Heart palpitations: a serious problem or no big deal?

22 Nov

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-day 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.”

© 2013 Walk with a Doc

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

NOTE FROM CAROLYN:  This post was originally published here on Heart Sisters in January of 2013.  Because I’m starting a new writing project  – details soon! –  I find myself temporarily with fewer hours in the day when I’m able to write new blog articles here.  I’m hoping that running some updated favourites of mine from the archives of over 600 Heart Sisters posts will keep you informed, inspired and involved each week for a while.  And although I’m not able to write new blog posts for the time being, I do love reading your comments – so please feel free to leave a response here.   Meanwhile, thank you for your amazing support!

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9 Responses to “Heart palpitations: a serious problem or no big deal?”

  1. Anne Fertey January 12, 2017 at 6:42 pm #

    Thanks, your blog is full of information. 🙂
    Just discovered it tonight… Will come back soon as I love to go deeply in my heart disease – Heart attack in January 29th, 2016.
    Happy New year and Best Wishes for 2017!
    Anne
    France, Côte d’Azur

    Like

  2. Sarah Cherry July 16, 2016 at 9:15 pm #

    I am 26 years old. I started having palpitations a few months after my father passed away unexpectedly in late 2013. I was under a lot of stress and grief. I started to notice the palpitations. I have a few different types, the harder beat and the flutters (oh how I hate the flutters.) I was scared of course.

    I went to my general doctor who told me my heart sounded fine. Did blood work and I was anemic and so he gave me iron tablets and sent me to a cardiologist for a follow up. I had the full work up as far as I know, EKG, electrocardiogram, stress test and the cherry on top was the 30 day holter monitor I had to wear. It was a pain but I felt strength in having that monitor to press the button when I felt scared of the palpitations. I felt like I was connecting to the doctor and I prayed he would help me get rid of them.

    Here it is 2016 and I still have palpitations. The cardiologist said that there was nothing wrong with my heart. The holter did pick up a palpitation but he didn’t seem worried at all about it or about my heart. I took peace in that but when my palpitations flare up I have to wonder why…why do I still have them… what changed in my body after my dad passed away that has caused my body to go out of sorts? My aunt has me taking magnesium and I am taking beta blockers and a calcium blocker. I am hoping for the best, that one day the palpitations will leave on their own.

    Like

    • Carolyn Thomas July 17, 2016 at 5:32 am #

      Hello Sarah – it sounds like you have had the appropriate response to your palpitations (e.g. several cardiac tests) with no results that indicated anything wrong with your heart. Re-read Dr. Sabgir’s comments in this post, especially “in almost all situations, there is nothing to worry about”. Yet ironically, worrying about palpitations can cause more of them. The reality is that these palpitations may leave on their own, or they may not. Meanwhile, try some self-management techniques like exercise, meditation, yoga, etc. to see if they help (e.g. as Dr. Sabgir recommends: “Exercise lowers stress and anxiety levels and indirectly lowers your PVC’s.”) Best of luck to you…

      Like

  3. Cheryl Davis November 28, 2015 at 12:24 pm #

    My heart started pounding off and on when I was 53. I mentioned it to my doctor at my annual visit. He did an EKG and told me I had nothing to worry about. For the next two years, I tried to ignore the pounding even though I often felt that I was going to die.

    Then one morning at work, the pounding started again, but this time I got real dizzy and shaky and was suddenly so tired that I couldn’t walk across the room. I asked a coworker to drive me to the emergency room. At the hospital, I had a normal EKG and echo, but they admitted me for observation. The following afternoon, the hospital cardiologist told me, “You need to stop having so much stress.” He said that I didn’t need any kind of cardiology follow-up and said, “I GUARANTEE there is nothing wrong with your heart.” He was a very rude person.

    I work in a school and was seriously afraid of passing out while teaching my classes, but I went back to work as the doctor ordered. On the third day back at work, the same thing happened again. I had to be rolled out to my husband’s car in a wheelchair. This time, he took me to my primary care doctor who quickly set me up for a treadmill stress test.

    I lasted a minute and a half on the treadmill before the pounding started. The EKG confirmed that I had supraventricular tachycardia*, a type of arrhythmia. I was sent to an EP cardiologist who performed an ablation*.

    For the most part, my rhythm is back to normal now, but my doctor tells me that my heart is “jumpy.” I still get palpitations when I am ill or upset, but things are much better than they were before the ablation. I can go to work now without worrying about passing out in front of a room full of children.

    * Carolyn’s note: confused about cardiac terminology? Visit my Heart Sisters patient-friendly no-jargon glossary!

    Liked by 1 person

    • Carolyn Thomas November 28, 2015 at 2:45 pm #

      This reads like a cautionary tale to every physician who has ever said emphatically to a patient: “I can GUARANTEE there is nothing wrong with your _____” There are few guarantees in medicine, as anybody who has ever been misdiagnosed can readily confirm. Yours is also a good overall reminder to pay attention to that little voice inside that knows when something in your body is just not right. Thanks for sharing your story here…

      Like

  4. Curious to the Max November 23, 2015 at 6:22 pm #

    I was diagnosed with PVC’s in my 30’s. At the time I read about research that indicated PVC’s were more prevalent in small breasted women (had something to do with fetal development?) Since then I’ve blamed ALL my heart arrhythmias on my bra size.

    Liked by 1 person

    • Carolyn Thomas November 23, 2015 at 9:51 pm #

      Interesting theory, Judy-Judith… Coincidentally, at least two of my readers have written that they too have read that their cardiac arrhythmias may be more common in “tall women whose rib cages are narrow”. Haven’t been able to find any science on this yet… If anybody would like to confirm/debunk this theory, let us know!

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  5. Dr. Ralph Beckett November 23, 2015 at 10:40 am #

    I appreciate Dr Sabgir’s comments. It is important to read carefully “in almost all situations there is nothing to worry about”. Nevertheless a lot of worried healthy people get an unnecessary “workup”. I doubt there has been any person who presents to a cardiologist with complaints of palpitations who does not get an ECG. So, if you don’t want at least a $200 office visit and a $100 ECG, don’t go in the first place. ECGs have many false positives (electrical changes that can’t be explained but are actually normal) which lead to more tests, some of which have significant risks.

    The real question is when should palpitations be evaluated: 1) if the palpitations happen with exercise or 2) if there are other symptoms at the same time (anything, but be worried about weakness, light headedness, and especially passing out).

    Liked by 1 person

    • Carolyn Thomas November 23, 2015 at 1:31 pm #

      Thanks Dr. Beckett. As in many parts of medicine, there’s a fine line between unnecessary testing and over-testing. Even a 24-hour Holter monitor may not capture any palpitations, never mind a brief 12-second office recording! I have experienced these mild “flips” for years, very occasionally and almost always at bedtime as I’m lying there quietly (likely because I AM quiet enough to notice!)

      Like

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