Understanding the Types of Arrhythmia: In Plain English

“My heart skipped a beat when I saw you” is more than just a cute saying.

Our hearts physically respond to excitement, fear, and even love. They also react to other stimuli, such as food, drink, and illness. An occasional skipped beat is usually nothing to worry about. However, if it happens regularly, you might have an arrhythmia. Read on to learn about the different types of arrhythmia — in words you can actually understand.

What is an arrhythmia?

The heart is a fist-sized muscle responsible for pumping oxygen-rich blood throughout the body. It is equipped with its very own electrical conduction system, and the four chambers of the heart beat according to the electrical stimuli. The heart’s electricity typically follows the same route, as if it were driving down a familiar road. 

In a healthy heart, the electrical system causes the heart to contract at a regular rate and rhythm. Normally, the adult heart beats anywhere from 60-100 times per minute when the body is at rest. While there is slight variability, the rhythm is generally regular, meaning that it beats at a pace with similar intervals of rest between each contraction. A heart beating with a steady rate and rhythm is said to be in “normal sinus rhythm (NSR).” 

Sometimes, the heart’s electrical system misfires, causing the heart to beat fast, slow, or in an erratic pattern. A palpitation is the “feeling” or symptom experienced from the skipped or abnormal beat. However, you could even experience a palpitation feeling when your heart is in normal sinus rhythm (NSR).  An arrhythmia is when the electrical impulses in the heart don’t work properly, also known as an irregular heartbeat.

While some arrhythmias are harmless, others have the potential to be dangerous. The heart works best when it beats according to a regular rate and rhythm. When this pattern is interrupted, the heart pump works less effectively.

What causes arrhythmia?

Many different factors can cause an irregular heartbeat. Oftentimes, these abnormal beats are nothing more than a quick and harmless misfiring of the heart. Simple actions such as a cough or a sudden change in position can trigger an occasional abnormal beat or two. Other reversible causes of an irregular heartbeat include: 

  • Stress or anxiety
  • Caffeine
  • Alcohol
  • Nicotine
  • Electrolyte imbalances
  • Dehydration
  • Exercise 
  • Medication use
  • Diet imbalances

Other times, heart palpitations are red flags for an impending arrhythmia. Arrhythmias can be caused by an underlying disease, such as diabetes, thyroid disorder, high blood pressure, heart disease, sleep apnea, or recent infection.

Some arrhythmias result from scar tissue on the heart or problems with the heart valves. Finally, arrhythmias are occasionally caused by problems with the heart’s electrical circuitry. 

If you wonder why your heart is beating irregularly, consider it your body’s attempt to get your attention. The human body is made for health. When something is out of balance, your body will almost always find a way to let you know before it becomes a bigger problem. 

What are the types of arrhythmias?

Arrhythmias are often classified according to their rate. An adult’s resting heart rate is typically between 60 and 100 beats per minute (BPM). A heart rate faster than 100 BPM is called tachycardia. As long as the rhythm is normal, the person is in sinus tachycardia. Common causes of sinus tachycardia are exercise, stress, and caffeine. 

When a heart rate falls below 60 BPM, the individual has bradycardia. Again, if the rhythm is normal, the individual is in sinus bradycardia. 

Keep in mind that there are reasons why a heart rate might be low in a healthy individual. For example, athletes tend to have lower resting heart rates. A heart rate might fall below 60 BPM during sleep and may elevate with exercise or stress. While many reasons for a low heart rate are not concerning, sinus bradycardia can also be the first sign of an unhealthy heart. 

The origin of the irregular beat further classifies arrhythmias. The heart has four chambers. The top two are the atria, and the bottom two are the ventricles. Sometimes the problem begins at the top of the heart, while the issue is lower at other times. 

Supraventricular arrhythmias

These abnormal rhythms begin above the ventricles, in the atria or AV node of the heart. They typically produce a very rapid heart rate. A fast heart rate that starts above the ventricles is also called supraventricular tachycardia (SVT). Some examples of supraventricular arrhythmias include: 

  • Atrial fibrillation (AFib) – The most common type of heart arrhythmia, AFib, occurs when the heart’s upper chambers beat in a fast and irregular rhythm due to chaotic electrical activity. 
  • Atrial flutter– Similar to AFib, this abnormal heart rhythm originates in the heart’s upper chambers. However, atrial flutter makes the heart beat fast in an organized, regular pattern instead of an irregular rhythm. 
  • Atrioventricular reentrant tachycardia – This abnormal rhythm occurs due to an extra pathway in the AV node of the heart. Instead of a normal electrical path from the upper part of the heart to the lower, electricity travels in circles.

Ventricular arrhythmias

These more dangerous arrhythmias begin in the ventricles of the heart. 

  • Premature ventricular contractions (PVCs) – These abnormal beats are the most common cause of an irregular heartbeat. PVCs are unpredictable, early beats that originate in the ventricles instead of the atria. They are typically not a reason for significant concern unless they happen repeatedly.
  • Ventricular tachycardia (VTach) – This condition occurs when the heart’s normal pacemaker, the SA node, fails to control the heart rate. Instead, the electrical impulses start in the ventricles and cause the heart to beat very fast.  
  • Ventricular fibrillation (VFib) – This life-threatening condition occurs when multiple electrical signals are firing at once, creating irregular, chaotic, and ineffective contractions of the ventricles. 

When the electrical signal from the upper part of the heart to the lower part becomes blocked or impaired, heart block can occur. There are several different kinds of heart blocks, and they are named according to how severe or what degree the heart block is. 

How are arrhythmias diagnosed?

Diagnosing arrhythmias can be challenging for several reasons. First, they are often unpredictable. If they happen sporadically and at unexpected times, capturing them at the doctor’s office can be challenging. Additionally, the symptoms of the many different types of arrhythmias often overlap. Fatigue, weakness, shortness of breath, dizziness, and pounding in the chest can occur with all of the abnormal rhythms. 

If you wonder why your heart is beating irregularly, you should seek help from your medical provider. A thorough cardiac exam may include multiple diagnostic tests, including:

  • Electrocardiogram (EKG or ECG) – An EKG measures the electrical signals of the heart. It’s the most important diagnostic tool in evaluating the heart. However, because it’s just one snapshot in time, it can miss critical cardiac events.
  • Echocardiogram (Echo) – An echocardiogram uses sound waves to take photos of the heart. An echo can detect any structural abnormalities or changes to the heart. 
  • Holter monitor or other wearable monitors – These portable EKGs measure the heart’s electrical signals for a more extended period. Wearable monitors can be worn anywhere from 24-hours up to two weeks at a time. 
  • Cardiac mapping – More severe cardiac arrhythmias may require an electrophysiology (EP) study. This invasive surgery maps the heart’s electrical activity to determine the cause of the abnormal heart rhythm. 

How do I stop my arrhythmia?

As with all diseases, it’s essential to identify the root cause of your abnormal heart rhythm. After all, treating the arrhythmia without understanding the “why” behind it will only be a temporary fix. 

There are some simple things that you can immediately try at home that may help to reduce or eliminate your irregular heartbeat.  

  • Eat a clean, 100 Year Heart Diet
  • Eliminate alcohol use
  • Increase quality water consumption
  • Get good sleep
  • Reduce your exposure to toxins
  • Check your caffeine intake 
  • Manage stress 
  • Work with your doctor to determine any vitamin or mineral deficiencies

Some types of heart arrhythmias will require medical intervention, so always seek assistance from your healthcare provider. However, even if you require medical treatment, getting your body to its best state of health will optimize your chances of a successful recovery. 

Next steps 

Our hearts are very good at giving love to others, but are you giving your heart enough love in return? Sometimes irregular heartbeats are just our heart’s way of sending a signal that something is out of balance. If you take the time to listen to your body and treat it kindly, you might be able to avert a more significant health disaster. Fill out an application today to work with NHD’s expert practitioners and start working towards your 100 Year Heart.

Eat well, Live well, Think well

Medical Review: Dr. Lauren Lattanza 2022

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