A healthy heart usually beats at a steady rhythm, but a number of things can disrupt your heart’s regular pacing. When an abnormal heart rhythm develops, it’s called an arrhythmia.

While some arrhythmias are mild and have little or no effect on your health, others can lead to serious medical complications. The first step in managing an arrhythmia is to get a proper diagnosis, which is usually done by monitoring your heart’s electrical activity.

Once your type of arrhythmia is confirmed, a treatment plan can be created that may include some combination of medications, implantable cardiac devices, and lifestyle changes.

An arrhythmia can cause your heart to beat too quickly (tachycardia), too slowly (bradycardia), or with an irregular rhythm (fibrillation).


Tachycardia can feel as though your heart is racing or that it might pound out of your chest. Generally, a heart rate of more than 100 beats per minute (bpm) is considered tachycardia. This can result in poor circulation to your brain and other organs, weakening of the heart, blood clot formation, or weakening of dysfunction of the heart muscle.


With bradycardia, your resting heart rate is less than 60 bpm. You may feel as though your heart is thudding slowly, but it can also feel like your heart is skipping a beat. There is often an underlying health condition causing this slow heart rate.

As with tachycardia, this pace of your heartbeat with bradycardia means the organs and tissue in the body aren’t getting the steady, robust supply of oxygenated blood they need for optimal health. This can lead to fainting or passing out.


Unsteady heart rates, such as atrial fibrillation (AFib), can feel like fluttering in your chest or like your heart is quivering. In many cases, there are no obvious symptoms at first. But when your heart isn’t beating in a consistent, synchronized way, you have a higher chance of serious cardiovascular events, like blood clots and stroke.

An electrocardiogram (ECG) is the most common test used to diagnose an arrhythmia. A 2018 study suggests that getting an ECG recording as early as possible after having palpitations is helpful in managing arrhythmia.

An ECG, sometimes called an EKG, records the electrical activity of your heart. The standard ECG used in hospitals and medical offices includes a recorder, display screen, and wires attached to electrodes. The electrodes are placed on your chest and elsewhere on the body.

The rhythm recorded by an ECG is often printed out to show how fast (or slow) your heart is beating. It also detects the intervals in between heartbeats, which can show if they are too long, too short, or irregular in another way.

If a standard ECG doesn’t pick up an arrhythmia, your doctor or healthcare professional may have you wear a portable monitor. One type, the Holter monitor, is worn for 24 hours for days or weeks to hopefully capture an arrhythmia.

Another type — called an event monitor — is similar to a Holter monitor, but it doesn’t record the heart constantly. The user can switch it on when experiencing symptoms. Some event monitors switch on automatically when they detect a change in rhythm.

For people who have unexplained, infrequent arrhythmic episodes, an implantable loop monitor is sometimes recommended. It is placed in the skin of the chest and sends information about your heart’s rhythm without you having to do anything.

An echocardiogram is a test that uses sound waves to create live, moving images of your heart. This can help to diagnose structural problems that can cause arrhythmias.

Standard transthoracic echocardiography uses a transducer to send ultrasound waves through your chest. A computer converts the waves that bounce back from the heart into images that can be seen on a computer screen.

If the images aren’t clear enough, transesophageal echocardiography may be needed. It involves the use of a smaller, thinner transducer that is passed down the throat to the esophagus, which is behind the heart and may provide a better view.

To get a good look at your heart and lungs, and particularly to see if your heart is enlarged, a standard chest X-ray may be done. Several conditions can cause an enlarged heart, including a heart disease known as cardiomyopathy. Arrhythmias can lead to cardiomyopathy, and a 2018 study suggests that arrhythmia-induced cardiomyopathy is sometimes reversible once detected.

A chest X-ray can also help diagnose other conditions in the lungs that cause arrhythmias, such as pneumonia or fluid in the lungs.

A blood test can be particularly helpful in checking for factors that may be responsible for your arrhythmia. These include thyroid hormone levels, as well as potassium and other electrolytes that can affect heart rhythm.

Some arrhythmias only act up when you exercise or are under stress. During an exercise stress test, a healthcare professional will get your heart rate up by having you walk briskly on a treadmill or ride a stationary bicycle. In some cases, medicine may be given to accelerate the heart rate.

With test results and an understanding of your symptoms and medical history, a doctor can recommend a treatment plan for your specific type of arrhythmia and its severity. Mild and infrequent arrhythmias often require no medications, devices, or other treatment. Instead, you may be advised to adopt a more heart-friendly lifestyle, avoid stimulants, and schedule regular checkups.

More severe arrhythmias can cause symptoms such as lightheadedness and fainting and can raise the risk of blood clots. In these cases, a more aggressive treatment plan will be necessary.


Several types of medications are usually prescribed to people with an arrhythmia. These can either help stabilize the heart rhythm or protect against complications.

Common arrhythmia drugs include:

  • Beta-blockers are used to treat arrhythmias. They reduce the heart rate and lower blood pressure.
  • Antiarrhythmic drugs are used to prevent abnormal rhythms and reduce the intensity of arrhythmias. In recent years, there has been a shift toward tailoring specific antiarrhythmic medications to your heart rhythm needs and symptoms, rather than look for a one-size-fits-all answer.
  • Anticoagulants, also known as blood thinners, interfere with the blood’s natural tendency for clotting so an irregular heartbeat doesn’t allow blood to pool in the heart and form a clot.

Implantable devices

For people with severe, frequent arrhythmias, an implantable cardioverter device (ICD), can be a literal life-saver. An ICD is a small machine that contains a battery and a computer that constantly monitors your heart rate. When your heart is out of rhythm, the ICD sends a small electrical shock to the heart to jolt it back into a healthy rhythm.

A similar device, called a pacemaker, is primarily used to treat bradycardia. It works by monitoring your heart rate, and if it needs to speed up or slow down, the pacemaker will send a signal to the heart to get your heart rate in a healthier range.

Risk factor management/lifestyle choices

Making lifestyle changes that support healthy heart functioning are crucial, whether you take medications for your heart, have a pacemaker, or are otherwise being treated for an arrhythmia or other cardiac condition.

One way to stay on top of your condition is to measure your heart rate periodically and keep track of changes. There are watches and other health tracking devices that will record your pulse. You can also check your heart rate manually.

Talk with a healthcare professional about how often you should check your heart rate and what, if any, devices might work for you.

Other ways to manage risk factors and improve heart health include:

  • Manage your blood pressure, cholesterol, and blood sugar levels.
  • Exercise 30 to 40 minutes most days of the week.
  • Follow a heart-healthy diet, such as the Mediterranean diet.
  • Make a plan to quit smoking, if you do.
  • Follow your doctor’s advice regarding medications, blood work, and checkups.
  • Avoid cardiac stimulants such as alcohol, caffeine, energy drinks, and cannabis.

If you suspect you have an arrhythmia, explain your symptoms to a doctor or cardiologist. You may have an ECG or undergo other types of monitoring tests. These will help determine if you are indeed experiencing an abnormally slow, fast, or irregular heartbeat and what may be causing the problem.

You may also be referred to an electrophysiologist, a specialist who focuses on heart rhythm disorders. If you are diagnosed with an arrhythmia, consider making an electrophysiologist a permanent part of your healthcare team.