Irregular heartbeat should be checked out

Q: I am 82 years old and still very active. I have had an irregular heartbeat for four years, and sometimes feel lightheaded, dizzy or tired. Would you give a detailed explanation about irregular heartbeat, including how or why it happens? What should I do to prevent it from getting worse? Is it life-threatening? Will it become atrial fibrillation?

A: Everyone has irregular heartbeats from time to time. Early beats can come from electrically active areas anywhere in the heart, and an electrocardiogram can tell whether they are from the atria (the top chambers) or the ventricles (the bottom chambers) of the heart.

An average person might have 500 or so of these a day — some people have many more. Most are seldom aware of them. Having patients with this concern over and over during my career, I can reassure you that most cases turn out to be nothing to worry about.

However, the fact that you are having symptoms, especially the lightheadedness and fatigue, is a warning sign, and I recommend you get an evaluation. Start with your regular medical provider, after which you might be referred to a cardiologist. The EKG in the doctor’s office is a first step, but you might need a longer evaluation, such as wearing a 24-hour EKG (a Holter monitor) or newer technologies that allow longer readings.

Atrial fibrillation is a concern, because most people will need treatment to reduce stroke risk or to return the rhythm to normal. Nevertheless, there are many other kinds of irregular heart rhythms, and you need a diagnosis first. If no cause is found, there are medications to reduce the irregularity, but they are seldom used. My experience is that when a person knows the heartbeats are not dangerous, they can be lived with more easily.