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Your heart rhythm is controlled by electrical impulses that start each heartbeat. These impulses cause the heart muscles to contract and pump blood. This process runs smoothly with a normal resting heart rate of 60 to 100 beats a minute in a healthy heart.

Heart rhythm problems (heart arrhythmias) occur when the electrical impulses don't work properly. During an arrhythmia, the heart can beat too fast, too slowly, or with an irregular rhythm. Arrhythmias can be harmless or life-threatening.

Doctors classify arrhythmias not only by where they originate (atria or ventricles) but also by heart rate.

There are two common types of arrhythmias:

  • Tachycardia: This is a fast heartbeat—greater than 100 beats a minute at rest.

  • Bradycardia: This is a slow heartbeat—less than 60 beats a minute at rest.

Not all tachycardias or bradycardias mean you have heart disease. For example, during exercise, it's normal for your heart to beat fast. During sleep or when you're deeply relaxed, your heartbeat may be slower.

What happens once you have arrhythmias?

Arrhythmias may not cause any signs or symptoms. In fact, your doctor might find you have an arrhythmia before you do, during a routine examination.

Arrhythmia symptoms that you notice may include:

  • Chest pain.
  • Anxiety.
  • Fatigue.
  • Sweating.
  • A fluttering in your chest.
  • Shortness of breath.
  • A racing heartbeat (tachycardia).
  • A slow heartbeat (bradycardia).
  • Lightheadedness or dizziness.
  • Fainting (syncope) or near fainting.

If the arrhythmias don't go away or happen often, seek medical care. Seek urgent medical care if you suddenly or frequently experience any of these signs and symptoms at a time when you wouldn't expect to feel them.

Ventricular fibrillation is one type of arrhythmia that can be deadly. It occurs when the heart beats with rapid, erratic electrical impulses. This causes the lower chambers in your heart (ventricles) to quiver uselessly instead of pumping blood. Without an effective heartbeat, your blood pressure drops, cutting off blood supply to your body.

Arrhythmias may increase your risk of developing serious problems such as:

  • Stroke: Heart arrhythmias are associated with a risk of blood clots. If a clot breaks loose, it can travel to your brain and cause a stroke. Certain medications, such as blood thinners, can greatly lower your risk of blood clots.
  • Heart failure: Heart failure can result if your heart is pumping ineffectively for a prolonged period of time. Sometimes controlling the rate of an arrhythmia that's causing heart failure can improve your heart's function.

What causes arrhythmias?

Certain conditions that can lead to an arrhythmia include:

  • Sleep apnea.
  • High blood pressure.
  • Thyroid problems.
  • A current heart attack.
  • Uncontrolled diabetes.
  • Infection with COVID-19.
  • Scarring of heart tissue from a prior heart attack.
  • Changes to your heart and vascular structures include cardiomyopathy, coronary artery disease, previous heart surgery, abnormal heart valves, heart failure, and congenital heart disease.

Other things that can cause an arrhythmia include:

  • Smoking.
  • Drug abuse.
  • Genetics.
  • Stress or anxiety.
  • Electrolyte imbalance.
  • Drinking too much alcohol or caffeine.
  • Certain medications and supplements, including over-the-counter cold and allergy drugs.

What types of tests are used to diagnosis arrhythmias?

Your doctor will review your symptoms and your medical history to diagnose a heart arrhythmia and give you a physical examination.

Your doctor may give you tests specific to arrhythmias. These include:

  • Electrocardiogram (EKG): An EKG measures the timing and duration of each electrical phase in your heartbeat.
  • Holter monitor: This portable EKG device can be worn for a day or more to record your heart's activity as you go about your routine.
  • Event recorder: For sporadic arrhythmias, you keep this portable EKG device attached to your body and press a button when you have symptoms. This lets your doctor check your heart rhythm at the time of your symptoms.
  • Echocardiogram: In this noninvasive test, a hand-held device (transducer) placed on your chest uses sound waves to produce images of your heart's size, structure, and motion.
  • Implantable loop recorder: If your symptoms are infrequent, an event recorder may be implanted under your skin in the chest area to continually record your heart's electrical activity and detect abnormal heart rhythms.

If your doctor doesn't find an arrhythmia during those tests, he or she may try to trigger your arrhythmia with other tests, which may include:

  • Stress test: Some arrhythmias are triggered by exercise. During a stress test, you'll be asked to exercise on a treadmill or stationary bicycle while your heart activity is monitored.
  • Tilt table test: Your doctor may recommend this test if you've had fainting spells. Your heart rate and blood pressure are monitored as you lie flat on a table. The table is then tilted as if you were standing up. Your doctor observes how your heart and the nervous system respond.
  • Electrophysiological testing and mapping: Doctors thread thin, flexible tubes (catheters) tipped with electrodes through your blood vessels to a variety of spots within your heart to map the electrical impulses.

What types of treatments and procedures are used to treat arrhythmias?

If you have an arrhythmia, treatment is required only if it is causing significant symptoms or is putting you at risk of a more serious problem.

Treatments include:

  • Vagal maneuvers: You may be able to stop an arrhythmia by holding your breath and straining, dunking your face in ice water, or coughing. These maneuvers affect the nervous system that controls your heartbeat.
  • Medications: Medications are available for many types of tachycardia (fast heartbeats).
  • Cardioversion: In this procedure, a shock is delivered to your heart through paddles or patches on your chest. This can restore a normal rhythm.
  • Catheter ablation: In this procedure, your doctor threads one or more catheters through your blood vessels to your heart. Electrodes at the catheter tips damage (ablate) a small spot of heart tissue to create an electrical block causing your arrhythmia.
  • Devices:
    • Pacemaker: If your heart rate is too slow or if it stops, a pacemaker sends out electrical impulses that stimulate your heart to beat at a steady rate.
    • Implantable cardioverter-defibrillator (ICD): An ICD detects an abnormal heart rhythm and sends out energy shocks to reset the heart to a normal rhythm.
  • Surgery:
    • MAZE procedure: A surgeon makes a series of incisions in the heart tissue to create a pattern or maze of scar tissue. The scar tissue interferes with stray electrical impulses that cause arrhythmia.
    • Coronary bypass surgery: A surgeon uses blood vessels taken from another area of your body to bypass the damaged arteries.

What can I do to support my health when I have arrhythmias?

If your arrhythmia is causing symptoms or puts you at risk for more serious complications, your doctor will set a treatment plan. Take all medications exactly as prescribed. If you have any side effects, tell your doctor about them.

Your doctor may want you to take your pulse – especially if you have an artificial pacemaker.

  1. Put the second and third fingers of one hand on the inside of the wrist of the other hand, just below the thumb OR on the side of your neck, just below the corner of your jaw.
  2. Feel for the pulse.
  3. Count the number of beats in one full minute.
  4. Keep a record of your pulse along with the day and time taken and notes about how you felt at the time. Use the American Heart Association's blood pressure/pulse tracker (PDF).

Certain substances can contribute to an abnormal/irregular heartbeat. If you're being treated for arrhythmia and use any of these substances, be sure to discuss this with your doctor.

  • Caffeine.
  • Tobacco.
  • Alcohol.
  • Cold and cough medications.
  • Appetite suppressants.
  • Psychotropic drugs (used to treat certain mental illnesses).
  • Beta-blockers for high blood pressure.
  • Illegal drugs such as cocaine or methamphetamines.

Just having certain arrhythmias increases your risk of heart attack, cardiac arrest and stroke. Work with your healthcare team and follow their instructions to control other risk factors:

  • Reduce high blood pressure.
  • Control cholesterol levels.
  • Lose excess weight.
  • Eat a heart-healthy diet.
  • Avoid tobacco smoke.
  • Enjoy regular physical activity.

The best thing you can do for your health is to follow your treatment plan.

Why choose Presbyterian for arrhythmia treatment?

Presbyterian’s Heart and Vascular team has many different options to help you manage your heart condition. The team performs various diagnostic tests and procedures to help form an accurate diagnosis and create individualized treatment plans for your heart health needs. Depending on the type of heart condition you have and its underlying cause, the team can recommend a wide variety of treatment options, including lifestyle modifications, medications, and procedures. Our cardiologists and cardiovascular surgeons work closely together for cases in which surgery is the best treatment option. We also offer a customized cardiac rehabilitation program at our Healthplex, where clinically appropriate, which can improve your endurance and exercise tolerance, as well as improve heart-related symptoms. Your cardiologist will work with the rehabilitation team to create a plan that will be tailored to your individual health needs.