How can I plan for arrhythmia episodes, and should I keep a log or diary? 

For many people with arrhythmias, the most difficult part of the condition is its unpredictability. You may feel perfectly fine for weeks, only for a racing or skipping sensation to strike while you are at work, driving, or trying to sleep. In the UK, the ‘snapshot’ nature of clinical testing means that your doctor often relies on your personal account to make life-changing treatment decisions. Planning for these episodes isn’t just about managing the physical sensation; it is about becoming a ‘citizen scientist’ of your own heart. By keeping a structured log and having a clear action plan, you can turn a moment of panic into a moment of data collection. This article explains how to effectively plan for arrhythmia episodes and why keeping a detailed diary is one of the most powerful tools in your medical arsenal. 

What We’ll Discuss in This Article 

• Why a symptom diary is often more valuable than a one-off ECG. 

• The essential ‘data points’ you should record during an episode. 

• How to create a ‘Cardiac Action Plan’ for when a flutter starts. 

• Distinguishing between ‘nuisance’ episodes and clinical emergencies. 

• The role of technology versus traditional pen-and-paper logs. 

• Practical tips for sharing your log with your GP or cardiologist. 

• Emergency safety guidance for sudden or severe cardiac symptoms. 

1. Why Keeping a Diary is Essential 

A heart rhythm disorder is often paroxysmal (it comes and goes).¹ Unless you happen to have an episode while lying on a couch in a GP surgery, a standard ECG might miss it entirely. 

• Identifying Patterns: A diary helps you see if your episodes are linked to specific triggers like caffeine, stress, poor sleep, or alcohol. 

• Refining Medication: Your doctor can use your log to see if your ‘rate control’ meds are working throughout the day or if they wear off by the evening. 

• Evidence for Specialists: In the UK, a well-kept diary can often speed up your referral to a specialist arrhythmia clinic, as it proves the frequency and impact of your symptoms. 

2. What to Record in Your Log 

A good diary isn’t just a list of dates. To be clinically useful, it needs to capture the ‘character’ of the episode. When a flutter starts, try to note the following: 

1. The Timing: What time did it start, and exactly how long did it last? 

2. The Tempo: Was it fast and regular (like a drum), or chaotic and ‘bumpy’ (like a bag of worms)? 

3. The Onset: Did it start instantly (like a light switch) or build up gradually? 

4. The Triggers: What were you doing? Had you just eaten, exercised, or felt a surge of stress? 

5. Physical Signs: Did you feel dizzy, breathless, or have chest pain? Did you look pale or feel sweaty? 

6. The Recovery: How did it stop? Did it just ‘snap’ back to normal, or fade away? 

3. Creating Your ‘Cardiac Action Plan’ 

Knowing exactly what to do when an episode starts can significantly reduce the anxiety that often makes the heart race even faster. 

• Step 1: Stop and Sit: If you feel a race or a skip, sit down immediately. This reduces the physical demand on your heart. 

• Step 2: Check Your Pulse: Perform a 30-second manual pulse check. Note the rate and whether it feels regular or irregular. 

• Step 3: Vagal Manoeuvres: If your doctor has taught you techniques like the ‘Valsalva manoeuvre’ (straining as if on the toilet) or ‘Carotid Sinus Massage,’ try these to see if they reset the rhythm. 

• Step 4: Record the Event: Once you are stable, write down the details in your log. 

• Step 5: Follow Your Safety-Netting: Use the table below to decide if you need to call for help. 

4. Differentiation: Nuisance vs. Emergency 

Your plan should include clear ‘triggers’ for when to seek medical intervention. 

Feature	Nuisance Episode (Log it)	Emergency Episode (Call 999)
Duration	Lasts seconds or a few minutes.	Lasts over 20-30 minutes or is worsening.
Dizziness	Brief ‘lightheaded’ feeling.	Feeling like you will actually black out.
Pain	None, just an annoying flutter.	Chest pain, pressure, or tightness.
Breathing	Slightly faster due to anxiety.	Severe breathlessness (cannot speak).
Consciousness	Fully awake and alert.	Fainting or loss of consciousness.

5. Technology vs. Paper Logs 

In the modern UK health system, you have choices in how you keep your records. 

• Paper Diary: Reliable, never runs out of battery, and easy to hand over to a doctor. It is often the best for recording ‘feelings’ and triggers. 

• Smartphone Apps: Apps like ‘AliveCor’ (KardiaMobile) or Apple Health allow you to attach an actual ECG strip to your symptom notes. 

• Wearables: Smartwatches can provide a general ‘trend’ of your heart rate over weeks, which is helpful for seeing if your resting heart rate is gradually rising. 

The Verdict: A combination is often best. Use a watch to track the rate, but use a paper diary to track the context, why you think it happened and how it felt. 

Conclusion 

Planning for an arrhythmia episode is about moving from a place of fear to a place of control. By keeping a detailed symptom log, you provide your clinical team with the ‘missing pieces’ of the diagnostic puzzle, allowing for more precise medication adjustments and faster referrals. A diary turns the unpredictable nature of heart flutters into a manageable set of data points. When combined with a clear action plan, knowing when to rest, how to check your pulse, and when to call for help, you ensure that you are always prepared, regardless of when your heart decides to skip a beat. In the UK, the best heart rhythm management is a partnership between a prepared patient and an informed doctor. 

If you experience severe, sudden, or worsening symptoms, call 999 immediately. 

Authority Snapshot (E-E-A-T Block) 

This article was written by Dr. Stefan Petrov, a UK-trained physician with an MBBS and certifications in Advanced Cardiac Life Support (ACLS). Dr. Petrov has managed hundreds of cardiac patients in emergency and intensive care settings, where precise patient-reported data is vital for accurate diagnosis. This guide follows NHS and NICE standards to help you create a structured plan for managing heart rhythm episodes.