A healthy heart beats as regularly as an old-fashioned pendulum clock. If it starts racing or pounding irregularly, it scares us. Not every heart stumble is threatening. Experts consulted by the Revyuh team explain with which arrhythmia you really need to see a doctor.

Some people only really notice on hot summer days how fast their heart sometimes beats or that they run out of breath at the slightest exertion.

In fact, heat and the body’s own cooling reaction to it put a strain on the circulation and require greater pumping power. Sometimes the heartbeat gets out of step. It can be harmless, but it can also end dramatically.

Palpitations – widespread and mostly harmless

“Heart palpitations are common,” says electrophysiologist, Oussama Wazni, MD who specializes in abnormal heart rhythms.

“They can be linked to heart problems. But they’re usually harmless.”

It feels as if the heart does somersaults when additional beats (extrasystoles) slip between the steady heartbeats and disrupt the usual rhythm. Those affected often feel clearly when the heart is beating irregularly.

However, if the extrasystoles occur more frequently during the day, repeatedly after exercise, or if they last longer than 30 seconds, a doctor should clarify whether this is due to a disease of the cardiovascular system. High blood pressure, for example, promotes extrasystoles.

A doctor may also ask if the palpitations are accompanied by dizziness, impaired consciousness, chest pain or shortness of breath.

What helps against palpitations?

Since even harmless palpitations are uncomfortable and somewhat frightening, patients can counter this with the mineral potassium: for example with one or two bananas or a handful of apricots a day. 

If you want to use a potassium supplement, you should definitely clarify this with your doctor. Too high a dose of potassium can lead to arrhythmias instead of normalizing the heartbeat.

However, “If you’re having palpitations frequently, or the sensation lasts more than a few seconds, it’s a good idea to get checked out,” says Dr. Wazni.

Benign palpitations – too fast for a short time, but not dangerous

Most of the time isolated skipped beats are related to stress or too many stimulants such as caffeine, nicotine or alcohol, says pediatric cardiologist Peter Aziz, MD.  Though uncomfortable, these are often benign.

A fast pulse is not just a completely normal reaction to physical exertion, excitement or anxiety. Palpitations, also called heart-pounding, can also be a form of arrhythmia.

Cardiologists speak of benign palpitations when the seizures start unexpectedly and end suddenly, do not depend on certain situations, and also occur during periods of rest. Even if a racing heart is not dangerous in many cases, it is stressful for those affected.

An electrocardiogram (ECG) – a non-invasive study that assesses the electrical conduction of the heart in its resting state –  likely will be performed during the initial evaluation. Occasionally, even at rest, the ECG can show subtle clues that an extra electrical connection exists.

If the ECG is normal and the details of the history suggest an arrhythmia, ambulatory monitoring may be employed. Ambulatory monitors are wearable devices that serve to capture the electrical activity in the heart during an episode. Your doctor will instruct you to record any symptomatic events with your device. This strategy provides a definitive diagnosis if an arrhythmia is in fact captured.

Atrial fibrillation – the most common cardiac arrhythmia

Butterflies in the stomach can signal excitement or nervousness, but fluttering in the chest can signal a short circuit in the heart’s natural electrical wiring called arrhythmia. Atrial fibrillation (Afib), the most common arrhythmia, is an off-speed rhythm in the heart’s upper chambers.

With atrial fibrillation, the electrical impulses that control the pumping function of the heart are disturbed. There are irregular electrical waves. The atria no longer contract, but twitch (“flicker”) up to 600 times per minute. The atria then no longer contribute much to the pumping function of the heart. The consequences:

• The heart beats irregularly and quickly.
• The blood flows more slowly through the atria.
• The blood builds up in some areas of the atria.

Blood clots can form, which are then flushed with the blood flow to the brain, where they clog the blood vessels and cause a stroke. One in five strokes is caused by untreated atrial fibrillation.

Exhausted and sweaty quickly? It may be due to the heart rhythm

A normal resting heart rate is 60 to 80 heartbeats per minute. With atrial fibrillation, the heart can beat 100 times or more per minute. Further symptoms, individually or in combination, are:

• Palpitations
• Racing heart
• sweat
• dizziness
• exhaustion
• Chest tightness
• anxiety

While the heart symptoms may startle at first, some patients get used to them as well. The atrial fibrillation is not treated and may not become apparent until a stroke noticeable.

“Over time, episodes usually become more frequent and last longer,” says Electrophysiologist Walid Saliba.

“Up to 30% of Afib episodes cause no symptoms at all, but treatment is still needed to prevent stroke in high risk patients.”

Not age, but other risk factors that can be remedied

Predisposition and age are among the uncontrollable risk factors for atrial fibrillation. Only one percent of the U-50-year-olds are affected, and more than 15 percent of the 80-year-olds. Other risk factors are:

• Pre-existing heart disease
• high blood pressure
• diabetes
• Hyperthyroidism
• Sleep apnea (breathing pauses during sleep)
• chronic obstructive pulmonary disease (COPD)
• pronounced alcohol consumption
• Obesity

Electrocardiogram reveals an abnormal heart rhythm

Atrial fibrillation and its severity can be determined with the following examinations:

• Resting electrocardiogram (EKG)
• Long-term ECG
• Exercise ECG
• Ultrasound scan of the heart

What helps against atrial fibrillation?

In any therapy, it is important not only to treat the atrial fibrillation, but also the risk factors and underlying diseases. Stroke prophylaxis is also part of it.

If the heart keeps getting out of rhythm, a too low or too high potassium level can be to blame. The normalization of the potassium level is therefore an important part of the therapy for atrial fibrillation as well as for other cardiac arrhythmias.

Potassium, beta-blockers, anticoagulants

Antiarrhythmics, beta blockers and blood coagulation inhibitors can be used as medication. When and in what combination they are used depends on the state of the disease. Doctors differentiate between seizure-like, persistent and permanent atrial fibrillation.

“Up to three types of medication are used in combination to treat Afib: those that control heart rate, such as beta blockers; anti-arrhythmic drugs to help maintain normal rhythm; and anticoagulants, also known as blood thinners, to prevent blood clots and reduce the risk of stroke,” says Dr. Saliba.

Surgical intervention is also possible in many cases: During catheter ablation, cardiac muscle cells in the left atrium are obliterated to create scars. This cuts off the path of the disruptive electrical impulses. The procedure is not an option for all patients and it has no guarantee of success, but if it is successful it can free you from long-term medication and its side effects.

Ventricular fibrillation – heart completely out of control

Ventricular fibrillation is when the entire heart muscle suddenly just twitches. The heart no longer fills up and no longer pumps blood into the circulation. It finally stands still. In the operating room, the patient is then immediately given electric shocks.

In everyday life, where there is not necessarily a defibrillator nearby, a patient with ventricular fibrillation collapses unconscious and dies in a few minutes if resuscitation with chest compressions is not performed immediately. Because after about ten minutes it is too late for any rescue.

Sudden cardiac death in young people – this is due to ventricular fibrillation

The sudden cardiac death often strikes young, completely healthy people, again and again, and athletes. However, they are only apparently healthy. Because almost always the acute event is based on either a previously unknown congenital heart disease or equally undiscovered myocarditis.

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