Complaints & connections · borters.ch
A skipped beat alone is usually harmless — what counts is what comes with it and whether it can be recorded.
Also known as: arrhythmia · atrial fibrillation · palpitations · extrasystoles
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
The heartbeat can be too fast, too slow or irregular, and the range runs from entirely harmless to serious. Commonest are single extra beats: the heart seems to skip briefly and then catches up forcefully. They are noticed above all at rest, in the evening and lying down, and with a healthy heart they are not dangerous. At the other end stands atrial fibrillation, in which the pulse runs irregular without any pattern. It is common, often not felt at all, and matters because clots can form in the atrium. What decides is not the sensation itself but what comes with it: dizziness, breathlessness, chest pain or a brief loss of consciousness. The course counts too — a racing heart that starts out of nowhere and stops just as suddenly has a different cause from one that climbs and fades slowly. This is settled by the recording, not by blood values: one electrocardiogram during the symptoms is worth more than ten at rest. The blood values clarify the conditions under which the heart works. With fainting, chest pain or shortness of breath it is the emergency number 144 and not the next appointment. If the faint happens during physical exertion or while lying down, with no recognisable trigger, that counts as a sign in its own right of a cause in the heart.
Count for fifteen seconds at the wrist, times four. Note the number, the regularity, the time and what came with it. These notes are often the most useful part of the appointment.
A resting electrocardiogram between episodes is usually normal and proves nothing. What is wanted is a long-term recording, an event recorder or a strip from the watch at the very moment of the symptoms.
Two values that can be treated and that sometimes make a rhythm disturbance disappear entirely. They belong at the start of the workup, not at the end.
The main question is not how fast the heart beats but whether protection against clots is needed. That is decided by the personal risk and not by how strongly it is felt.
Coffee, alcohol, energy drinks, little sleep and some decongestant nasal sprays. Leaving them out together for two weeks and keeping a diary gives a clear answer.
A loss of consciousness without warning, during sport or while lying down, and a sudden cardiac death in the family are the signs that make this urgent.
Anyone who lived for years in Latin America and develops new rhythm disturbances is tested for it. The test is a simple blood draw, and monitoring starts before the symptoms.
Beta blockers and similar drugs slow the rate — they do not remove the arrhythmia, they make it bearable. Blood thinners in atrial fibrillation prevent stroke but change nothing about the rhythm; the two are often confused. Ablation targets the source and holds for a year in about seven out of ten people; some need a second procedure.
About two to three in a hundred people have atrial fibrillation, and nearly one in ten over eighty. An episode that ends within forty-eight hours can be converted without prior examination of the atrium; beyond that, three weeks of anticoagulation before and four after are needed, otherwise a clot can break loose. A twenty-four-hour ECG finds only what happens in that time — for rare episodes seven to thirty days are needed.
In the evening on the sofa and in bed every extra beat is noticed, because nothing else distracts. If the extra beats vanish on exertion, that speaks more for the harmless form.
Anyone who feels the pulse and finds no beat to it, neither evenly fast nor evenly slow, thinks of atrial fibrillation. It is the commonest lasting rhythm disturbance and can be recognised at the wrist.
A racing heart as if at the touch of a button, often with an urge to pass water afterwards, points to a form of its own that is usually treatable. Describing exactly this course is half the diagnosis.
That is the line between annoying and dangerous. A loss of consciousness without warning, especially while sitting or lying, belongs assessed before it happens again.
The combination is the commonest trigger of all and explains why it is often noticed at weekends or after holidays. Leaving it out for two weeks tells more than any test.
Too little and too much both cause rhythm disturbances. Water tablets lower it, some blood pressure drugs raise it — with new symptoms the value belongs alongside.
Is lost with diarrhoea, alcohol and some stomach drugs and encourages extra beats. The blood value underestimates a shortage, so the context counts as well.
An overactive thyroid is one of the few truly correctable causes of a racing heart and atrial fibrillation. This value belongs with every new rhythm disturbance.
Anaemia forces the heart to beat faster. Anyone who gets out of breath on exertion and feels palpitations should know this value.
Stress/adrenal hormones can trigger palpitations and extra beats.
Caffeine and alcohol can trigger extra beats in sensitive people.
Potassium and magnesium keep the rhythm steady. Both are measured before supplementing — with weak kidneys too much potassium can itself cause dangerous rhythm problems.
Slow breathing out activates the vagus nerve and can stop a fast heart rate. In certain forms this is a recognised manoeuvre, in others it has no effect — the diagnosis tells which.
AWMF 030-072 · S1 · 2020-04 — in force
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checked 2026-09