Skipped beats, flutters, and racing pulses are types of irregular heartbeat that are commonly experienced by the general population. These usually aren’t concerning, but irregular heartbeats can sometimes indicate a more serious condition that isn’t immediately obvious. This is a guide on how to distinguish between benign irregular heartbeats, when you should see a doctor, and when you should call an ambulance.
Muscle contractions of the heart are triggered by electrical signals. When these signals are disrupted, the heart is said to be in arrhythmia. There are many types of arrhythmias and they can range from a relatively benign extra beat that requires no treatment to life-threatening rhythms that can cause stroke and cardiac arrest. Because of this wide spectrum, “irregular heartbeat” can often be misleading.
Types of Arrhythmia: Fast, Slow, Irregular
When thinking about arrhythmias, doctors take into account how the rhythm behaves and where in the heart it originates. Here’s a simplified guide:
| Type | What it is | How serious is it, generally? |
|---|---|---|
| Ectopic (extra) beats | Early beats from the upper chambers (PACs) or lower chambers (PVCs); often felt as a skip, thump or pause | Frequently benign in people with otherwise healthy hearts, but frequent ones or those with known heart disease may deserve investigation |
| Atrial fibrillation (AF) | Chaotic electrical activity in the upper chambers causing an irregular, often fast pulse | Needs medical management: it is linked to a substantially higher risk of stroke, so the main goal is often to reduce that risk, not just control the rate |
| Supraventricular tachycardia (SVT) | Sudden-onset, regular, very fast heartbeat that starts and stops abruptly | Usually not life-threatening, but disruptive and worth a diagnosis; effective treatments exist |
| Bradycardia (slow rhythm) | Heart rate that is too slow to meet the body’s needs | Normal in some fit people; a problem if it causes dizziness, fainting or fatigue, sometimes needing a pacemaker |
| Ventricular tachycardia / fibrillation | Dangerous rapid rhythms from the lower chambers | Potentially life-threatening and can cause cardiac arrest: a medical emergency |
Irregular Heartbeat Symptoms That Change the Picture
How a particular rhythm feels is not an indicator of how serious it is. Some arrhythmias, like atrial fibrillation (AF), can actually be asymptomatic. It is more important to consider the association of a given arrhythmia. For example, if you are experiencing shortness of breath, chest pain, light headedness, or other symptoms, and you are also having an arrhythmia, that arrhythmia is more serious.
- Fainting or near-fainting
- Chest pain, pressure or tightness
- Severe shortness of breath
- Sudden weakness, confusion, facial droop or difficulty speaking (possible stroke)
Don’t drive yourself, and don’t wait to see whether it settles. Call your local emergency number or go to the nearest emergency department.
What a check-up usually involves
- History and examination
When it happens, how long it lasts, what you were doing, and any family history of heart rhythm problems or sudden cardiac death. Caffeine, alcohol, medications, and thyroid problems can all trigger rhythm changes and are worth mentioning.
- Electrocardiogram (ECG)
A quick, painless recording of the heart’s electrical activity. It shows the rhythm at that moment, which is useful only if the arrhythmia is happening during the test.
- Longer monitoring
Because arrhythmias come and go, doctors often use a wearable monitor that records for a day or longer, or a patch or event recorder for weeks, to catch what a single ECG misses.
- Echocardiogram and blood tests
An ultrasound of the heart check’s structure and pumping function, and blood tests look for triggers such as thyroid problems or electrolyte imbalances.
- Further tests if needed
Stress testing, or in selected cases an electrophysiology study that maps the heart’s electrical pathways, can pinpoint the source of a more complex rhythm problem.
How arrhythmias are treated
Treatment varies depending on the type of arrhythmia, and for a good number of benign arrhythmias, the treatment is reassurance and avoiding inciting factors. In this case, the main treatment strategies described at an overview level would be:
- Lifestyle and trigger management: losing weight, treating sleep disorders, and controlling blood pressure.
- Medications: there are a number of medications used to control the heart rate and/or rhythm and to manage stroke risk in atrial fibrillation. These are prescribed and monitored by a physician and should never be started by a patient on their own.
- Procedures: catheter ablation or other surgeries to treat the arrhythmia are available.
- Implantable devices: pacemakers and implantable cardioverter defibrillators are also available.
When to see a doctor (non-emergency)
- Palpitations are frequent, last more than a few minutes, or are getting more noticeable.
- You have a smartwatch or home-device alert for an irregular rhythm.
- You tire easily or feel breathless with activity you used to manage.
- You have known heart disease, high blood pressure, or diabetes and notice new rhythm symptoms.
- A close relative had a sudden unexplained death or a serious rhythm condition at a young age.
Not sure whether your symptoms fit this list? A cardiology consultation can help you find out.
Frequently asked questions
Q: Is a skipped beat dangerous?
Usually not. Extra beats happen every now and then and are not a concern for people with healthy hearts. They should be evaluated if they occur frequently, or happen with fainting, chest pain or shortness of breath.
Q: Can stress, caffeine or lack of sleep cause palpitations?
Yes, these are common triggers of benign changes in heart rhythm. However, frequent and prolonged symptoms warrant an assessment to rule out pathology. Stress is not always the cause of these symptoms and other factors should be considered.
Q: Can atrial fibrillation be present without symptoms?
Yes. Some patients are entirely asymptomatic, and the rhythm disturbance is identified on a routine evaluation or by a device alarm. Although it may appear benign, atrial fibrillation is associated with a stroke and therefore, it is best to rule it out.
Q: Do all arrhythmias need a pacemaker or surgery?
No. Most people with atrial fibrillation do not require treatment, and many others are treated with lifestyle modification and/or medication. Treatment with a device or procedure is only for specific indications and is decided after careful consideration by the cardiologist.
Q: Can I get a cardiology opinion on a rhythm problem before travelling?
Yes. Our partner cardiology specialists can review your ECG, monitor reports, and history through a free, no-obligation second opinion service to give you peace of mind.
Conclusion
Rhythm disturbances are a wide spectrum of conditions ranging from benign to serious. While it’s important not to catastrophize every chest pain or irregular heart beat, it is also important to not totally disregard any concerning or persistent symptoms. Adequately record and evaluate all fainting, chest pain, shortness of breath, and/or other concerning symptoms.