What is an irregular heartbeat?
In a healthy adult, the heart should beat regularly for between 60 and 100 times a minute. Anything outside of these limits – if the heartbeat is too fast, too slow or irregular – is called an arrhythmia.1 One key symptom of arrhythmia is palpitations – an uncomfortable awareness of the heartbeat.3
If you begin to feel or become aware of your heart beating (unless for an obvious reason, such as strenuous exercise), you should see your GP. They will want to know how long it lasted, whether the heartbeat felt regular or irregular, what you were doing at the time, and if there were any other symptoms such as chest pain, dizziness or shortness of breath. It’s also worth mentioning if you have just started any new medicines as palpitations can be caused by some antibiotics, antidepressants and even inhalers used for asthma.
Why is my heart beating irregularly?
The heart has an electrical conduction system embedded within it which acts as a natural pacemaker to regulate heartbeat. If there is a problem in this system, then the heart may beat too fast, or irregularly. There are many types of irregular heartbeat, generally caused by different problems with the electrical conduction within the heart.
Tachycardia and bradycardia
A consistently racing heartbeat is known as tachycardia, whereas an excessively slow rate is called bradycardia. The most common cause of bradycardia is a partial blockage in the heart. A blockage can cause delayed electrical impulses to the extent that heartbeats are delayed or skipped altogether. However, bradycardia can also be found in extremely healthy individuals such as athletes, because continually exercising strengthens the heart muscles, causing the heart to do less work when resting.
On the other hand, main causes of tachycardia include stress, high blood pressure and atherosclerosis (blocked arteries), because the increased strain on the heart causes it to beat faster in order to pump enough oxygen around the body. Some forms of tachycardia are linked to a higher risk of cardiac arrest (e.g. a heart attack) potentially resulting in organ damage or failure. In both bradycardia and tachycardia, typical symptoms include dizziness, shortness of breath, and fainting spells. Those with tachycardia may also experience chest pain.
The most common form of arrhythmia is atrial fibrillation (AF). Although atrial fibrillation can present with palpitations, often it has no symptoms and is only discovered when a healthcare professional notices that your pulse is irregular.5 AF is more common with increasing age – other risk factors include heart disease or surgery, high blood pressure, lung disease, excessive alcohol and an overactive thyroid. The importance of atrial fibrillation is that it can lead to stroke, so if you notice that your pulse is irregular then you should see your GP who can check for AF.
An atrial flutter is an arrhythmia that occurs in the upper chambers of your heart — the atria. The electrical impulses that tell your heart when to beat form a smaller circuit in the atria, instead of travelling through the entire heart as they should, causing the atria to beat much faster than the bottom half. This creates a fluttering feeling felt in the upper chest, sometimes accompanied by pain. Other rarer causes of an atrial flutter heartbeat include a heart block, ectopic beats and inherited diseases such as Brugada syndrome, all caused by interruptions at different points in the electrical system of the heart.6,3,7
How will my GP diagnose an irregular heartbeat?
In order to get to the bottom of what is causing your irregular heartbeat, your GP will need to carry out an ECG — a recording of the electrical conduction through the heart.8 This can be done as a one-off test lasting about a minute, or you can wear an ECG machine to measure your heart over 24 hours. The latter is used when palpitations come and go and you will need to keep a diary of your symptoms so that they can be matched up to the exact time on the ECG trace.
For those whose palpitations don’t happen every day, the ECG can be continued for longer to try and catch an episode of palpitations. A GP will usually also carry out blood tests to screen for other risk factors for heart disease, such as diabetes and high cholesterol. Your kidney function is likely to be checked because some of the drugs used in the treatment of arrhythmias can’t be used (or should be used at a lower dose) if the kidneys aren’t working as well as they should do.
How to regulate your heartbeat
Treatment for irregular heartbeats will depend on the exact cause of the arrhythmia. However, typically a GP will prescribe medication to make the heart beat regularly, or an anticoagulation which thins the blood to reduce the risk of a stroke caused by atrial fibrillation.9
In more serious cases, a cardiologist will suggest correcting the irregular beat with cardioversion (a one-off electric shock treatment carried out under anaesthetic or sedation), or by inserting either a pacemaker or implantable defibrillator which can detect and regulate arrhythmias.10,2,11 In some cases, arrhythmias may be treated by inserting a catheter into the heart to target the exact place where the electrical wiring has gone wrong.5
As well as medical attention, diet and lifestyle are important factors for helping to regulate your heartbeat. Smoking, obesity and excessive alcohol intake are all risk factors for atrial fibrillation and heart disease, which can lead to arrhythmia. On top of this, caffeine can also cause mild heart palpitations, so if you can’t get through the day without regular cups of tea or coffee, try switching to a decaf option.
For more information on how to keep your heart healthy, see our heart health hub.
1NHS (2018). Arrhythmia
2BHF (2016). Implantable cardioverter defibrillator, British Heart Foundation Online
3NHS (2016). Heart palpitations and ectopic beats
4HRS (no date). Electrical system, Heart Rhythm Society
5NHS (2018). Atrial fibrillation
6NHS (2017). Heart block
7NHS (2017). Brugada syndrome
8NHS (2018). Electrocardiogram (ECG)
9NHS (2018). Anticoagulant medicines
10BFH (no date). Cardioversion, British Heart Foundation Online
11NHS (2018). Pacemaker implantation