Your pulse skips, or runs away with itself, then settles. It may be nothing. It may also be atrial fibrillation — the commonest preventable cause of stroke, and one that often causes no symptoms at all.
An irregular pulse is one of the few things you can check on yourself, at home, in a minute. What it means depends far less on how it feels than on what the rhythm is actually doing.
Why an irregular pulse matters more than how it feels
In atrial fibrillation the top chambers of the heart quiver instead of contracting properly. Blood pools, and pooled blood can form a clot. If that clot travels to the brain, it causes a stroke. Many people with atrial fibrillation feel nothing at all — for some, the stroke is the first sign. That is why the rhythm matters even when you feel perfectly well.
How to check your pulse properly at home
- Sit quietly for five minutes before you start.
- Place your index and middle fingers — not the thumb — on the wrist, just below the base of the thumb.
- Count for the full 60 seconds. Counting 15 seconds and multiplying by four hides exactly the irregularity you are looking for.
- Note the rate, and note whether the gaps between beats are even.
If a home blood pressure machine flags “irregular heartbeat”, treat that as a reason to get an ECG — not as a diagnosis in itself.
What makes atrial fibrillation more likely
Age over 60, high blood pressure, diabetes, an overactive thyroid, obstructive sleep apnoea with heavy snoring, heavy or binge alcohol use, a leaking or narrowed valve, and a heart muscle that is already weak. Several of those are modifiable, which is the useful part of the list.
The ECG is the test that names the rhythm
A 12-lead ECG takes about two minutes and either shows the irregular rhythm or it does not. If episodes come and go, what kind of longer or repeat recording is appropriate is a decision made at consultation, with your history and examination in front of the cardiologist — not a test booked in advance and interpreted afterwards.
Treatment answers two separate questions
First: does the rhythm itself need controlling — with rate-slowing medicines, rhythm medicines, or in selected patients an ablation. Second, and more important: does this person need an anticoagulant to prevent stroke? That question is settled with a formal risk score, kidney function and bleeding history. Aspirin is not an adequate substitute for proper anticoagulation in atrial fibrillation.
When to get help immediately
- Sudden weakness or numbness down one side of the body.
- A drooping face, or an arm that drifts down when both are raised.
- Slurred speech, or sudden difficulty understanding what is said.
- A racing pulse together with chest pain, severe breathlessness or fainting.
Any of the first three is a stroke until proven otherwise. Call for emergency help straight away — do not wait to see whether it passes.