Cardiac arrhythmia (heart rhythm problems): symptoms, causes and treatment

The NHS says there are different types of heart rhythm problem: you may have a fast heartbeat (tachycardia), a slow heartbeat (bradycardia), or an irregular heartbeat where the rhythm changes. This can make you feel like your heart is pounding, racing, fluttering or missing a beat (heart palpitations), which may last from a few seconds up to a few minutes. You may also feel short of breath, lightheaded, dizzy or like you might faint, tired, or have chest pain or discomfort.

The NHS stresses that having these symptoms does not necessarily mean you have a heart rhythm problem. Heart palpitations, where your heartbeat becomes more noticeable, can feel like racing or beating very fast, irregular with skipped or extra beats (ectopic beats), pounding or thumping, or fluttering, and may be felt in the chest, neck or throat. They can last seconds, minutes or longer.

Some arrhythmias cause no symptoms. The NHS says that with atrial fibrillation sometimes there are no symptoms and it is found at a routine check-up or when you are having tests for something else.

The NHS says heart rhythm problems happen when there is a fault with the electrical system that makes your heart beat. The NHS says a normal resting heart rate is 60 to 100 beats per minute. An arrhythmia can be fast, slow or irregular.

The NHS describes several named conditions that cause heart rhythm problems. The page for each is linked below. The table summarises what the NHS says about two common ones.

The NHS says heart rhythm problems can be the result of a heart rhythm condition such as atrial fibrillation or supraventricular tachycardia (SVT). Sometimes other conditions can also cause them, including high blood pressure, coronary heart disease, heart valve disease, heart attack and Wolff-Parkinson-White syndrome. You can also get an abnormal heartbeat from medicines, viruses, caffeine, alcohol, smoking or drugs.

For palpitations, the NHS lists common causes including strenuous exercise, lack of sleep, stress and anxiety, medicines, and alcohol, caffeine, nicotine and recreational drugs. They can be a sign you are going through the menopause, and some people get them during pregnancy. They can also be caused by iron deficiency anaemia, an overactive thyroid, a heart rhythm problem or other heart problems such as heart valve disease.

For AF, the NHS says you may be more likely to get it if you are aged 55 or older, are a man, are living with obesity or overweight, smoke, take certain medicines (such as levothyroxine, lithium or some asthma medicines like salbutamol), or do endurance sports. It can also be caused by high blood pressure, heart failure, a heart attack, chronic kidney disease, an overactive thyroid, diabetes and sleep apnoea.

The NHS says you may have an electrocardiogram (ECG), a test in which small pads are stuck to your skin to check the electrical signals from your heart, to help find the cause of palpitations, and you may be referred to a heart specialist (cardiologist). For suspected AF, the NHS says tests may include an ECG, an echocardiogram (echo), a chest X-ray and blood tests. For SVT it says you might need an ECG to find out what is going on.

Episodes come and go, so an ECG taken in clinic may not capture them. The site has guides to the Holter monitor and event recorders, linked below, which record the rhythm over a longer period.

The NHS says how a heart rhythm problem is treated depends on the type you have and what is causing it. Many people may not need any treatment at all, or only regular check-ups. Possible treatments include medicine to control the rate and rhythm of your heartbeat, such as beta blockers; burning or freezing the section of heart that is causing the faulty rhythm (ablation); using electrical signals to reset your heart rhythm (cardioversion); and a small electronic device fitted under your skin (pacemaker) that helps monitor and correct your heart rhythm. You may also need treatment for any condition causing the problem.

For AF, the NHS adds anticoagulants to lower the risk of blood clots or stroke, and says that sometimes an implantable cardioverter defibrillator (ICD) is fitted. For SVT, if episodes last only a few minutes and do not bother you, you may not need treatment, and a doctor may recommend simple techniques to stop episodes; for long or frequent episodes, medicines, cardioversion or catheter ablation may be used, which the NHS says permanently cures the problem in most people.

For palpitations not caused by a health condition, the NHS says avoiding triggers such as stress, smoking, caffeine and alcohol can help. For AF, it advises avoiding triggers such as caffeine, spicy food, stress, dehydration and lack of sleep, keeping to a healthy weight, eating a balanced diet, aiming for at least 150 minutes of moderate exercise a week, not smoking, not drinking too much alcohol and not exercising too much or too hard, which can trigger AF.

The NHS says some people get heart palpitations during pregnancy, and that palpitations are common and not usually a sign of anything serious. If palpitations keep coming back, last longer than a few minutes, or come with chest pain, breathlessness or fainting, get medical advice from your midwife, GP or urgent care.

The NHS says to see a GP if you think you may have heart rhythm problems, or have heart palpitations that keep happening or are getting worse. For palpitations in someone who feels well, it also lists lasting longer than a few minutes, having a heart condition, and a family history of heart problems as reasons to see a GP.

Call 999 or go to A&E if you currently have heart palpitations with chest pain, shortness of breath, feeling dizzy or lightheaded, or fainting or feeling like you might faint. The NHS says not to drive to A&E; ask someone to drive you or call 999 and bring any medicines you take. If you have had these symptoms but they have now stopped, ask your GP surgery for an urgent appointment, call 111 or get help from 111 online. With AF, also call 999 for signs of stroke such as weakness or numbness on one side of the face or body, difficulty speaking, blurred vision or loss of sight.

On the NHS, a GP can arrange an ECG and refer you to a cardiologist for tests and treatment. Specialist arrhythmia services provide monitoring, ablation and device implantation. Some people use private cardiology for quicker tests or procedures; the principles are the same, and results should be shared with your GP. The NHS points to the British Heart Foundation and the Arrhythmia Alliance for further information.