What causes an irregular EKG?

An irregular electrocardiogram (EKG or ECG) may be the result of problems with the test or problems with the patient's heart. This test measures the electrical activity in the heart and provides a graph of the activity for review by a doctor. If a patient has an irregular EKG, the doctor may interview the patient and recommend some additional tests to learn more, with the goal of determining what, if anything, should be done for the patient.

In this test, a technician attaches electrodes to the chest and briefly records the electrical activity of the heart. If the patient is stressed or nervous, the results may be biased. Similarly, if someone exercised before the test or moved during the test. Sometimes the technician doesn't connect the leads correctly, and the signals from the heart aren't recorded reliably. All of these factors will be considered when a patient has an irregular EKG.

Heart abnormalities, whether congenital or acquired, can also cause an irregular EKG. The patient could have heart block, where the electrical signals in the heart do not move smoothly and reliably through the heart, leading to irregular or mismatched contractions. Some patients have a rapid heart rate, known as tachycardia or bradycardia, where the heart beats too slowly. Sometimes an irregular EKG is the result of premature contractions, a common phenomenon that is usually not a cause for concern, where the heartbeat randomly stops and then returns to normal.

Having an irregular EKG does not necessarily mean there is a problem, and conversely, normal results do not always mean a patient is healthy. Sometimes heart problems only show up at certain times, such as during exercise or periods of stress. If a patient reports heart problems, the doctor may recommend stress tests of the heart or order ambulatory monitoring, where the heart is recorded over several hours or days to see when the patient experiences problems.

A cardiologist can review an irregular EKG to learn more about the patient's heart rhythm and make treatment recommendations. The doctor will consider the patient's history and other symptoms. For example, athletes often have a low resting heart rate that would be considered bradycardia in another person. A competitive athlete with a healthy history probably does not need bradycardia treatment, while a person with normal or low activity levels and the same heart rate is cause for concern.

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