Dr. Cristina Toteanu: Symptoms, Diagnosis & Monitoring of Arrhythmia

Almost everyone has felt their heart beat very fast, felt a "fluttering" in their chest or thought that their heart was "skipping a beat." These can be signs of arrhythmia, or abnormal or irregular heartbeat.

Don't panic if you've occasionally had these symptoms. Arrhythmias are extremely common, especially as you get older. Each year millions of people have them.

Most cases are harmless, but some arrhythmias are extremely dangerous and require treatment and management. See your doctor if you have felt any of these symptoms to rule out other problems, such as heart disease, and to give you peace of mind.

Symptoms

Arrhythmias can produce a broad range of symptoms, from barely perceptible to cardiovascular collapse and death.

A single premature beat may be felt as a "palpitation" or "skipped beat."

Premature beats that occur often or in rapid succession may cause a greater awareness of heart palpitations or a "fluttering" sensation in the chest or neck.

When arrhythmias last long enough to affect how well the heart works, more serious symptoms may develop:
Fatigue
Dizziness
Lightheadedness
Fainting (syncope) or near-fainting spells
Rapid heartbeat or pounding
Shortness of breath
Chest pain
In extreme cases, collapse and sudden cardiac arrest.

Classes of medications used to treat arrhythmias include:

Antiarrhythmic drugs

Symptomatic tachycardias and premature beats may be treated with a variety of antiarrhythmic drugs. These may be given intravenously in an emergency situation or orally for long-term treatment. These drugs either suppress the abnormal firing of pacemaker tissue or depress the transmission of impulses in tissues that either conduct too rapidly or participate in reentry.

In patients with atrial fibrillation, a blood thinner (anticoagulant or antiplatelet agent such as aspirin) is usually added to reduce the risk of blood clots and stroke.

When tachycardias or premature beats occur often, the effectiveness of antiarrhythmic drug therapy may be gauged by electrocardiographic monitoring in a hospital, by using a 24-hour Holter monitor or by serial drug evaluation with electrophysiologic testing.

The relative simplicity of antiarrhythmic drug therapy must be balanced against two disadvantages. One is that the drugs must be taken daily and indefinitely. The other is the risk of side effects. While side effects are a risk of all medication, those associated with antiarrhythmic drugs can be very hard to manage. They include proarrhythmia, the more-frequent occurrence of preexisting arrhythmias or the appearance of new arrhythmias as bad as or worse than those being treated.

Some commonly prescribed antiarrhythmic drugs include (generic name first; common brand names in parentheses – read drug brand name disclaimer above):