Up to around 5% of people have arrhythmia, possibly more. Two heart doctors say these symptoms can deceive and present as other conditions.
5 Surprising Signs and Symptoms of Cardiac Arrhythmia, Say Expert Cardiologists
Published on Aug. 07, 2025
5 surprising signs and symptoms of cardiac arrhythmia
1. Panic attacks
Dr. Ayoub says panic attacks are one of the more surprising cardiac arrhythmia symptoms patients report, often mistaking them for anxiety disorders. That’s because the sudden changes in heart rhythm caused by an arrhythmia can trigger many of the same sensations as a panic attack, including a racing heartbeat, dizziness, sweating, shortness of breath, and even chest pain. When the heart’s electrical system misfires, the body releases a surge of adrenaline and other stress hormones, creating the same physical response you’d expect during an episode of panic.
If you’re unsure whether you’re experiencing a panic attack or an arrhythmia, pay attention to when and how your symptoms occur. Arrhythmias can happen at rest, during sleep, or without any emotional trigger, while panic attacks are often linked to stressful situations or anxious thoughts. Anyone with new, unexplained, or frequent episodes—especially if they include fainting, severe chest discomfort, or shortness of breath—should see a doctor or cardiologist for an evaluation.
2. Confusion
Dr. Ayoub says that confusion is a lesser-known cardiac arrhythmia symptom that can occur when the brain isn’t getting enough oxygen-rich blood due to an erratic or inefficient heartbeat.
When the heart isn’t pumping effectively, especially in conditions like atrial fibrillation or bradycardia (a very slow heart rate), it can reduce blood flow to the brain. This can lead to episodes of confusion, forgetfulness, or difficulty concentrating. In older adults, this symptom is especially easy to overlook or misattribute to dementia or medication side effects, making a proper cardiac evaluation essential if mental clarity suddenly declines.
3. Nausea
Nausea is usually linked to digestive problems, but it can also be a surprising symptom of cardiac arrhythmia, says Dr. Ayoub. When the heart beats irregularly, particularly in arrhythmias that affect the lower chambers or cause sudden drops in blood pressure, it can impact blood flow to the stomach, leading to queasiness.
Some people experience nausea along with lightheadedness or sweating during an arrhythmia episode, which can make it easy to confuse with a stomach bug or low blood sugar. If nausea appears out of nowhere and isn’t tied to food or illness, it’s worth asking your doctor about your heart as a possible cause.
4. Frequent nighttime urination (nocturia)
Getting up several times a night to use the bathroom may seem like a bladder or prostate problem, but it can also be a surprising cardiac arrhythmia symptom, especially in people with atrial fibrillation (AFib).
Published in Scientific Reports, a 2022 study found that nocturia (waking two or more times per night to urinate) was independently associated with structural heart changes, including left atrial enlargement, which is often linked to arrhythmias like AFib. One possible explanation is that irregular heart rhythms can stretch the atria, prompting the release of atrial natriuretic peptide (ANP), a hormone that tells the kidneys to excrete more sodium and water. This can lead to increased urine production at night.
5. Persistent cough
A lingering cough isn’t always due to allergies, asthma, or a respiratory infection. In rare cases, it can be a surprising symptom of cardiac arrhythmia.
According to a 2020 review published in Physiological Research, researchers stated that “cough induced by cardiac pathologies (mainly arrhythmias) seems to be an interesting and underestimated phenomenon.” Certain arrhythmias, such as premature ventricular contractions (PVCs) or supraventricular tachycardia (SVT), may trigger cough through a reflex involving the vagus nerve or by altering blood flow in the lungs. These changes can stimulate airway receptors, creating a dry, tickling cough that appears without other respiratory symptoms.
When should I be worried about an irregular heartbeat?
While occasional heart flutters or skipped beats can be harmless, persistent or worsening cardiac arrhythmia symptoms may indicate a more serious underlying condition.
Dr. Ayoub and Dr. Aman say to seek immediate medical attention if you experience:
- Syncope (passing out)
- Chest pain or tightness
- Sweating
- Nausea
- A sustained rapid heart rate greater than 120 beats per minute (bpm) at rest or a new irregular rhythm accompanied by shortness of breath or dizziness
“More broadly, if something just doesn’t feel right and it happens frequently, it should be evaluated by a cardiologist,” Dr. Aman says.
Are people born with arrhythmia?
Yes, some people are born with cardiac arrhythmia, but Dr. Ayoub and Dr. Aman explain that it is far more common to develop an arrhythmia later in life.
Common factors that can contribute to an acquired arrhythmia include:
- Aging: Natural degeneration of the heart’s electrical conduction system
- High blood pressure: Can strain and damage the heart over time
- Structural heart changes: Such as those caused by heart failure or valve disease
- Obesity or sleep apnea: Both increase stress on the heart
- Thyroid disease: Overactive or underactive thyroid function can disrupt heart rhythm
- Lifestyle factors: Diet, alcohol and caffeine intake, sleep quality, and chronic stress all play a role in heart health
While you can’t change your age or genetics, managing underlying health conditions and making heart‑healthy lifestyle choices can lower your risk of developing arrhythmias later in life.
Cardiac arrhythmia treatment
“We usually start with an electrocardiogram (ECG),” says Dr. Aman. “That’s where we place leads on the chest and get a printout that shows the heart’s rhythm at that moment.” If more data is needed, he explains, “we might use a Holter monitor or an event monitor.” These wearable devices track heart activity over 24 hours or even several days. “In harder‑to‑diagnose cases, we sometimes implant a loop recorder under the skin to capture long‑term data.”
“Once we’ve diagnosed the arrhythmia, treatment usually begins with medications, often beta blockers to slow the heart rate, and antiarrhythmic drugs to help maintain a normal rhythm, also called sinus rhythm,” he says.
If a patient has atrial fibrillation and additional risk factors, blood thinners may be prescribed to reduce the risk of stroke. Beyond medications, procedures are also an option. One of the most common procedures is called ablation. “This is where an electrophysiologist (a cardiologist who specializes in the heart’s electrical system) uses catheters to perform targeted treatment on the affected areas of the heart,” Dr. Aman says. While it’s a complex procedure, it is routinely performed and can be highly effective in restoring a healthy heart rhythm.
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