DEAR MAYO CLINIC: I've noticed that sometimes my heart races or skips a beat. What causes this? Is there treatment for it?
ANSWER: What you're experiencing may be an abnormal heart rhythm, also known as an arrhythmia. Arrhythmias fall into two categories: too fast or too slow. A racing heart or a skipped beat typically falls into the "too fast" category. When an abnormal heartbeat interrupts the normal rhythm, you may feel palpitations — sensations that your heart is racing, fluttering, skipping a beat — or a sense of panic. Often these symptoms are more noticeable at night or when lying down.
In younger people, typically those in their 20s to 50s, the heart may suddenly speed up from a normal rate to 180-200 beats per minute. This rapid heartbeat can cause lightheadedness, dizziness, anxiety or, in some cases, fainting.
Fast or skipped heartbeats can originate in either the upper or lower chambers of the heart. Those that begin in the top chamber are called premature atrial contractions (PACs), while those starting in the bottom chambers are premature ventricular contractions (PVCs). Although they can feel alarming, PACs and PVCs generally aren't dangerous or life-threatening. They don't cause heart attacks, strokes or increase the risk of death.
These irregular heartbeats may be caused by:
- An abnormal electric circuit that people are born with.
- Thyroid disorders.
- Hormonal changes related to pregnancy or menopause.
- Excessive caffeine or alcohol consumption.
If symptoms are infrequent and don't interfere with daily activities, people often learn to live with them. However, if they become bothersome, medication may help suppress the extra heartbeats.
One way to slow a sudden racing heart is by performing a vagal maneuver, which can help interrupt the abnormal rhythm. Vagal maneuvers include bearing down like you are having a bowel movement, blowing into a straw with one end closed, clearing your ears as you might on an airplane, dipping your face in ice-cold water or taking a cold shower.
Evaluation
However, these are temporary fixes. If symptoms persist, patients may be referred for further evaluation, such as an electrophysiology study and possible catheter ablation. During this procedure, catheters are threaded through veins in the groin and guided to the heart. Doctors use specialized wires to find where the arrhythmia is coming from. Then energy is delivered via the catheter to eliminate the abnormal circuit.
Ablation is usually done under twilight sedation and typically is a same-day procedure. Patients need someone with them for 24 hours, should avoid driving for 24 hours and shouldn't lift anything heavy for a week to let the groin incisions heal. After that, they can resume their normal activities.
PACs and PVCs are most common in younger people. For older adults, the most common fast rhythm is atrial fibrillation (AFib) or atrial flutter. These are different types of heart rhythms which become increasingly common with age.
AFib can cause irregular heartbeat, palpitations, chest discomfort, lightheadedness, dizziness, fatigue and sometimes passing out. Some people have no symptoms, and the condition is discovered during routine care or procedures.
Common causes of AFib include untreated sleep apnea, excessive caffeine, binge drinking or overconsumption of alcohol, thyroid disorders, and hormonal changes. In a small group of patients, spicy foods may trigger AFib.
Treatment for AFib
Treatment options include:
- Medication to control fast heart rate.
- Medication to control heart rhythm.
- Catheter ablation.
Ablation for AFib is done under general anesthesia. It's a minimally invasive procedure in which doctors access the heart through the groin and target areas on the left side of the heart responsible for triggering or sustaining the abnormal rhythm. Traditionally, two types of energy — radiofrequency (heat) and cryoablation (cold) — have been used for ablation.
Most recently, a new, nonthermal option — pulsed field ablation — has been introduced. This energy source selectively targets heart muscle cells. This reduces the risk of serious or life-threatening damage to the surrounding structures, such as the esophagus and the phrenic nerve, which controls the diaphragm and breathing.
Recovery after ablation is similar regardless of the energy source used, including about one week of limited activity.
During AFib, blood can pool in the heart, form clots and cause a stroke. Depending on individual risk factors, patients are often prescribed a blood thinner once they're diagnosed with atrial fibrillation or atrial flutter, even after undergoing ablation. If they're not able to tolerate blood thinners, a permanent device may be implanted in their heart to seal off the left atrial appendage, where most clots form, to reduce the risk of stroke.
If you're experiencing a racing heart, noticing skipped beats or symptoms of an irregular heart rhythm, consult with your healthcare professional or a cardiologist to determine whether further evaluation or treatment is needed.
Divya Korpu, M.B.B.S., Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, Wisconsin