are harmless, some need treatment, and a few carry a stroke risk worth finding.
When to seek urgent care
- Fainting, or collapse, during palpitations
- Palpitations with chest pain or with breathlessness at rest
- A racing heart that does not settle after several minutes of rest
- Palpitations in someone with a known weak heart or previous heart attack
- A new irregular pulse together with weakness on one side, facial droop or difficulty speaking — treat as a stroke and call emergency services
Call 108 for an ambulance, or go straight to the nearest emergency department. Do not wait for a reply from this website.
What it is
Every heartbeat begins as an electrical impulse. It starts in the sinoatrial node in the right atrium, spreads across the upper chambers, pauses briefly at the atrioventricular node, then travels down specialised conducting tissue into the ventricles. That sequence is what makes the chambers contract in the right order.
An arrhythmia is a fault anywhere in that sequence. The heart may beat too fast, too slowly, or irregularly.
The most important thing to understand is that palpitations and dangerous arrhythmia are not the same thing. Most people who feel their heart racing, skipping or thumping have a benign rhythm — extra beats, or a fast rhythm triggered by anxiety, fever, dehydration, thyroid overactivity, caffeine or anaemia. These are worth explaining and often worth treating, but they are not dangerous.
A smaller group matters more. Atrial fibrillation, an irregular rhythm of the upper chambers, allows blood to pool and clot, and is a major cause of stroke — often in people who feel nothing at all. A very slow rhythm from conduction block can cause blackouts. Ventricular arrhythmias, usually in a heart already damaged, are the serious end of the spectrum.
The purpose of assessment is to work out which group a person is in, and the answer is usually reassuring.
What people notice
- A sensation of the heart racing, pounding, fluttering or skipping
- A single strong thump in the chest, often with a pause before it — usually an extra beat
- An irregular pulse with no pattern to it
- Light-headedness, particularly on standing
- Fainting or near-fainting, which always warrants assessment
- Breathlessness or chest discomfort during an episode
- Reduced exercise tolerance and fatigue, in sustained fast or slow rhythms
- Nothing at all — atrial fibrillation is often found incidentally on a routine pulse check or ECG
What contributes
- Structural heart disease — previous heart attack, heart failure, valve disease
- High blood pressure over years, which enlarges the left atrium
- Thyroid overactivity
- Anaemia and fever, which drive the heart rate up
- Caffeine, alcohol, nicotine and stimulants
- Electrolyte disturbance, particularly potassium and magnesium
- Obstructive sleep apnoea, a strong and under-recognised driver of atrial fibrillation
- Some medications, including certain inhalers, decongestants and thyroid replacement
- Age — the conduction system fibroses over decades
How it is assessed
- A 12-lead ECG, which is definitive if it happens to be recorded during an episode
- Holter monitoring — a portable ECG worn for 24 to 72 hours, to catch a rhythm that comes and goes
- Longer event or patch monitoring where episodes are infrequent
- Echocardiography, to establish whether the heart is structurally normal, which strongly influences how seriously a rhythm is treated
- Blood tests — thyroid function, haemoglobin, electrolytes, kidney function
- A treadmill test, where symptoms are reliably brought on by exertion
The single most useful thing a patient can do is get a recording during an episode. If palpitations last long enough to reach a clinic or hospital, an ECG taken then answers in one minute what monitoring may take weeks to catch.
How it is treated
- Reassurance and trigger management, which is the whole treatment for a large proportion of benign palpitations
- Correcting the driver — thyroid disease, anaemia, electrolytes, sleep apnoea
- Rate-controlling or rhythm-controlling medication where an arrhythmia is sustained or symptomatic
- Anticoagulation in atrial fibrillation where stroke risk assessment supports it — this is the intervention that changes outcomes most
- Cardioversion, to restore normal rhythm in selected cases
- Catheter ablation, for suitable recurrent arrhythmias
- Pacemaker implantation for symptomatic slow rhythms and conduction block
In atrial fibrillation, the decision about blood thinning is made on a formal stroke-risk assessment, not on how bad the symptoms feel. People with almost no symptoms can carry substantial risk.
Reducing the risk
- Treat blood pressure — it is the leading modifiable cause of atrial fibrillation.
- Get snoring with daytime sleepiness assessed. Treating sleep apnoea reduces recurrence.
- Keep alcohol modest; binge drinking is a well-recognised trigger.
- Check your own pulse occasionally, especially over 65. An irregular pulse is worth an ECG.
The things people most often ask in the consulting room.
Discuss rhythm disorders with a cardiologist
Bring your previous reports and current medicines. A consultation turns a general guide into an answer about you.
- Clinic
- 13, Ground Floor, M.K. Plaza, Hospital Road, near Madhav Dispensary
Gwalior 474001
Directions - OPD hours
- Monday to Saturday
12:30–2:30 pm, 5:30–6:30 pm
Closed Sunday - In an emergency
- Do not use this site. Call 108 for an ambulance or go to the nearest emergency department.