Heart palpitations – what do they mean?

by Carolyn Thomas    ♥  @HeartSisters

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.

It’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?