What Are Arrhythmias?

Arrhythmias (also called dysrhythmias) are abnormal heartbeats usually caused by an electrical "short circuit" in the heart.

The heart normally beats in a consistent pattern, but an arrhythmia can cause it to beat too slowly, too quickly, or irregularly. This can cause the heart to pump inconsistently, which can lead to symptoms like fatigue, dizziness, and chest pain.

What Causes Them?

Your heart has its own electrical system that sends electrical signals around the heart, telling it when to contract and pump blood around the body. The electrical signals start in a group of cells, called the sinus node, located in the right atrium. The sinus node is the heart's pacemaker and makes sure the heart beats at a normal and consistent rate. The sinus node normally increases your heart rate in response to exercise, emotions, and stress, and slows your heart rate during sleep.

But sometimes the electrical signals flowing through the heart don't "communicate" well with the heart muscle, and the heart can start beating in an abnormal pattern, or arrhythmia.

Arrhythmias can either be temporary or permanent and they can be caused by several things — but they also can happen for no apparent reason. Arrhythmias can be congenital, meaning a person is born with the condition.

Other causes of arrhythmias include chemical imbalances in the blood, infections or other diseases that cause irritation or inflammation of the heart, medications (prescription or over-the-counter), and injuries to the heart from chest trauma or heart surgery. Other factors like illegal drugs, alcohol, tobacco, caffeine, stress, and some herbal remedies can also cause arrhythmias.

Signs and Symptoms

Because arrhythmias can cause the heart to beat less effectively, blood flow to the brain and to the rest of the body can be interrupted. If the heart is beating too fast, the heart's chambers can't fill with the right amount of blood. If it's beating too slowly or irregularly, the right amount of blood can't be pumped out to the body.

Because the body isn't getting the supply of blood it needs to run smoothly, these symptoms can occur:

• dizziness
• fatigue
• lightheadedness
• weakness
• palpitations (a feeling of fluttering or pounding in the chest)
• shortness of breath
• chest pain
• fainting

Arrhythmias can be constant, but usually come and go at random. Sometimes arrhythmias can cause no symptoms at all — in these cases, the arrhythmia can only be discovered during a physical exam or a heart function test, like an electrocardiogram (ECG/EKG).

What's a Normal Heart Rate?

Heart rate is measured by counting the number of beats per minute. Normal heart rate can be different for each person, depending on factors like age and whether the person leads an active lifestyle or not (for example, athletes often have a low resting heart rate).

The resting heart rate decreases as people get older. Typical normal resting heart rate ranges are:

• babies (birth to 3 months of age): 100-150 beats per minute
• kids 1-3 years old: 70-110 beats per minute
• kids by age 12: 55-85 beats per minute

Your doctor can determine whether or not your heart rate is abnormally fast or slow, since the significance of an abnormal heart rate depends on the situation. For example, a teen or adult with a slow heart rate might begin to show symptoms when the heart rate drops below 50 beats per minute. However, keep in mind that trained athletes have a lower resting heart rate — so a slow heart rate in these people isn't considered abnormal if no symptoms are associated with it.

Types of Arrhythmias

There are several types of arrhythmias, including:

Premature Atrial Contraction (PAC) and Premature Ventricular Contraction (PVC)

Premature contractions are usually considered minor arrhythmias, in which the person may feel a fluttering or pounding in the chest caused by an early or extra beat. PACs and PVCs are very common, and are what happens when it feels like your heart "skips" a beat. It doesn't skip a beat — an extra beat actually comes sooner than normal. Occasional premature beats are common and considered normal, but in some cases they can indicate an underlying medical problem or heart condition.

Tachycardias

Tachycardias are arrhythmias that involve an abnormally rapid heartbeat. They fall into two major categories — supraventricular and ventricular:

• Supraventricular tachycardia (SVT): is the most common significant arrhythmia, it's characterized by bursts of fast heartbeats that originate in the upper chambers of the heart. The bursts can happen suddenly, and episodes can last anywhere from a few seconds to several days. Specific treatment is usually recommended if incidents of SVT are long-lasting or happen often.
• Ventricular tachycardia: is a serious but relatively uncommon condition that originates in the lower chambers of the heart and can be dangerous.

Bradycardias

Bradycardias — arrhythmias characterized by an abnormally slow heartbeat — include:

• Sinus node dysfunction: is when the heart's sinus node isn't working correctly, most commonly following surgery to correct a congenital heart defect. An abnormally slow heartbeat is typically seen in this condition; however, episodes of rapid heartbeat due to SVT also can occur.
• Heart block: is often caused by a congenital heart defect, but also can be the result of disease or injury. Heart block happens when electrical impulses can't make their way from the upper to lower chambers of the heart. When this happens, another node in the lower chambers takes over and acts as the heart's pacemaker. Although it sends out electrical impulses to keep the heart beating, the transmission of the signals is much slower, leading to a slower heart rate.

How Are Arrhythmias Diagnosed?

Arrhythmias can be diagnosed in several ways. The doctor will use a person's medical history information, along with a physical examination, to begin the evaluation. If an arrhythmia is suspected, the doctor will probably recommend an ECG/EKG to measure the heart's electrical activity.

There's nothing painful about an ECG/EKG — it's just a procedure where a series of electrodes (small metal tabs) are attached to the skin with sticky papers. Then, information about the electrical activity of the heart is transferred to a computer, where it's interpreted and drawn as a graph.

A doctor might recommend the following types of ECG/EKG tests:

• Resting ECG/EKG. This measures resting heart rate and rhythm, and lasts about a minute.
• Exercise ECG/EKG (also called a stress test). This measures heart rate and rhythm while a person exercises (like riding a stationary bicycle or walking on a treadmill).
• Signal-average EKG. This measures heart rate much like a resting ECG/EKG. The only difference is the signal-average EKG monitors a heartbeat over a longer time period (around 15-20 minutes).
• Holter monitor. This is an ECG/EKG done over a very long period of time, usually 24 hours or more. The electrodes are connected to a person's chest, and the wires are attached to a portable ECG/EKG recorder. The person is encouraged to continue normal daily activities, but must be careful to not get the electrodes wet (for example, no swimming, showering, or activities that cause a lot of sweating). There are two kinds of Holter monitoring — continuous recording, which means the ECG/EKG is on throughout the entire monitoring period; and event monitoring, which means data is recorded only when the person feels symptoms and then turns the Holter monitor on.

How Are Arrhythmias Treated?

Someone may have an arrhythmia but may feel no symptoms at all. Many arrhythmias don't require treatment; however, some can pose a health problem and need to be evaluated and treated by a doctor.

Depending on the type and severity of the arrhythmia, one of the following options might be recommended by a doctor:

• Medications. Many types of prescription anti-arrhythmic medications are available to treat arrhythmia. A doctor will determine which is best by considering the type of arrhythmia, possible underlying medical causes, and any medications you are taking. Sometimes, anti-arrhythmic medications can increase symptoms and cause unwanted side effects, so their use and effectiveness should be closely monitored by a doctor, your parent, and you.
• Pacemakers. A pacemaker is a small, battery-operated device implanted into the body (near the collarbone) through a surgical procedure. Connected to the heart by a wire, pacemakers can help treat bradycardia. Through a sensing device, a pacemaker can detect if a person's heart rate is too slow and sends electrical signals to the heart to speed up the heartbeat.
• Defibrillators. Like a pacemaker, a defibrillator can deliver electrical impulses to the heart. A small battery-operated implantable cardioverter defibrillator (ICD) can be implanted into the body (near the left collarbone) through a surgical procedure. Wires run from the defibrillator to the heart. It can sense if the heart had developed a dangerously fast or irregular rhythm, and deliver an electrical shock to restore a normal heartbeat.
• Catheter ablation. "Ablation" literally means removal or elimination. In the case of catheter ablation, a catheter (a long, thin wire) is guided through a vein in the leg to the heart. Arrhythmias are often caused by microscopic defects in the heart muscle. Once the problem area of the heart is pinpointed, the catheter heats or freezes the muscle cells and destroys them.
• Surgery. Surgery is usually the treatment recommended only if all other options have failed. In this case, a person is put under anesthesia, the chest is opened, and the heart is exposed. Then, the tissue causing the arrhythmia is removed.

When to Call the Doctor

Although many arrhythmias are minor and don't represent a significant threat to a person's health, some can indicate a more serious health problem. If you've been having any symptoms, talk to your parent or call your doctor.

Reviewed by: Joel D. Temple, MD
Date reviewed: August 2012