Heart palpitations – what do they mean?

by Carolyn Thomas     @HeartSisters

Dr. David Sabgir at one of his
Dr. David Sabgir at one of his “Walk With A Doc” events

I love the concept of Walk With A Doc. This non-profit group was founded in 2005 by Dr. David Sabgir, an Ohio cardiologist. His reason was simple: telling his heart patients to get out and exercise just wasn’t working. His WWAD project involves recruiting volunteer physicians willing to lace up their sneakers and lead scheduled walks in their communities. These docs kick off each walk with a brief informational talk on some aspect of health. WWAD now boasts doctor-led neighbourhood walks all over the U.S. and Canada – as well as overseas in Russia, India, Australia and Abu Dhabi so far.

Walk With A DocIt’s absolutely free to register a Walk With A Doc program, and in return, physicians receive cool stuff like WWAD pedometers, T-shirts, banners, prescription pads so they can write WWAD orders for their patients, and even sample press releases to send to local media. If your doctor isn’t already leading a Walk With A Doc group in your community, please forward this info about how to get started. And while you’re waiting, here’s what Dr. Sabgir had to say in a recent WWAD newsletter about how he views the common patient experience of heart palpitations

“We see more patients for palpitations than any other concern. In almost all situations, there is nothing to worry about, but let me take you through my work-up, or at least most of it.

“The majority of people we meet with palpitations are having premature ventricular and/or atrial contractions (PVCs and PACs). Most office patients mention noticing them primarily in the evening when winding down. They usually last only seconds and are described as a “quick flutter”, “extra beats”, or very brief chest pain.

“What causes them?  Let’s first share that over 60% of us have these. Circumstances in my experience that may increase their frequency include:

  • poor sleep (recent) or sleep apnea
  • increased stress or anxiety
  • low potassium levels
  • mitral valve prolapse
  • abnormal thyroid levels (T4)
  • tobacco, alcohol, and caffeine (yes, that includes chocolate)

“What am I feeling?  Because there is a premature beat, the heart has longer to fill for the subsequent contraction. In this squeeze, it may pump out 50% more blood than on a ‘normal’ beat. That large ejection of blood can give that feeling of a jolt.

“What tests do we order?  Every situation is unique, but for the cheaper alternative that doesn’t require you to mortgage your house or get a short term loan – one test I always order is an EKG (a 10-second heart tracing with 12 leads and all the spikes and bumps). Occasionally I will also get a rhythm strip (long EKG)I routinely order a 24- or a 48-hour Holter monitor (an all day – or two –  EKG).

“In this discussion, we are talking about PVCs/PACs, but I and your doc will likely want to make sure it’s not another arrhythmia such as atrial fibrillation, atrial flutter, ventricular tachycardia, sick sinus syndrome, etc.  If there are cardiovascular risk factors (smoking, high blood pressure, etc.), I will often order an echocardiogram and occasionally a treadmill stress test.

“How do I get rid of PVCs?  So you’ve corrected the possible causes and they’re still bugging you. Honestly, if we determine that the symptoms are correlated to PVC’s, most of my patients are relieved and don’t want medicines (beta blockers are typical first choice) because they (a) don’t like beta blockers and/or (b) they understand that the side effects may be worse than the symptoms.

“However, it’s not uncommon that the PVC’s can disrupt your quality of life and something needs to be done. We have also used calcium channel blockers or anti-arrhythmic drugs for those times.  If these don’t work and you’re still having issues, there is a relatively simple ablation procedure where we go into the heart and zap them.

“Okay, thanks for the free consult, Dr. Cardiologist Man. Now I’m good, right?”  Nope. Please make sure your doc is aware, because it’s not always PVCs/PACs and they will want to know about them.

“What does exercise do for PVC’s?  Thought you’d never ask. Exercise lowers stress and anxiety levels and indirectly lowers your PVC’s.  It also allows for better sleep and decreased cravings for cigarettes.”

Q: Have you experienced heart palpitations? What did they turn out to be?

8 thoughts on “Heart palpitations – what do they mean?

  1. I appreciate the post very much. It gives me hope that I will feel better with proper diagnosis and possible treatment.

    I am 35 and am struggling with heart palpitations. It is happening almost every night and wakes me out of a dead sleep. Typically it is within the first hour of falling asleep and is really awful the week leading up to my cycle. I am currently scheduled to rule in/out sleep apnea and getting results for blood work done this past week regarding thyroid. I also am currently having a looper test (14 day monitoring). I have many factors in my life such as high stress, being overweight (although I have lost 55 lbs these last 4 months), and was pushing myself by not sleeping as much as I should. Wish me luck with my diagnosis.
    Burlington, Ontario, Canada


  2. I’ve reported “flutters” for years. They don’t bother me all that much (except for concern that it might mean something worse).

    In October I wore a 14 day Ziopatch to check out my apical hypertrophic cardiomyopathy. (HCM patients are at risk for atrial fibrillation.) I was supposed to push a button whenever I felt something. That was not in fact possible, given frequency and social/safety situations, but apparently it was enough that clear correlation was established. Yes, I really do feel them.
    SVTs in my upper chamber, PVCs in lower – .3% of total beats.

    The cardiologist did not consider anything in that reading alarming. My resting heart rate is very slow already, and meds would reduce that, so we’re doing nothing.


    1. Thanks for sharing your experience here, Kathleen. Yours is a good example of “watchful waiting”. It’s what Dr. Bernard Lown (author of “The Lost Art of Healing: Practicing Compassion in Medicine”) has been writing about during his 62-year long medical career, e.g. “We did much FOR the patient and as little as possible TO the patient.”

      His further advice to patients: “Be ready to be helped, even if a cure is not possible.” The truth is sometimes there’s a magic pill, and sometimes there simply isn’t! Thank you again for your comment today.


  3. Great post – I learned a thing or two. I get them and have had all the tests the Dr. was talking about and my Dr. determined it was not something to get overly concerned about and we are treating it with medication. Nice to have all this confirmed.


  4. Great post Carolyn!

    Other health conditions — and some normal stages of life or experience — can also cause “skipped” beats and palpitations, including menopause, fresh exposure to high altitudes, physical stress (such as running a marathon), hypothyroid and hyperthyroid issues, pregnancy, some drugs (prescribed, over-the-counter and recreational) and some psychological & psychiatric problems.

    Barbara Bronson Gray, RN, MN


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