The heart is one of the body’s most powerful organs. Inexhaustibly producing billions of beats over a lifetime, your heart serves the rest of the body by ensuring a constant flow of oxygen-rich blood to other vital organs (and itself, of course). The heart is divided into four chambers; the top two chambers are the right and left atria, and the bottom the right and left ventricles. Deoxygenated blood flows into the right side of the heart, out to the lungs to collect oxygen, then back through the left sided chambers to be pumped forcefully out into the body again.
Your heart’s rhythm is maintained by a series of coordinated electrical impulses, directed by highly specialized cells, that cause the top and bottom chambers of the heart to contract in one smooth motion. The repeating signal begins in the right atrium in an area known as the sinoatrial or SA node, and travels down the myocardium, resulting in your heartbeat. Due to a variety of factors, people can sometimes lose this rhythmic control and develop an irregular heartbeat, known as an “arrhythmia”. Arrhythmias may be benign and cause only mild symptoms, or can become serious or even deadly.
A number of symptoms accompany arrhythmias, and it’s important to learn what to look for if you feel you may be experiencing a rhythm disorder.
1. Chest pain
Also known as angina, chest pain is one of the most common reasons for emergency room utilization, accounting for up to ten million visits each year. While approximately half of these turn out to be related to non-cardiac causes, such as reflux disease, lung issues, or anxiety, the other half represent true cardiac emergencies.
Angina is often described as a dull throb or deep pressure over the left side of the chest. There are several causes for chest pain, generally divided into ischemic and nonischemic heart conditions. Ischemic heart disease is related to narrowing of the arteries due to plaque formation from coronary artery disease, a condition that results in a reduction of oxygen to the heart muscle. This type of chest pain is usually more apparent during exertion. Nonischemic heart disease is caused by other disorders, such as cardiac arrhythmias. People experiencing tachycardia (fast heartbeat) and some types of electrical disruptions often complain of angina.
Angina should never be ignored, especially if accompanied by other symptoms, such as dizziness, shortness of breath, radiating neck or back pain, or an irregular heart rhythm. These symptoms may indicate an imminent threat to your health and warrant a trip to the ER.
2. Dizziness
Dizziness can be described in a number of ways. Most people will complain of feeling unsteady or out of orientation. Sometimes it is felt as loss of balance or the sense of having the “room spin around you”. While dizziness is a common symptom for many ailments, including inner-ear disorders, it is also one of the more important signs for those who are having an irregular heartbeat. Orthostatic hypotension, the temporary drop in blood pressure and subsequent “blackout” that follows standing up too quickly, is not concerning. However, if you have any unexplained wooziness, especially in combination with a fast or erratic heart rate, high blood pressure, or chest pain, it’s important to seek help.
3. Fainting
Fainting, also called syncope, is a temporary loss of consciousness. Fainting is a common sign of several heart arrhythmias, and is sometimes the diagnostic indicator for insidious underlying heart conditions. Disorders such as atrial fibrillation, atrial flutter, and varying degrees of heart block can cause syncope, sometimes very suddenly. Although fainting can occur without warning, more often it’s preceded by what is known as presyncope, characterized by nausea, blurred vision, or a feeling of “fading in and out”. Syncope is never normal, and unexplained sudden syncopal episodes should always be medically evaluated, as they may indicate a serious heart condition.
4. Lightheadedness
Lightheadedness can have many causes, but like fainting, it is not normal and may be pointing to a cardiac issue. People who have been diagnosed with cardiac arrhythmias frequently experience bouts of lightheadedness, especially during arrhythmic episodes. Lightheadedness differs from dizziness in that rather than experiencing vertigo or loss of balance, people will complain that their head feels “fuzzy” or “weightless”. This particular sensation is often caused when there is a disruption in blood flow or when precipitous spikes or drops in blood pressure occur. Before rushing off to the ER, though, assess your hydration and blood sugar level first. If the symptoms don’t resolve with adequate food, water, and rest, then it’s time to rule out cardiac causes.
5. Heart palpitations
Heart palpitations are often described as a fluttering or pounding feeling under the sternum, or simply an elevated awareness of the heart beating. Heart palpitations are often caused by what are known as preventricular contractions, or PVCs. These extra beats issued by the ventricles are common, but in excess can cause symptoms of anxiety, shortness of breath, and a lack of energy. Chronic stress, excessive caffeine or alcohol, dehydration, hormone changes, and medications can all cause this troublesome irregular heartbeat. Though miserable, PVCs are generally benign and can usually be managed by lifestyle adjustment. A high percentage of PVCs can be harmful, though, and may require treatment.
6. Slow heart rate
A heart rate that drops below 50 beats per minute is considered to be a slow heart rate, a condition known as bradycardia. Slow heart rhythms may be regular or irregular, and can be caused by a number of things. Bradycardia with a regular rhythm and the absence of troubling symptoms may simply be due to excellent cardiovascular fitness, as seen in runners and cyclists. Bradycardia that causes fatigue or lightheadedness, however, requires medical attention. Slowed or stuttering heart rhythms are commonly caused by age, rate-controlling medications, or a progressive heart condition called heart block, in which a delay in the electrical signal across the heart slows its contraction. Slow heart rate is usually corrected with a pacemaker.
7. Shortness of breath
Shortness of breath (SOB), or dyspnea, commonly goes hand in hand with many heart conditions. Dyspnea is the sensation of not being able to get enough air, resulting in rapid or gasping respirations. It is an especially distressing and unpleasant condition. Dyspnea occurs because of lung conditions such as COPD or emphysema, chronic anemia, or any number of heart conditions. People who are experiencing repetitive PVCs, fast heart rate, atrial fibrillation, or signs of heart attack can all suffer shortness of breath. If you notice any irregularity in your heartbeat and are experiencing unusual SOB, especially without exertion, call your doctor.
