HealthONE - January 07, 2021

When Should You See a Doctor for an Irregular Heartbeat?

Why you may need an electrophysiologist to help regulate your rhythm

Does your heart sometimes skip a beat? Or maybe your heart beats too fast? Perhaps it beats too slow? Most people have experienced an episode or two of abnormal heart rhythm, but when does the irregularity warrant a trip to the doctor or an electrophysiologist?

“An abnormal heart rhythm is called an arrhythmia. Sometimes, the electrical system of the heart doesn’t work properly which causes a temporary change in the feeling of your heartbeat,” explains Jason Huang, MD, an electrophysiologist at Denver Heart. “Many times, this is not a cause for concern. But if it happens regularly, you should talk to your primary care doctor or make an appointment with a cardiologist. An electrophysiologist is a cardiologist who has undergone additional training focused on heart rhythm disorders and treatment.”

The heart of the matter

The heart is comprised of upper and lower chambers, known as the atria and ventricles. It is split into the right and left side that separates the blood to and from the lungs for oxygenation. Normal heart rhythm is initiated by the sinus node, which serves as the heart’s internal pacemaker. This electrical signal is transmitted to the ventricles by the atrioventricular node, allowing for a coordinated impulse between the right and left sides of the heart. A normal heart rate typically ranges between 60 to 100 beats per minute.

“When the heart beats more than 100 times a minute, we call it tachycardia. When the heart beats less than 60 times per minute, we call it bradycardia,” Dr. Huang details. “There are occasions when it is normal for the heart to beat faster or slower—upon exercise or when sleeping, for example.”

Types of arrhythmia

Heart rhythm abnormalities can be split into tachycardia, where the heart rate is greater than 100 beats per minute, versus bradycardia, where the heart rate is slower than 60 beats per minute. In the setting of an abnormal tachyarrhythmia, there are typically three categories: supraventricular arrhythmias, atrial fibrillation/flutter and ventricular arrhythmias. Symptoms related to these arrhythmias can vary between palpitations, shortness of breath, chest discomfort, or light-headedness. Many individuals can have minimal to no symptoms at all. Identification of these arrhythmias is performed through a standard electrocardiogram or ambulatory cardiac monitoring.

Bradycardia can often be a normal variant, particularly in young, healthy individuals. Concerning associated symptoms include fatigue, light-headedness and at times syncope or loss of consciousness. Distinguishing normal and potentially dangerous variants of bradycardia is based upon the baseline electrocardiogram in addition to the patient’s associated symptoms.

Most importantly, arrhythmias can affect individuals of all ages. Otherwise, healthy individuals with a structurally normal heart can be susceptible to recurrent symptomatic arrhythmias. If concerned over any of the above symptoms, further discussion with your physician is advised.

When to see a doctor for arrhythmia

An occasional abnormal heartbeat is not cause for serious concern. However, if symptoms last for long periods of time, are significant or come back time and again, it’s important to seek medical attention.

“If you have fainting, swelling in your leg, shortness of breath—seek medical attention right away,” Dr. Huang emphasizes. “These are signs that there may be a serious problem. However, if you experience a racing heart from time to time or notice your heart skips a beat now and then, take note and make an appointment with your physician or reach out to an electrophysiologist.”

Dr. Huang explains that many times patients do not know they can self-refer to an electrophysiologist. “Of course, your primary care physician (PCP) is a great place to start—this provider’s job is to manage all aspects of your care. But if you have a heart rhythm concern, you may look for an electrophysiologist (EP) or ask your PCP to recommend one,” Dr. Huang shares. “This is a physician who has dedicated his/her career to the diagnosis and treatment of heart rhythms. Because of this unique level of focus, an EP often is better able to help patients more quickly and more fully resolve or manage the condition.”

What to expect during an EP visit

An EP will begin by diagnosing the cause of the disturbance. “We usually start with an echocardiogram, which is a non-invasive ultrasound that looks at the structure of the heart and how it is performing. If that looks normal, we often prescribe a monitor that records your heart rhythm while you are performing normal activities. This allows us to catch an episode of arrhythmia and review it. Once we have an appropriate diagnosis, we have many treatments available to manage or eradicate the malfunction,” Dr. Huang says.

“You don’t have to live with an irregular heartbeat. If it affects your day-to-day life, we encourage you to speak with a doctor who can help appropriately diagnose, correct, or manage your arrhythmia,” Dr. Huang encourages. “The health of your entire body relies on the health of your heart—pay attention to what it’s telling you and let us help keep it at its best!”

Dr. Jason Huang is a clinical cardiac electrophysiologist at Denver Heart. He completed his medical school and internal medicine residency at the University of Virginia. Dr. Huang continued his education with a general cardiology fellowship at the University of Washington. In Seattle, he discovered his true passion in cardiac electrophysiology, which led him to one of the country’s best EP training programs at the Hospital of the University of Pennsylvania. Dr Huang is particularly interested in complex ablation and device extractions.