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PALPITATIONS:
What they are and what to do
about them.
“Fill what's empty,
empty what's full, and scratch where
it itches."
- The Duchess of Windsor,
when asked what is the secret of
a long and happy life
Palpitations are heartbeat sensations
that may feel like your heart is
pounding, racing, jumping or skipping a
beat. They can occur with other
symptoms (shortness of breath, chest
pain, dizziness) and can last for a few
seconds to a few hours.
Palpitations may be caused by
abnormal heart rhythms called
arrhythmias. Some patients can simply
have increased awareness of their heart
beat during times of stress and anxiety,
and in these patients no heart disease
or abnormal heart rhythms can be found.
However, palpitations can also be a
presenting symptom for serious heart
conditions.
In order to understand what
arrhythmias are and why they happen, we
need to understand how the electrical
system of the heart normally works.
Normal resting adult heart beats
regularly at an average rate of 60 to
100 times per minute. How fast the heart
beats is governed by the speed of
electrical signals originating from the
pacemaker of the heart, the SA node. The
electrical signals from the SA node
travel across the two upper heart
chambers (atria) resulting in
contraction of these chambers and
delivering blood into the lower heart
chambers, the ventricles. These
electrical signals then pass through the
AV node to reach the ventricles and also
cause these chambers to contract,
pumping blood to the rest of the body,
generating the pulse. During rest, the
speed of electrical signals originating
from the SA node is slow, thus the heart
beats slowly. During exercise or
excitement, the speed of signals from
the SA node increases, and heartbeat
quickens. Arrhythmias occur when there
is malfunction of any part of this
perfectly designed electrical system.
In some patients, arrhythmias are caused
by diseases of the heart muscle, valves
or coronary arteries. In others,
arrhythmias can reflect disease of the
electrical system of the heart only,
while the rest of the heart is healthy.
Other causes of arrhythmias include
medications, alcohol excess, excessive
levels of thyroid hormone, low blood
oxygen levels etc…
Since some arrhythmias can be life
threatening if left untreated, the first
step in the evaluation of patients with
palpitations is to determine whether
their symptoms are due to arrhythmias.
Because the treatment of varying types
of arrhythmias can differ, it is also
important to determine the type of
arrhythmia involved. Tests that are
used to detect abnormal heart rhythms
include resting EKG, 24-hour rhythm
monitoring (Holter), and event
monitoring (monitor that is activated by
patients when they have symptoms). As we
mentioned previously, arrhythmias can be
related to underlying disease of the
heart valves, heart muscle, and coronary
arteries, therefore exercise stress test
and echocardiography (ultrasound of the
heart) are often performed to exclude
these heart abnormalities.
Fortunately, most arrhythmias are
treatable. Certain types require no
specific treatment and simple
interventions like stopping cigarettes,
and reducing caffeine and alcohol
consumption will be adequate. Often
medications called anti-arrhythmics are
used. Sometimes, electrical
cardioversion (delivering direct
electrical current to the chest wall
after patients are put to asleep) is
necessary to restore normal rhythm.
Blood thinners might need to be used to
prevent strokes. Pacemakers might be
indicated for patients with slow heart
rhythms. Implantable defibrillators are
considered in patients with life
threatening arrhythmias. In the last
decade, radio-frequency ablation (the
destruction of abnormal electrical
pathways by using local heating via
special catheters) has emerged as an
extremely effective way of eliminating
certain types of arrhythmias, often
resulting in a cure. In patients with
arrhythmias associated with significant
heart muscle or valve disease,
correction of the underlying heart
disease is also very important.
All of this leads to one simple
conclusion; patients experiencing
palpitations should seek medical
attention as soon as possible. This is
especially important for those who are
above 40 years old, who are experiencing
other symptoms like chest pain,
lightheadedness or syncope (passing out)
or who already have other heart
conditions like coronary artery disease,
hypertension or cardiomyopathy (weakness
of the heart muscle).
We hope that this article answered
some of your questions about a very
common, anxiety producing symptom,
“palpitations”. Stay healthy.
Yamac Gungor, MD
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