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Out of Sync

Feeling off beat? An arrhythmia may be at the heart of the problem. Here, we drum up the signs and symptoms of this usually harmless condition affecting nearly five percent of Americans

WRITTEN BY Alex Keith
PHOTOGRAPHS BY Maggie Wilcox & Scott Henderson

Have you ever watched someone clap out of sync with a song? It’s a good visual illustration of a cardiac arrhythmia, a condition in which a person’s heart doesn’t keep a steady beat. Cardiac arrhythmias are the result of faulty electrical signals that tell the heart to beat too quickly, too slowly or irregularly. When that happens, some people may sense a racing heartbeat, while others may feel nothing at all. Still others may experience palpitations, shortness of breath, chest pain and discomfort akin to a heart attack.

Dr. Brett Baker

With so many arrhythmia sensations, how do you know which symptoms necessitate a doctor’s visit? Can you tell the difference between harmless fluttering and a cardiac emergency? Roper St. Francis Healthcare affiliated cardiac electrophysiologist Dr. Brett Baker takes a closer look at this surprisingly common condition to make sure you don’t miss a beat.

“The heartbeat is the way the heart knows how to squeeze,” explains Dr. Baker. It’s triggered by electrical impulses that cause the chambers of the heart to contract and relax, acting as the heart’s natural pacemaker. A healthy heart beats steadily, much like a clock or metronome, around 50 to 80 times per minute at rest. “It may speed up or slow down with exertion or stress, but it’s still one beat regularly after another,” says the doctor.

With an arrhythmia, however, “the electrical system doesn’t function the way that it should,” he continues. While it’s normal to have an occasional skipped or extra beat—and many of us do—some forms of an irregular heartbeat can be dangerous. “Certain arrhythmias can lead to cardiac arrest, especially in people with a history of congestive heart failure or previous heart attack.”

Matters of the Heart

The two types of arrhythmias are differentiated by how the heart beats. Tachyarrhythmias are abnormally fast heart rhythms of 100 or more beats per minute. Bradyarrhythmia is the medical term for an irregularly slow heart rate. This condition most often affects the elderly, as it’s primarily caused by degeneration of the heart’s natural pacemaker.

These two types can also combine into tachycardia-bradycardia syndrome, where the heart sometimes beats too quickly and sometimes too slowly. The diagnosis is frequently found in patients with atrial fibrillation, the most common kind of arrhythmia. AFib or AF, as the condition is often called, occurs when the heart’s upper chambers beat out of sync with the lower chambers, leading to an irregular, usually rapid heart rate that causes poor blood flow. “As a result, blood clots can form in the heart, then travel to the brain and cause a stroke,” cautions Dr. Baker. In fact, people with AFib are up to five times more likely to have a stroke than those without.

Age and genetics make a person susceptible to developing a cardiac arrhythmia, but “arrhythmias can also be related to lifestyle choices,” says Dr. Baker. Excessive use of alcohol, caffeine and nicotine have been linked to dangerous arrhythmias. And conditions such as diabetes, thyroid disease, obstructive sleep apnea and high blood pressure significantly increase the risk of developing the condition. Obesity is also a major risk factor for AFib. “Of course, not all of our AFib patients are obese, but those who are can benefit from losing weight,” says the doctor.

As a triathlete, Erin Boineau gets her heart pumping every day, but a rash of palpitations had her worried. When she passed out during a workout class, the 42-year-old sought help from a cardiologist. An EKG revealed that her heart skipped every other beat. “Meds could have controlled the issue, but I’m young and very active and didn’t want to take medication for the rest of my life,” says Erin. She opted instead for an ablation. The simple procedure, which scarred tissue in her heart to block irregular signals, put this fit mother of two back in motion.

Pace Yourself

Though they may vary in type, arrhythmias can result in a similar array of symptoms, including dizziness or light-headedness, fainting, fatigue, shortness of breath, chest pains, palpitations and seizures (though up to 30 percent of AFib patients report no symptoms). “If you have these sorts of mild to moderate symptoms, it’s worth having a conversation with your primary care physician,” Dr. Baker recommends. “But anytime you think something is wrong with your heart, particularly if you’re an older individual, you need to get care more promptly. The more severe the symptoms, the more immediate and intense the evaluation should be.”
To diagnose a potential electrical issue within the heart, “an EKG is the gold standard,” states Dr. Baker. An EKG, or electrocardiogram, is a painless and noninvasive procedure that attaches up to 12 electrodes to your chest and limbs. Over the course of a few minutes, these electrodes record the electrical signals that make your heart beat so that they can be analyzed for any heart rhythm irregularities.

“We also have smaller, scaled-down EKG heart monitors that patients can wear for a month. And we have injectable monitors that go under the skin to look at the heart rhythm for a couple of years. Then there are newer devices like the Apple Watch and the KardiaMobile,” says Dr. Baker. The doctor does note that while these over-the-counter devices have helped to diagnose arrhythmias in patients, “they only offer one look, as opposed to the 12 shown when using a regular EKG machine in the hospital.”

Find Your Rhythm

While not all types of arrhythmias are curable, some of these conditions may be entirely reversed with a treatment called ablation. This minimally invasive procedure scars tissue in the heart to block abnormal electrical signals and restore normal heart rhythm. Other arrhythmias may be addressed using medications such as blood thinners to decrease the risk of stroke or by implanting devices such as pacemakers and defibrillators.

You can also reduce your risk of developing an irregular heartbeat by choosing to follow a healthy lifestyle, including eating a balanced diet, exercising regularly, limiting caffeine and alcohol, avoiding smoking and managing stress.

A Different Beat

Arrhythmias and heart attacks share many overlapping symptoms, including shortness of breath and chest pressure. While it can be difficult for the average person to differentiate between the two, Dr. Brett Baker points out some important distinctions. “When people feel like their heart is racing or beating irregularly, that is much more likely to be an arrhythmia,” says the cardiac electrophysiologist. “If a person’s only symptom is chest tightness or fullness, particularly if it happens with exertion or emotional stress and then gets better with rest or stress relief, that’s more likely to be angina or possibly a heart attack.” If you suspect you may be having a heart attack, immediately seek emergency medical help. When medically appropriate, ask to be taken to a Roper St. Francis Healthcare hospital.

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