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All seven Medical Spheres ›Skipped beats, a racing heart or a noticeably slow pulse can point to an arrhythmia – harmless or in need of treatment. The ECG classifies it; treatment depends on the type, the cause and your personal risk.
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Guide values. What is normal in an individual case can only be determined by a medical examination.
Arrhythmia
The heart’s rhythm is set by the sinus node, a small cluster of cells in the right atrium. Its electrical impulses travel across the atria to the ventricles and trigger every heartbeat. At rest, an adult’s heart usually beats 60 to 100 times a minute. Doctors speak of an arrhythmia when it beats too fast, too slowly or irregularly.
Many arrhythmias are harmless. Most people know occasional extra beats, felt as a flutter or a brief pause, for example after coffee, alcohol, stress or a short night. Others need treatment because they reduce the heart’s pumping capacity or can have serious consequences. What matters is whether the heart is otherwise healthy and which symptoms occur: a racing heart, dizziness, shortness of breath, reduced stamina or a brief faint.
The most common persistent arrhythmia is atrial fibrillation. The atria beat in a disorganised way, and the pulse becomes irregular and often fast; some people notice nothing at all. Because clots can form in the fibrillating atria, it increases the risk of stroke. It becomes more common with age and is promoted by high blood pressure, excess weight, diabetes, sleep apnoea and alcohol.
If the heart beats too slowly on a permanent basis, for example because electrical conduction weakens over the years, stamina suffers: tiredness, dizziness and fainting can result, and a pacemaker is then often an option. More serious are fast arrhythmias that originate in the ventricles. They usually occur in a previously damaged heart and can turn into ventricular fibrillation, a cardiac arrest. Chest compressions and a defibrillator are then needed immediately.
The treatment
Medicines slow down a pulse that is too fast or stabilise the rhythm. A targeted electric shock under brief anaesthesia, known as cardioversion, can restore a regular rhythm.
In atrial fibrillation, blood-thinning medication lowers the risk of a blood clot causing a stroke. Whether it is needed depends on age and other conditions.
A pacemaker steps in when the heart beats too slowly; an implanted defibrillator detects dangerous ventricular rhythms and can stop them. Catheter ablation deliberately scars the areas from which a disturbance originates.
The path
The decisive step is to record the rhythm at the moment symptoms occur. Treatment then depends on the type, the cause and your personal risk.
When do the symptoms occur, for how long, and what triggers them? Plus existing conditions, medication, pulse and blood pressure. Your own notes or recordings from a watch help with the assessment.
The resting ECG captures the rhythm at the moment of the examination. An ambulatory ECG records over 24 to 48 hours, and an event recorder over a longer period if the disturbance occurs only rarely.
Heart ultrasound, blood tests such as thyroid hormones and potassium and, if needed, an exercise ECG show whether a heart condition or another trigger is behind it.
Depending on the findings, medication, cardioversion or anticoagulation. Acute disturbances with severe symptoms are treated in the emergency department with monitoring.
If medication is not enough or the heart beats too slowly, catheter ablation, a pacemaker or a defibrillator may be considered; ablation requires a cardiac catheter lab at a specialised centre.
Regular ECG checks show whether the treatment is working. Pacemakers and defibrillators are read out and tested at fixed intervals.
Statutory, private, self-pay
Statutory health insurance
ECG, ambulatory ECG, heart ultrasound and the treatment of an arrhythmia are covered by German statutory health insurance when medically indicated. For a planned appointment, bring your insurance card and a referral from your GP or specialist.
In Wertheim, care covered by statutory insurance is provided by the Bürgerspital – in an emergency via the central emergency department.
Private insurance or self-pay
Private health insurance and the Beihilfe allowance for civil servants cover medically necessary treatment according to their tariffs. Privately insured and self-pay patients can also be treated at the Main-Tauber-Klinik, the private clinic in the same building.
Specialists
In Wertheim, arrhythmias are treated by the Department of Internal Medicine – planned treatment in cardiology, acute treatment via the central emergency department. Listed here are a specialist in internal medicine from cardiology and a specialist in internal and emergency medicine.
Locations
Each clinic shows on its own website how the treatment works there.
Germany
ECG, ambulatory ECG, heart ultrasound and pacemaker checks at the Bürgerspital, a hospital with a public healthcare mandate, and in an emergency the central emergency department, around the clock; the Main-Tauber-Klinik under the same roof looks after privately insured and self-pay patients.
Frequently asked questions
Usually not. Occasional extra beats are very common and generally harmless in a healthy heart. You should have them checked if they are new or frequent, come with dizziness, shortness of breath or chest pain, or if you have a known heart condition.
If chest pain, shortness of breath, severe dizziness or fainting occur, or if the racing does not subside: then call 112 – likewise with a very slow pulse and dizziness or loss of consciousness. If it settles by itself, it should still be seen by a doctor promptly, ideally with a note of when it happened and how long it lasted.
In the fibrillating atrium, blood flows more slowly, especially in the atrial appendage, a small pouch. Clots can form there, travel with the bloodstream to the brain and block a vessel. Whether blood-thinning medication is recommended depends on your personal risk, based on age and other conditions.
Not always. Some episodes end on their own, others with medication or cardioversion. For many people, catheter ablation can make relapses less frequent, but they cannot be ruled out. Well-controlled blood pressure, less alcohol, losing weight if overweight and treating sleep apnoea can also help.
When the heart beats too slowly or pauses, causing dizziness, fainting or reduced stamina. The device sits under the skin below the collarbone and sets the pace via leads as soon as the heart becomes too slow. Daily life is usually only slightly restricted afterwards; before an MRI scan, you need to check with your doctor.
Many watches measure the pulse, and some record a simple ECG and flag possible atrial fibrillation. Such an alert does not replace a diagnosis and should be checked with an ECG by a doctor. Conversely, a normal reading does not rule out an arrhythmia.
That depends on the type and effects of the disturbance. After fainting, you should only drive again once the cause has been identified and treated. After a pacemaker or defibrillator has been fitted, a break from driving also applies, its length set by your doctor.
Consultation
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