Arrhythmias are health problems associated with the rate or rhythm of your heartbeat. This could mean that your heart is beating too fast, too slow, or in an irregular pattern. When the heart beats faster than normal, it is called tachycardia. When the heart beats too slowly, it is called bradycardia. The most common type of arrhythmia is atrial fibrillation – which causes an irregular and fast heartbeat.
Many factors can affect your heart rhythm, such as having a heart attack, smoking habits, congenital heart defects, and stress. Certain substances or drugs can also cause arrhythmias.
Symptoms of arrhythmias include:
- Fast or slow heartbeat
- Skipped heartbeat
- Dizziness or lightheadedness
- Chest pain
- Shortness of breath
Your doctor may run tests to find out if you have an arrhythmia. Treatment to restore normal heart rhythm may include medications, implanted cardioverter-defibrillator (ICD) or pacemaker, or in some cases, surgery.
Most arrhythmias are harmless, but some can be serious or even life-threatening. In arrhythmia, your heart may not be able to pump enough blood to the rest of the body. Lack of blood flow can damage the brain, heart, and other organs.
Understanding the Heart’s Electrical System
To understand arrhythmias, it is key to understand the heart’s internal electrical system. The heart’s electrical system controls the rate and rhythm of the heartbeat. With each heartbeat, an electrical signal travels downwards from the top of the heart. When the signal travels, it makes the heart contract and pump blood.
Each electrical signal starts in a group of cells called a sine node or sinoatrial (SA) node. The SA loop is located in the right upper chamber of the heart, which is the right atrium. In a healthy adult heart, the SA node emits an electrical signal to initiate a new heart rate of 60 to 100 beats per minute at rest.
From the SA node, the electrical signal travels through special pathways in the right and left atria. This causes the atria to contract and pump blood into the two lower chambers of the heart, the ventricles. The electrical signal then travels to a group of cells called the atrioventricular (AV) node, which is located between the atria and ventricles. Here, the signal slows down only slightly – giving the ventricles time to finish filling with blood.
The electrical signal then leaves the AV node and travels along a pathway called the bundle of His. This path divides into a right bundle branch and a left bundle branch. Signals travel down these branches to the ventricles – causing them to contract and pump blood to the lungs and the rest of the body.
The ventricles then relax, and the heart rate process begins again at the SA node.
Any problems that interfere with the process can lead to arrhythmias. For example, in atrial fibrillation, a common type of arrhythmia, electrical signals travel through the atria in a fast and disorganized manner. This causes the atria to vibrate instead of contract.
There are many types of arrhythmias. Life expectancy for someone with an arrhythmia depends on the type and severity of the arrhythmia.
Even serious arrhythmias can often be successfully treated. Most people who have arrhythmias can live normal, healthy lives.
Types of Arrhythmia
The four main types of arrhythmias are premature (extra) beat, supraventricular arrhythmias, ventricular arrhythmias, and bradyarrhythmias.
Premature Beat (Extra)
Premature beats are the most common type of arrhythmia. This type of arrhythmia is usually harmless and typically does not cause any symptoms. When symptoms do occur, they usually feel like a pounding chest or a feeling of a skipped heartbeat. Usually, premature beats do not require treatment, particularly in healthy people.
Premature beats that occur in the atria (the upper chambers of the heart) are called premature atrial contractions, or premature atrial contraction (PAC). Premature beats that occur in the ventricles (the lower chambers of the heart) are called premature ventricular contractions, or premature ventricular contraction (PVC).
In most cases, premature beats occur naturally. However, some heart diseases can cause premature beats. It can also happen due to stress, too much exercise, or too much caffeine or nicotine.
Supraventricular arrhythmias are tachycardia (fast heart rate) that begin in the atria or atrioventricular (AV) knot. The AV node is a group of cells located between the atria and ventricles.
Types of supraventricular arrhythmias include atrial fibrillation (AF), atrial flutter, paroxysmal supraventricular tachycardia or paroxysmal supraventricular tachycardia (PSVT), and Wolff-Parkinson-White syndrome (WPW).
Atrial Fibrillation (AF) Arrhythmia
Atrial Fibrillation (AF) is the most common type of arrhythmia. It involves very fast and irregular contractions of the atria. In AF, the heart’s electrical signals do not start at the SA node. Instead, they start in another part of the atrium or in a nearby pulmonary vein.
Signals do not operate normally and can spread throughout the atrium in a fast and irregular manner. This causes the walls of the atria to vibrate very fast (fibrillate), instead of pulsing normally. As a result, the atria cannot pump blood to the ventricles in the way they should.
In AF, electrical signals can travel through the atria at rates in excess of 300 per minute. Some of these abnormal signals can travel to the ventricles, causing them to beat too fast and with an irregular rhythm. AF is usually not life-threatening, but it can be dangerous if it causes the ventricles to beat very fast.
AF has two main complications — stroke and heart failure.
In AF, blood can pool in the atria, causing blood clots to form. If the clot breaks and travels to the brain, it can cause a stroke. Blood thinners that reduce the risk of stroke are an important part of treatment for people with AF.
Heart failure occurs when the heart cannot pump enough blood to meet the body’s needs. AF can lead to heart failure because the ventricles beat very fast and cannot fill completely with blood. Thus, the ventricles may not be able to pump enough blood to the lungs and body.
Damage to the heart’s electrical system causes AF. The damage most often results from other conditions that affect heart health, such as high blood pressure, coronary heart disease, and rheumatic heart disease. Inflammation is also thought to play a role in the development of AF.
Other conditions can also cause AF, including an overactive thyroid gland (too much thyroid hormone produced) and heavy use of alcohol. The risk of AF increases with age. Sometimes AF and other supraventricular arrhythmias can occur for no apparent reason.
Atrial Flutter Arrhythmia
Atrial flutter is similar to AF. However, the heart’s electrical signals travel through the atria in a fast, regular – rather than irregular – rhythm. Atrial flutter is much more common than AF, but has similar symptoms and complications.
Paroxysmal Supraventricular Tachycardia Arrhythmia
Paroxysmal supraventricular tachycardia (PSVT) is a very fast heart rate that starts and ends suddenly. PSVT occurs because of a problem with the electrical connection between the atria and ventricles. In PSVT, the electrical signals that start in the atria and travel to the ventricles can reenter the atria, causing an extra heartbeat. This type of arrhythmia is usually harmless and tends to occur in young people. It can happen during vigorous physical activity.
A particular type of PSVT is called Wolff-Parkinson-White syndrome. WPW syndrome is a condition in which the heart’s electrical signals travel along extra pathways from the atria to the ventricles.
This extra pathway interferes with the timing of the heart’s electrical signals and can cause the ventricles to beat very fast. This type of arrhythmia can be life-threatening.
Ventricular arrhythmias begin in the lower chambers of the heart, the ventricles. This arrhythmia can be very dangerous and usually requires immediate medical care.
Ventricular arrhythmias include ventricular tachycardia and ventricular fibrillation (v-fib). Coronary heart disease, heart attack, weakened heart muscle, and other problems can cause ventricular arrhythmias.
Ventricular tachycardia arrhythmias
Ventricular tachycardia is a rapid and regular beat of the ventricles that can last only a few seconds or longer.
Multiple beats of ventricular tachycardia often cause no problem. However, episodes that last longer than a few seconds can be dangerous. Ventricular tachycardia can turn into more severe arrhythmias, such as v-fib.
Ventricular Fibrillation Arrhythmias
Ventricular fibrillation (v-fib) occurs when an irregular electrical signal causes the ventricles to vibrate instead of pumping normally. Without the ventricles pumping blood to the body, sudden heart attack and death can occur within minutes.
To prevent death, the condition must be treated immediately with electric shocks to the heart called defibrillation. V-fib can occur during or after a heart attack or in someone whose heart has become weak due to another condition. Torsades de pointes (torsades) is a type of v-fib that causes a unique pattern on an ECG (electrocardiogram) test. Certain medications or an imbalance potassium, calcium, or magnesium levels in the bloodstream can cause this condition.
People who have long QT syndrome are at higher risk for torsades. People with this condition need to be careful about taking certain antibiotics, heart medicines, and over-the-counter medicines.
Bradyarrhythmias occur when the heart rate is slower than normal. If the heart rate is too slow, insufficient blood reaches the brain. This can cause you to pass out.
In adults, a heart rate slower than 60 beats per minute is considered bradyarrhythmia. Some people usually have a slow heart rate, especially people who are very physically fit. For them, a heart rate slower than 60 beats per minute is harmless and causes no symptoms. However, in others, serious illness or other conditions can cause bradyarrhythmias.
Bradyarrhythmias can be caused by:
- Heart attack
- Conditions that harm or alter the electrical activity of the heart, such as an underactive thyroid gland
- Imbalance of chemicals or other substances in the blood, such as potassium
- Medications such as beta blockers, calcium channel blockers, some antiarrhythmic medicines, and digoxin
Arrhythmia in Children
Children’s heart rates usually decreases as they get older. A newborn’s heart beats between 95 and 160 beats per minute. The heart of a 1 year old child beats between 90 and 150 beats per minute, and the heart of a 6-8 year old child beats between 60 and 110 beats per minute.
The heart of a baby or child can beat fast or slow for many reasons. Similar to adults, when children are active – their hearts will beat faster. While sleeping, their hearts will beat slower. Their heart rate can speed up and slow down as they inhale and exhale. All of these changes are normal.
Some children are born with heart defects that cause arrhythmias. In other children, arrhythmias can develop later in childhood. Doctors use the same tests to diagnose arrhythmias in both children and adults.
Treatment for children with arrhythmias includes medications, defibrillation (electric shock), surgically implanted devices to control heart rate, and other procedures that correct abnormal electrical signals in the heart.
Causes of Arrhythmia
Arrhythmias can occur when the electrical signals that control the heart rate are delayed or blocked. This can happen if particular nerve cells that produce electrical signals do not function properly. It can also happen if electrical signals do not travel normally through the heart. Arrhythmias can also occur when other parts of the heart start generating electrical signals. This augments signals from the nerve cells and disrupts the normal heart rate.
In some cases, smoking habits, excess consumption of alcohol, consumption of certain illegal drugs (such as cocaine or amphetamines), use of prescription or over-the-counter drugs, or too much caffeine or nicotine can cause arrhythmias.
Strong emotional stress or anger can make the heart work harder, raise blood pressure, and release stress hormones. Sometimes, this reaction may lead to an arrhythmia.
Heart attacks or other conditions that damage the heart’s electrical system can also cause arrhythmias. Examples of such conditions include high blood pressure, coronary heart disease, heart failure, an overactive or underactive thyroid gland (too much or too little thyroid hormone produced), and rheumatic heart disease.
Congenital heart defects can cause some arrhythmias, such as Wolff-Parkinson-White syndrome. The terms “congenital” means the defect occurs at birth.
In some cases, the exact cause of the arrhythmia is unknown.
Risk Factors for Arrhythmia
Arrhythmias are very common in older adults. Atrial fibrillation (a common type of arrhythmia that can cause problems) affects millions of people, and the numbers are increasing. Arrhythmias can turn into a more severe condition in people over 60 years of age. This is because older adults are more likely to have heart disease and other health problems that can cause arrhythmias.
Older adults also tend to be more sensitive to the side effects of drugs – some of which can cause arrhythmias. Certain medicines used to treat arrhythmias can even cause arrhythmias as a side effect.
Some types of arrhythmia are more common in children and young adults. Paroxysmal supraventricular tachycardia (PSVT), including Wolff-Parkinson-White syndrome, is more common in young people. PSVT is a fast heart rate that starts and ends suddenly.
Main Risk Factors
Arrhythmias are more common in people who have diseases or conditions that weaken the heart, such as:
- Heart attack
- Heart failure or cardiomyopathy, which weakens the heart and changes the way electrical signals travel through the heart
- Heart tissue that is too thick or stiff or that does not form normally
- The heart valves leak or become narrowed, which makes the heart work too hard and lead to heart failure
- Congenital heart defects (birth defects) that affect the structure or function of the heart
Other conditions can also increase your risk of arrhythmias, such as:
- High blood pressure
- Infections that damage the heart muscle or the sac around the heart
- Diabetes, which increases the risk of high blood pressure and coronary heart disease
- Sleep apnea, which can stress your heart because it does not get enough oxygen
- An overactive or underactive thyroid gland (too much or too little thyroid hormone in the body)
Several other risk factors can also increase your risk of developing arrhythmias. Examples include certain drugs (such as cocaine or amphetamines), or imbalances of chemicals or other substances (such as potassium) in the bloodstream.
Signs and Symptoms of Arrhythmias
Many types of arrhythmias do not cause signs or symptoms. Although when they do, the most common are:
- Palpitations (the feeling of your heart pounding, or beating too hard or fast)
- Slow heart rate
- Irregular heartbeat
- Feel pauses between heartbeats
More serious signs and symptoms include:
- Weakness, dizziness
- Fainting or nearly fainting
- Shortness of breath
- Chest pain
Diagnosis of Arrhythmias
Arrhythmias can be difficult to diagnose, especially the one that only causes occasional symptoms. Doctors diagnose arrhythmias based on medical and family history, a physical test, and the results of tests and procedures.
Specialist Doctors To Treat Arrhythmias
Doctors who specialize in diagnosing and treating heart disease, including arrhythmias, are
- Cardiologist. This specialist doctor diagnoses and treats adults who have heart problems.
- Pediatric cardiologist. This specialist doctor diagnoses and treats babies, children, and adolescents who have heart problems.
- Electrophysiologist. This specialist doctor is a cardiologist or pediatric cardiologist who specialises in arrhythmias.
Personal and Family’s Medical History
To diagnose an arrhythmia, your doctor will ask you to describe your symptoms. He or she will ask if you feel like your heart is pounding hard or if you experience dizziness or lightheadedness.
Your doctor may also ask if you have other health problems, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems. He or she may ask about your family medical history, including whether anyone in your family:
- Has a history of arrhythmias
- Has had heart disease or high blood pressure
- Sudden death
- Has a certain disease or other health problem
Your doctor will also ask you about the medications you are taking, including over-the-counter medicines and supplements.
Your doctor may ask about your health habits – such as physical activity, smoking habits, or consumption of alcohol or illegal drugs (for example, cocaine). She or he may also want to know if you have experienced emotional stress or anger.
Physical Test for Arrhythmias
When conducting physical tests, your doctor may:
- Listen to the rate and rhythm of your heartbeat
- Listen for heart murmurs (extra or unusual sounds heard during your heartbeat)
- Check your pulse to find out how fast your heart is beating
- Check for swelling in your legs or feet, which could be a sign of an enlarged heart or heart failure
- Look for signs of other diseases – such as thyroid disease, that could cause the problem
Diagnostic Tests and Procedures for Arrhythmia
An ECG is a simple, painless test that detects and records the electrical activity of the heart. This test shows how fast your heart is beating and its rhythm (steady or irregular). An ECG also records the strength and timing of electrical signals as they pass through your heart. A standard ECG only records the heart rate for a few seconds. It will not detect arrhythmias that do not occur during the test.
To diagnose arrhythmias that come and go, your doctor may ask you to wear a portable ECG monitor. The two most common types of portable ECGs are Holter monitors and event monitors.
Holter and Event Monitor
The Holter monitor records the heart’s electrical signals over a full 24 or 48 hour period. You wear it when you do your normal daily activities. This allows the monitor to record your heart for a longer time than a standard ECG. An event monitor is similar to a Holter monitor. You wear an event monitor when doing normal activities. However, an event monitor only records your heart’s electrical activity at certain times while you are wearing it. For many event monitors, you press a button to start the monitor when you experience symptoms. Another event monitor starts automatically when it senses an abnormal heart rhythm.
Some event monitors can transfer data of the heart’s electrical activity to a central monitoring station. The technician at the station reviews the information and sends it to your doctor. You can also use the device to report any symptoms you are experiencing.
You can wear the event monitor for weeks or until symptoms appear.
Other tests are also used to help diagnose arrhythmias.
Blood test. Blood tests are done to examine the level of substances in the blood, such as potassium and thyroid hormones. Abnormal levels of these substances can increase your chances of developing an arrhythmia.
Chest x-ray. A chest x-ray is a painless test that creates images of the structures in your chest, such as your heart and lungs. This test can show if your heart is enlarged.
Echocardiography. This test uses sound waves to create a moving image of your heart. Echocardiography (echo) provides information about the size and shape of your heart and how well your heart chambers and valves are working. This test can also identify areas of poor blood flow to the heart, areas of the heart muscle that are not contracting normally, and previous injury to the heart muscle caused by poor blood flow. There are several types of echo, including stress echo. This test is done before and after a stress test . A stress echo is usually done to find out if you have decreased blood flow to your heart, a sign of coronary heart disease (CHD). Transesophageal echo, or TEE, is a special type of echo that takes pictures of the heart through the esophagus. The esophagus is the tube from the mouth that leads to your stomach.
Stress test. Certain heart problems are easier to diagnose when your heart is working harder and beating faster. In a stress test, you will be asked to exercise to make your heart work harder and beat faster during a heart test. If you are unable to exercise, you may be given medication to make your heart work harder and beat faster. Heart tests performed during the stress test may include a nuclear heart scan, echo, and positron emission tomography (PET) heart scan.
Electrophysiology study (EPS). This test is used to assess serious arrhythmias. In EPS, a thin, flexible wire is passed through a vein in your groin (upper thigh) or arm to your heart. The wire records your heart’s electrical signals. Your doctor can use wires to electrically stimulate your heart and trigger arrhythmias. This lets the doctor see if antiarrhythmic drugs can stop the problem. Catheter ablation, a procedure used to treat some arrhythmias, may be performed during EPS.
Tilt table test. This test is sometimes used to help find the cause of fainting. You lie on a table that moves from a reclined to an upright position. The change in position can cause you to pass out. The doctor watches your symptoms, heart rate, ECG reading, and blood pressure during the test. He or she may give you medicine and then observe how your body reacts to the medication.
Coronary angiography. Coronary angiography uses special dyes and X-rays to show the inside of your coronary arteries. To get dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization. A thin, flexible tube called a catheter is inserted into a blood vessel in your arm, groin (upper thigh), or neck. The tube is inserted into your coronary artery, and the dye is released into your bloodstream. A special X-ray is used when the dye travels through your coronary arteries. The dye allows the doctor to study blood flow through the heart and blood vessels. This helps doctors find blockages that could be causing a heart attack.
Implantable loop recorder. This device detects abnormal heart rhythms. Minor surgery is used to place this device under the skin in the chest area. A heart recording implant helps doctors figure out why someone palpitates or faints, especially if these symptoms do not occur frequently. This device can be used for 12 to 24 months.
Treatment for Arrhythmia
Common arrhythmia treatments include medications, medical procedures, and surgery. Your doctor may recommend treatment if your arrhythmia is causing serious symptoms – such as dizziness, chest pain, or fainting.
Your doctor may also recommend treatment if an arrhythmia increases your risk of problems such as heart failure, stroke, or sudden cardiac arrest.
Medications can slow down a heart that is beating too fast. Medicines can also stabilize an abnormal heart rhythm – which are called antiarrhythmics. Some medications used to slow a fast heart rate are beta blockers (such as metoprolol and atenolol), calcium channel blockers (such as diltiazem and verapamil), and digoxin (digitalis). These medications are often used to treat atrial fibrillation (AF).
Several medications used to restore normal heart rhythm are amiodarone, sotalol, flecainide, propafenone, dofetilide, ibutilide, quinidine, procainamide, and disopyramide. These medicines often have side effects. Some of the side effects can make the arrhythmia worse or even trigger a different arrhythmia.
There has not been found a medicine that can accelerate a slow heart rate. An abnormally slow heart rate is usually treated with a pacemaker. People with AF and some other arrhythmias can be treated with blood thinners. These medicines help reduce the risk of blood clots. Warfarin (Coumadin®), dabigatran, heparin, and aspirin are examples of blood thinners.
Medicines can also control any underlying medical conditions that may cause arrhythmia – such as heart disease or thyroid conditions.
Medical Procedures for Arrhythmia
Certain types of arrhythmias are treated with a pacemaker. A pacemaker is a small device that is placed under the skin of the chest or abdomen to help control abnormal heart rhythms. Pacemakers have sensors that detect the electrical activity of the heart. When the device senses an abnormal heart rhythm, it sends an electric pulse to encourage the heart to beat at a normal rate.
Meanwhile, some arrhythmias are treated with an electric jolt to the heart. This type of treatment is called cardioversion or defibrillation, depending on the type of arrhythmia.
In people that are at risk for ventricular fibrillation, they are treated with a device called a cardioverter defibrillator (ICD) implant. Similar to a pacemaker, an ICD is a small device that is placed under the skin on the chest. This device uses pulses or electric shocks to help control life-threatening arrhythmias.
The ICD continuously monitors your heart rate. If you experience serious ventricular arrhythmia, the ICD will send an electric shock to your heart to restore a normal heart rate.
A procedure called catheter ablation is used to treat some arrhythmias if medicines do not work. During this procedure, a thin, flexible tube is inserted into a vein in your arm, groin (upper thigh), or neck. Then, the tube is directed toward your heart. A special machine sends energy through a tube to your heart. Then, energy finds and destroys small areas of heart tissue where abnormal heart rhythms may begin. Catheter ablation is usually performed in a hospital as part of an electrophysiological study.
Your doctor may recommend transoesophageal echocardiography before catheter ablation to make sure there are no blood clots in the atria (upper chambers of the heart).
Doctors may treat certain types of arrhythmias through surgical procedures. This may happen if the surgery is already performed for another reason, such as heart valve repair surgery.
A type of surgery for AF is called labyrinth surgery. During this surgery, a surgeon creates small incisions or burns in the atria. These cuts or burns prevent the irregular spread of electrical signals.
If coronary heart disease is the cause of your arrhythmia, your doctor may recommend a coronary artery bypass graft. This surgery increases blood flow to the heart muscle.
Vagal maneuvers are another type of treatment for arrhythmias. This simple procedure can help stop or slow down certain types of supraventricular arrhythmias. The maneuver works by affecting the vagus nerve, which helps control heart rate.
Some of the vagal maneuvers include:
- Induce vomiting
- Hold your breath and exhaling forcefully while covering your lips and nose (valsalva maneuver)
- Immerse your face in a bowl filled with ice water
- Put finger on the eyelid and press gently
Vagal maneuvers are not the right treatment for everyone. Discuss with your doctor whether vagal maneuvers can be a treatment option for you.
Home Care for Patients Diagnosed with Arrhythmias
Many arrhythmias are harmless. It is common to have an extra heartbeat or mild palpitations every now and then. People who suffer from harmless arrhythmias can live healthy lives. They usually do not require treatment for their arrhythmia.
Even people who have serious arrhythmias can fully recover and lead normal lives.
If you have an arrhythmia that requires treatment, here’s what you should do:
- Adhere to all your medical appointments. Bring the list of all your medications to each doctor and emergency room’s visits. This will help your doctor know exactly the right medication for you.
- Take medication as prescribed. Check with your doctor before taking over-the-counter medicines, nutritional supplements, or cold and allergy medications. Some of these products can trigger a rapid heart rhythm or interact poorly with heart rhythm medicines.
- Tell your doctor if you experience side effects from your medicines. Side effects may include depression and palpitations. These side effects are often treatable.
- Tell your doctor if the arrhythmia symptoms get worse or if you experience new symptoms.
- See your doctor for regular check-ups if you are taking blood thinners. You may need regular blood tests to check how the medicines work
It is important to take care of yourself if you have an arrhythmia. You should lie down when you feel dizzy or feel like you want to pass out. You should not try to walk or drive. Make sure that you let your doctor know about these symptoms.
Ask your doctor if vagal maneuvers can be an option for you. This procedure can help stop a fast heartbeat. However, it is not suitable for everyone.
Furthermore, you should learn how to check your pulse. Ask your doctor to understand the normal pulse rate for you. Record your pulse changes and pass this information to your doctor.
Lifestyle Changes for Arrhythmia Patients
Arrhythmias are caused by underlying heart disease. Take care of your heart health by implementing a healthy diet.
A healthy diet includes a variety of fruits and vegetables, whole grains, fat-free or low-fat dairy products, and protein food sources – such as lean meats, skinless chicken, seafood, processed soy products, nuts, seeds, beans, and peas. Other healthy diets may include low-sodium (salt) diet, added sugar, solid fats, and refined grains. Solid fats consist of saturated fats and trans fatty acids. Refined grains come from processing whole grains – which causes a loss of nutrients (such as dietary fiber).
Implementing healthy lifestyle also means being physically active, quitting smoking, maintaining an ideal body weight, and keeping your blood cholesterol and blood pressure at normal levels.
Moreover, strong emotional stress or anger can also cause arrhythmias. Try to manage stress and anger by relaxing through yoga, spending me-time in a quiet place, doing meditation, and other relaxation techniques. Getting support from friends and family can also help you manage stress.
Your doctor may ask you to avoid certain substances that make your heart beat too fast. These substances may include alcohol as well as cold & cough medicines.