Heart arrhythmia - Diagnosis and treatment (2023)

Diagnosis

To diagnose a heart arrhythmia, the doctor will usually do a physical exam and ask questions about your medical history and symptoms. Tests may be done to confirm an irregular heartbeat and look for conditions that can cause arrhythmias, such as heart disease or thyroid disease.

Tests to diagnose heart arrhythmias may include:

• Electrocardiogram (ECG or EKG). During an ECG, sensors (electrodes) that can detect the electrical activity of the heart are attached to the chest and sometimes to the arms or legs. An ECG measures the timing and duration of each electrical phase in the heartbeat.
• Holter monitor. This portable ECG device can be worn for a day or more to record your heart's activity as you go about your routine.
• Event recorder. This wearable ECG device is used to detect sporadic arrhythmias. You press a button when symptoms occur. An event recorder may be worn for a longer period of time (up to 30 days or until you have an arrhythmia or typical symptoms).
• Echocardiogram. In this noninvasive test, a hand-held device (transducer) placed on the chest uses sound waves to produce images of the heart's size, structure and motion.
• Implantable loop recorder. If symptoms are very infrequent, an event recorder may be implanted under the skin in the chest area to continually record the heart's electrical activity and detect irregular heart rhythms.

If your doctor doesn't find an arrhythmia during those tests, he or she may try to trigger the arrhythmia with other tests, which may include:

• Stress test. Some arrhythmias are triggered or worsened by exercise. During a stress test, the heart's activity is monitored while you ride on a stationary bicycle or walk on a treadmill. If you have difficulty exercising, a drug may be given to stimulate the heart in a way that's similar to exercise.
• Tilt table test. A doctor may recommend this test if you've had fainting spells. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up. The doctor observes how your heart and the nervous system that controls it respond to the change in angle.

• Electrophysiological testing and mapping. In this test, also called an EP study, a doctor threads thin, flexible tubes (catheters) tipped with electrodes through the blood vessels to different areas within the heart. Once in place, the electrodes can map the spread of electrical impulses through the heart.

  Sometimes, a heart doctor (cardiologist) uses the electrodes to stimulate the heart to beat at rates that may trigger — or stop — an arrhythmia. Doing this helps the doctor determine the location of the arrhythmia, its possible causes and the best treatment options. This test may also be done to determine if a person with certain health conditions is at risk of developing heart arrhythmias.

Treatment

Treatment for heart arrhythmias depends on whether you have a fast heartbeat (tachycardia) or slow heartbeat (bradycardia). Some heart arrhythmias do not need treatment. Your doctor may recommend regular checkups to monitor your condition.

Heart arrhythmia treatment is usually only needed if the irregular heartbeat is causing significant symptoms, or if the condition is putting you at risk of more-serious heart problems. Treatment for heart arrhythmias may include medications, therapies such as vagal maneuvers, cardioversion, catheter procedures or heart surgery.

Medications

Medications used to treat heart arrhythmias depend on the type of arrhythmia and potential complications.

For example, drugs to control the heart rate and restore a normal heart rhythm are often prescribed for most people with tachycardia.

If you have atrial fibrillation, blood thinners may be prescribed to prevent blood clots. It's very important to take the medications exactly as directed by your doctor in order to reduce the risk of complications.

Therapies

Therapies to treat heart arrhythmias include vagal maneuvers and cardioversion to stop the irregular heartbeat.

• Vagal maneuvers. If you have a very fast heartbeat due to supraventricular tachycardia, your doctor may recommend this therapy. Vagal maneuvers affect the nervous system that controls your heartbeat (vagus nerves), often causing your heart rate to slow. For example, you may be able to stop an arrhythmia by holding your breath and straining, dunking your face in ice water, or coughing. Vagal maneuvers don't work for all types of arrhythmias.

• Cardioversion. This method to reset the heart rhythm may be done with medications or as a procedure. Your doctor may recommend this treatment if you have a certain type of arrhythmia, such as atrial fibrillation.

  During the cardioversion procedure, a shock is delivered to your heart through paddles or patches on your chest. The current affects the electrical impulses in your heart and can restore a normal rhythm.

Surgery or other procedures

Treatment for heart arrhythmias may also involve catheter procedures or surgery to implant a heart (cardiac) device. Certain arrhythmias may require open-heart surgery.

Types of procedures and surgeries used to treat heart arrhythmias include:

• Catheter ablation. In this procedure, the doctor threads one or more catheters through the blood vessels to the heart. Electrodes at the catheter tips use heat or cold energy to create tiny scars in your heart to block abnormal electrical signals and restore a normal heartbeat.

• Pacemaker. If slow heartbeats (bradycardias) don't have a cause that can be corrected, doctors often treat them with a pacemaker because there aren't any medications that can reliably speed up the heart.

  A pacemaker is a small device that's usually implanted near the collarbone. One or more electrode-tipped wires run from the pacemaker through the blood vessels to the inner heart. If the heart rate is too slow or if it stops, the pacemaker sends out electrical impulses that stimulate the heart to beat at a steady rate.

• Implantable cardioverter-defibrillator (ICD). Your doctor may recommend this device if you're at high risk of developing a dangerously fast or irregular heartbeat in the lower heart chambers (ventricular tachycardia or ventricular fibrillation). If you have had sudden cardiac arrest or have certain heart conditions that increase your risk of sudden cardiac arrest, your doctor may also recommend an ICD.

  An ICD is a battery-powered unit that's implanted under the skin near the collarbone — similar to a pacemaker. One or more electrode-tipped wires from the ICD run through veins to the heart. The ICD continuously monitors your heart rhythm.

  If the ICD detects an abnormal heart rhythm, it sends out low- or high-energy shocks to reset the heart to a normal rhythm. An ICD doesn't prevent an irregular heart rhythm from occurring, but it treats it if it occurs.

• Maze procedure. In the maze procedure, a surgeon makes a series of incisions in the heart tissue in the upper half of your heart (atria) to create a pattern (or maze) of scar tissue. Because scar tissue doesn't conduct electricity, it interferes with stray electrical impulses that cause some types of arrhythmia.

  The maze procedure is usually reserved for people who don't get better with other treatments or who are having open-heart surgery for other reasons.

• Coronary bypass surgery. If you have severe coronary artery disease in addition to a heart arrhythmia, your doctor may perform coronary bypass surgery. This procedure may improve the blood flow to your heart.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

If you have heart disease or a heart condition, your doctor will likely recommend making lifestyle changes to keep your heart as healthy as possible.

Examples of heart-healthy lifestyle changes are:

• Eat heart-healthy foods. Eat a healthy diet that's low in salt and solid fats and rich in fruits, vegetables and whole grains.
• Exercise regularly. Aim to exercise for at least 30 minutes on most days.
• Quit smoking. If you smoke and can't quit on your own, talk to your doctor about strategies or programs to help you break a smoking habit.
• Maintain a healthy weight. Being overweight increases the risk of developing heart disease.
• Keep blood pressure and cholesterol levels under control. Make lifestyle changes and take medications as prescribed to manage high blood pressure or high cholesterol.
• Drink alcohol in moderation. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.
• Maintain follow-up care. Take your medications as prescribed and have regular follow-up appointments with a doctor. Tell your doctor if your symptoms worsen.

Alternative medicine

Managing stress is an important step in keeping the heart healthy. Stress-relief techniques might also help prevent or reduce heart arrhythmias. Some ways to reduce stress include:

• Yoga
• Meditation or mindfulness
• Relaxation techniques

Some research suggests that acupuncture may help reduce irregular heartbeats in people with persistent arrhythmias, but further research is needed.

Preparing for your appointment

If you think you may have a heart arrhythmia, make an appointment with your doctor. If a heart arrhythmia is found early, treatment may be easier and more effective. You may be referred to a doctor trained in heart conditions (cardiologist).

If a heart arrhythmia persists for more than a few minutes or is accompanied by fainting, shortness of breath or chest pain, call 911 or your local emergency number or have someone drive you to the nearest emergency room.

Because appointments can be brief, and because there's often a lot to discuss, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. You may need to do this if your doctor orders any blood tests.
• Write down any symptoms you're having, including any that may seem unrelated to heart arrhythmia.
• Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
• Make a list of all medications, including vitamins or supplements that you're taking.
• Take a family member or friend along, if possible. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For heart arrhythmias, some basic questions to ask your doctor include:

• What's the most likely cause of my symptoms?
• Are there other possible causes for my symptoms?
• What kinds of tests will I need? Do I need to do anything to prepare for these tests?
• What's the most appropriate treatment?
• Are there any foods or drinks that you recommend I avoid? Is there anything you suggest that I add to my diet?
• What's an appropriate level of physical activity?
• How often should I be screened for heart disease or other complications of an arrhythmia?
• I have other health conditions. How can I best manage these conditions together?
• Is there a generic alternative to the medicine you're prescribing?
• Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

What to expect from your doctor

Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did you first begin experiencing symptoms?
• Have your symptoms been continuous, or do they come and go?
• How severe are your symptoms?
• Does anything seem to improve your symptoms?
• What, if anything, appears to worsen your symptoms?
• Is there a family history of arrhythmia?

Mayo Clinic Heart Rhythm Program

Arizona

• Mayo Clinic Heart Rhythm Program
• 13400 E. Shea Blvd.
  Scottsdale, AZ 85259
• Phone: 800-446-2279

Florida

• Mayo Clinic Heart Rhythm Program
• 4500 San Pablo Road
  Jacksonville, FL 32224
• Phone: 904-953-0859

Minnesota

• Mayo Clinic Heart Rhythm Program
• 200 First St. SW
  Rochester, MN 55905
• Phone: 507-284-3994