When Should You Worry About an Irregular Heartbeat?

If you’ve ever felt like your heart was skipping a beat or racing, you’re not alone.

“These sensations are fairly common and often not harmful,” says Jane Henoch, FNP-BC, a Mass General Brigham nurse practitioner. Henoch cares for patients at Massachusetts General Hospital and specializes in cardiac arrhythmias, or irregular heartbeats.

But persistent or frequent irregular heartbeats may require medical care, especially if they occur with other symptoms. “Certain arrhythmias can be serious and even life-threatening if not treated,” says Henoch.

What is an irregular heartbeat (arrhythmia)?

Cardiac arrhythmia occurs when your heart beats too fast (tachycardia), too slow (bradycardia), or skips beats (heart palpitations). An irregular heartbeat isn’t always cause for concern.

What are arrhythmia causes?

An electrical conduction system powers your heart. This system sends electrical signals that cause your heart muscle to contract and pump blood. You might think of this system as your heart’s natural pacemaker.

Your heart can beat out of rhythm when something goes wrong with this system, such as:

• Electrical signals travel through different pathways in the heart.
• Nerve cells that make and send electrical signals don’t function as they should.
• A different part of your heart starts sending electrical signals.

When should you see a health care provider about an irregular heartbeat?

You should see a health care provider if you have an irregular heartbeat that occurs several times a day or week, or if you experience heart rhythm changes that last for up to an hour or longer.

See a provider if an irregular heartbeat occurs with symptoms like:

• Chest pain
• Dizziness or fainting
• Shortness of breath

Other reasons to seek medical care for an irregular heartbeat

An irregular heartbeat is more likely to be a sign of arrhythmia (and therefore more concerning) if you have one or more of these risk factors:

• Cardiomyopathy
• Congenital heart disease
• Coronary artery disease
• Genetic heart disease
• History of smoking or substance use disorder
• Obesity
• Previous heart attack
• Sleep apnea

Pinpointing the cause of an irregular heartbeat

To determine whether your heartbeat is too fast, too slow, or erratic, you may see an electrophysiologist. These cardiologists specialize in diagnosing and treating heart rhythm disorders.

Heart rate monitor to record irregular heartbeats

Because an irregular heartbeat is just that — not regular or predictable — your provider may recommend wearing a heart rate monitor. These monitors work like an electrocardiogram (ECG or EKG). They monitor and record your heart rate and heart electrical activity while you go about your usual activities.

In the past, providers recommended Holter monitors. But this monitor only records heart activity for 48 hours. It also has a lot of electrodes (stickers) and connecting wires, which can be awkward to wear.

Modern heart rate monitors offer more options. Depending on your symptoms, your provider may recommend one of these simple wearable devices to monitor your heart rate:

• Prescription heart rate monitors: A small, thin, prescription-only device sticks to the skin above your heart. You press a button on the device when your heartbeat feels irregular. The device records the activity. You also describe the feeling in a logbook. After 14 days, you mail the monitor and logbook to the device company, which creates a report for your provider.
• Smartphone monitors: With this type of smartphone device, you press your fingertips onto a small pad when you feel an irregular heartbeat. The pad-like device sends information to a smartphone app, which you can share with your provider.
• Smartwatches: Smartwatches can measure heart rates and show when your heart beats too fast or slow. Some smartwatches have built-in sensors that work as an ECG/EKG. “We’ve found these watches to be extremely helpful in monitoring heart activities because people wear them all day, and sometimes all night,” says Henoch. “They provide a good snapshot of a person’s heart activity.”

Diagnosing arrhythmias

If a heart rate monitor detects a concerning heart rhythm change, or you have other symptoms like chest pain, you may get one or more of these heart tests:

• ECG/EKG: Sensors on the skin that measure the heart’s electrical activity.
• Echocardiogram (echo): High-frequency sound waves (ultrasound) show how well the heart pumps blood (ejection fraction).
• Cardiac MRIs: Radio waves and strong magnetic fields capture images of the heart muscle and blood flow to the heart.
• Stress tests: Imaging machines capture images of your heart while under exertion from physical activity or an IV medication that increases your heart rate.
• Electrophysiology (EP) tests: Sensors that doctors place inside the heart to measure electrical activity.
• Genetic testing: This advanced blood test helps doctors detect gene changes that can cause genetic heart disease and inherited arrhythmias.

When do you need treatment for an irregular heartbeat?

Not everyone who experiences an irregular heartbeat needs medical treatment. “Treatment depends on whether you have an arrhythmia, its type, and severity,” says Henoch. For instance, the most common type of arrhythmia, atrial fibrillation (AFib), increases your risk for blood clots that cause strokes. AFib always requires a medical evaluation.

Arrhythmia treatments

If you follow the cardiac arrhythmia treatment plan your provider creates for you, you can learn how to live with arrhythmia.

Arrhythmia treatments vary depending on the type and severity. They include:

• Antiarrhythmic medications to keep the heart beating in a normal heart rhythm.
• Blood-thinning medications (anticoagulants) to prevent blood clots.
• Cardioversion to deliver an electric shock that restores a normal heart rhythm.
• Pacemakers to send electrical impulses that keep your heart from beating too slowly.
• Implantable cardioverter-defibrillators (ICDs) to provide a shock, if needed, and pace the heart.
• Ablation to create a scar in the heart muscle that stops the electrical impulses causing arrhythmia.

It can be unsettling to feel your heart beat out of rhythm. While these feelings aren’t uncommon, it can be worth your peace of mind to see a provider and make sure everything is okay. “Today’s arrhythmia treatments are very safe and highly successful,” says Henoch, “especially when you receive care from an experienced team.”