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To diagnose a heart arrhythmia, your doctor may ask about or test for conditions that may trigger your arrhythmia, such as heart disease or a problem with your thyroid gland. Your doctor may also perform heart monitoring tests specific to arrhythmias.

Diagnosing an arrhythmia and its cause may be delayed or missed because in some cases the symptoms may not be severe or bothersome enough for a person to seek medical care. Some people may be unaware that they are experiencing symptoms of an arrhythmia. In addition, some symptoms of arrhythmia, such as palpitations and lightheadedness are similar to symptoms of other conditions. These include stress, anxiety attack or perimenopause.

An arrhythmia can be a symptom of some serious diseases, such as heart disease, so a thorough medical evaluation is needed to ensure an accurate diagnosis is made for the reason for the arrhythmia.

Arrhythmias can be hard to diagnose, especially the types that only cause symptoms every once in a while. Doctors use several methods to help diagnose arrhythmias, including medical and family histories, physical exam, and diagnostic tests and procedures.
Specialists Involved

Doctors who specialize in the diagnosis and treatment of heart diseases include:

Cardiologists. These doctors take care of adults who have heart problems.
Pediatric cardiologists. These doctors take care of babies, children, and youth who have heart problems.
Electrophysiologists. These doctors are cardiologists or pediatric cardiologists who specialize in arrhythmias.

Medical and Family Histories

To diagnose an arrhythmia, your doctor may ask about your signs and symptoms. He or she may ask about what symptoms you’re having, whether you feel fluttering in your chest, and whether you feel dizzy or lightheaded.

Your doctor also may ask about other health problems you have, such as a history of heart disease, high blood pressure, diabetes, or thyroid problems. He or she may ask about your family’ s medical history, including:

Has anyone in your family died suddenly?
Has anyone in your family ever had heart disease or high blood pressure?
Does anyone in your family have a history of arrhythmias?
Are there other illnesses or health problems in your family?

Your doctor will likely want to know what medicines you’re taking, including over-the-counter medicines and vitamin or mineral or nutritional supplements.

Your doctor may ask about your health habits, such as physical activity, smoking, or using alcohol or drugs (for example, cocaine). He or she also may want to know whether you’ve had episodes of strong emotional stress or anger.
Physical Exam

Your doctor will listen to the rate and rhythm of your heart and for a heart murmur (an extra or unusual sound heard during your heartbeat). He or she also will:

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 be causing the problem

1.Electrophysiologic testing:This procedure is carried out under local anesthesia and catheters are positioned through peripheral veins or peripheral arteries with the help of a fluoroscope in the atria, ventricles, or both and at strategic points along the conduction system. The cardiac electrical signals are recorded at various points simultaneously and the heart block is detected also showing the point of origin of tachycardia.

2.Intracardiac electrophysiologic procedure:In this procedure, one or more thin, long plastic tubes or catheters are introduced into the arteries/veins in the arms, legs or both and guided into the heart wherein the electrical signals are recorded, which provides a very precise information than a normal ECG.

3.Esophageal electrophysiological procedure:In this procedure, a thin, soft, flexible plastic tube is inserted into the nostril and positioned in the esophagus (since the esophagus is closer to heart’s upper chambers i.e., atria) and an ECG is recorded. An electric stimulator could be used to make the heart beat faster and detect the signals of arrhythmia.

4.Electrocardiogram:Electrocardiographic studies use sound waves to provide some valuable information about the heart and arrhythmia.

5.Transtelephonic monitor or transient event monitor:These small recorders can be attached with bracelets, finger clips or patches under the arms. The ECG recorded is stored and transmitted by phone to the cardiologist for analysis.

6.Tilt table studies:This test is conducted to determine fainting spells and record the changes in the heart rate and blood pressure to the positional changes such as lying down and standing up. A small plastic tube or a catheter is inserted into a vein to monitor the blood pressure and the cause for fainting spells is diagnosed.

7.Treadmill testing:This test may be carried out for suspected arrhythmias, which are exercise related. The heart rate and rhythm are monitored while the patient walks or runs on a treadmill or rides a bicycle.

8.Holter Monitor:This is a small, portable ECG recorder also called as continuous ambulatory electrocardigraphic monitor. A patient can perform normal activities while being tested and the rhythm disturbances are recorded to be analyzed later.

9.Electrocardiographic techniques:An electrocardiogram (ECG or EKG) records the relative timing of atrial and ventricular electrical events that can be used to measure the traveling time of impulse through the atria, AV conduction system and ventricles. Three major waves of electric signals appear on the ECG:

The first wave records the electrical activity of the atria.
The second, largest wave records the electrical activity of the ventricles.
The third wave records the heart’s return to resting state.

Shapes and sizes of these waves are studied along with the time interval, rates and regularity of the waves.

10.Blood Tests:Blood tests are carried out to check the sodium, potassium and thyroid hormone levels.

At the Cardiac Arrhythmia Service, evaluation and diagnosis of patients with arrhythmias or suspected arrhythmias includes inpatient and outpatient consultation along with comprehensive diagnostic electrophysiologic testing and intracardiac recording. If an arrhythmia is detected, various tests may be done to confirm or rule out suspected causes. EPS testing may be done to find the arrhythmia and determine the best treatment, especially if a pacemaker or catheter ablation procedure is being considered.

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