Arrhythmias - Palpitations

PALPITATIONS
© Alan B. Schwartz, M.D. January1999/version 1.2

INTRODUCTION

You have palpitations. In the past, your heartbeat was something you did not feel or think about. Now the beating is unsettling and makes you uncomfortable. You feel anxious that something is seriously wrong. Fortunately, although palpitations can be uncomfortable, they are not usually dangerous.

Hopefully, this information sheet will provide you with an understanding of the diverse causes of these symptoms, methods of evaluation and treatment options.

DEFINITION

Palpitations mean that you have a feeling that something is irregular with your heart rhythm.

CAUSE

Palpitations are usually due to premature beats. The beats are premature because they come earlier than expected for the next heart beat. This results in a longer time to the next beat. When this happens the next beat feels very forceful. The premature beats can come from the atrium (called premature atrial contractions or beats, PACs or APB’s) or the ventricle (called premature ventricular contractions or beats, PVC’s or PVBs). Rarely, palpitations are due to short runs of rapid heart beating.

No one really knows why people develop these premature beats. They may be due to isolated heart muscle cells that become irritable. In some cases they occur because of a scar within the heart muscle.

Certain circumstances make them more likely to occur. Alcohol, nicotine, caffeine, lack of sleep, stress and a low potassium level make those who are susceptible more likely to have these symptoms.

PROGNOSIS

The prognosis of people with palpitations is related to whether or not they have any underlying cardiovascular disease. If there is none, the prognosis is excellent. Furthermore, there is high chance of spontaneous remission and there is a very small risk of any life threatening consequence.

SYMPTOMS

Many words have been used to describe these feelings: Jumps, bumps, skips, hard beats, feeling that your heart is beating in your throat or ready to jump out of your body. Palpitations can feel like butterflies in your chest. Some people become aware of the irregular beating because they "hear it" particularly at night in bed. Sometimes you may feel dizzy or short of breath with these beats. If the beats are "hard" enough you may feel chest pain or heaviness which occurs with these beats. This kind of chest pain usually is very brief lasting for a second or two at most. Because there is a pause after the early beat, some people feel like their heart is "stopping". For others, the skipped beats will make them cough.

WORK UP

The most important part of the evaluation is the history taken by the doctor. In the majority of the cases this evaluation leads to the correct diagnosis. In some cases the diagnosis is in question and then further tests are necessary.

If there is no evidence for underlying heart disease based on the history, physical examination and EKG, the prognosis is excellent. There is no increased risk of heart attack. The life span is normal.

Your doctor may want to exclude heart problems which are not apparent from his initial evaluation including poor heart function, malfunctioning heart valves and/or blockages in your coronary arteries by having you get an echocardiogram, treadmill test or a "stress-echo" which is a combination of these two.

A test frequently employed to determine exactly what is causing the symptom is the event monitor. This is a very lightweight tape recorder that has a 5-minute memory loop and is worn on the belt with thin wires attached to electrodes on the body. The person pushes a button on the device when he or she feels symptoms. As long as no more than 5 minutes has elapsed, the recorder will show the rhythm associated with the symptoms. The recorder is can be played by telephone to a center which will provide a recording of your heart rhythm (EKG) so that your doctor will be able to "see" what has happened.

TREATMENT

Non-medical therapy is very effective.

• Avoid the main causes, i.e., alcohol, nicotine and caffeine. If you are not getting enough sleep, correct this if you can. If you can not, discuss this with your doctor.
• Avoid a low potassium level. This may occur with excessive sweating, diarrhea or vomiting. Eat foods that are high in potassium. This includes not only bananas and dried fruits such as raisins but also leafy green vegetables, brussel sprouts, citrus fruits and dates.
• Try to decrease emotional stress in your life (easier said than done).

If these measures do not help, there are medicines that can reduce or eliminate premature beats. The dilemma is that while these medicines are very effective they also have a little risk. The risk is that the rhythm disturbance may worsen rarely leading to death. Sometimes the reassurance and understanding that the symptoms do not represent danger and are in fact benign are all that is needed.

If you have any questions, please call or write Alan Schwartz, M.D. by telephone, e-mail or fax.

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