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Health See other Health Articles Title: When Heart Palpitations Become a Problem Yahoo... US News She knew it wasn't normal. For two years, Leah would have heart fluttering -- to the point where you could see her chest moving vigorously -- with no clear inciting event or warning. These symptoms commonly occurred during volleyball and therefore restricted her ability to compete effectively. Fearing something was wrong, she sought advice from physicians, both of which thought "it was in her head." Going with her instinct, she sought another opinion, which led her to my office. I met Leah about one year ago, and it was clear to both of us that her heart rhythm was abnormal. The Cause of an Off-Tempo Heart Beat The term "palpitation" refers to the sensation that the heart beat is faster than normal. Although some palpitations are considered benign, a carefully-taken patient history typically exposes important clues that an abnormal heart rhythm, or arrhythmia, might be the culprit. Palpitations that have a rapid onset and offset serve as an important clue that an arrhythmia is occurring. This is exactly what Leah described, and thanks to her very clear explanation of symptoms, I knew not to ignore her. Much like an orchestra maestro synchronizes complex sounds into symphony, electrical signals in the heart synchronize muscle contractions resulting in heart beats. In order for the heart to function effectively and efficiently, the electrical system has to perform in a regulated fashion. As such, the electrical system runs on the equivalent of railroad tracks -- a very specialized tissue that allows for efficient electrical conduction. Patients with arrhythmias often have extra electrical connections, and arrhythmias can occur when the electrical system uses these accessory connections. Instead of the heart beating at a normal rate, these extra electrical connections can cause the heart rate to abruptly race at rates which exceed the normal capacity of the heart. When this occurs, patients will sense a rapid and uncomfortable increase in their heart rate referred to as palpitations. Pulse Problem-Solving Not all palpitations are considered abnormal. It's common for the heart to skip for single beats, causing an unusual sensation. With rare exception, these single-skipped beats are considered normal. In contrast, a patient who experiences an abrupt change in heart rate -- like Leah -- requires further investigation. Palpitations in these scenarios can often be accompanied by discomfort, chest pain, dizziness or even passing-out spells. These important clues serve as red flags that the patient's palpitations represent an arrhythmia, and further evaluation is warranted. During an evaluation, your physician will obtain a detailed history with particular attention to symptoms such as discomfort, chest pain, dizziness and fainting. An electrocardiogram -- a non-invasive study that assesses the electrical conduction of the heart in its resting state -- will likely be performed during the initial evaluation. Occasionally, even at rest, the ECG can show subtle clues that an extra electrical connection exists. If the ECG is normal and the details of the history suggest an arrhythmia, ambulatory monitoring may be employed. Ambulatory monitors are wearable devices that serve to capture the electrical activity in the heart during an episode. Your doctor will instruct you to record any symptomatic events with your device. This strategy provides a definitive diagnosis if an arrhythmia is in fact captured. Irregular Palpitation Prognosis and Treatment Depending on the underlying electrical problem, the prognosis and treatment of arrhythmias can vary. Most often, arrhythmias that occur in otherwise healthy children (like Leah) are referred to as supraventricular tachycardia. The prognosis for SVT is excellent and luckily, SVT is not considered a life-threatening condition. Management for SVT is largely predicated on symptoms but can include observation, medical therapy or catheter ablation. Catheter ablation involves a procedure in which an electrophysiology doctor will use electrical wires placed inside the heart through the groin. These wires provide a map of the patient's electrical system and can identify accessory electrical connections. Typically, once the accessory tissue is identified, a special catheter called an ablation catheter can be used to deliver energy to the accessory tissue and destroy the electrical activity in that small area. Catheter ablation for SVT is considered quite safe and has outstanding success rates. Working on our suspicion, we prescribed a monitor for Leah and quickly captured her arrhythmia, which turned out to be SVT. After a careful discussion of treatment options with Leah and her family, she chose to undergo a catheter ablation. The procedure was extremely successful, and I'm happy to report Leah's symptoms are now gone. This active, volleyball-loving teenager is living proof that with the right prognosis and treatment, patients with arrhythmias are able to get their heart beat back on track and live normal, healthy lives. Dr. Peter Aziz completed his pediatric cardiology fellowship at the Children's Hospital of Philadelphia in 2010 and continued his training there in pediatric electrophysiology. During his fellowship, Dr. Aziz was awarded a training grant under the National Institute of Health (NIH) to investigate genotype and phenotype correlations in pediatric patients with long QT syndrome. Dr. Aziz also acquired skills in catheter ablation of pediatric arrhythmias and device (pacemaker and ICD) implantation. Following his fellowship, Dr. Aziz joined Cleveland Clinic Children's as a pediatric electrophysiologist. He is active in the training and teaching of medical students, residents and fellows, an activity that continuously inspires him. Dr. Aziz is also quite active in research and was the recent recipient of the SADS 2011 Young Investigator Award for his work on long QT syndrome. Dr. Aziz acquired skills in Catheter Ablation of pediatric arrhythmias and device implantation, which is a regular part of his clinical practice. Connect with him on Twitter at @PeterAzizMD. Poster Comment: Heather Since Jan. (after having a viral infection) I have been lightheaded/dizzy, low BP 78/60, heart rate 49-52 resting, palpitations. I was kept over night for cardiac observation in March (admitted from ER after passing out going from tachycardia to bradicardia - diagnosed with anxiety which I do not have at all), 5 EKGs, wore 48 hour halter monitor, 10 day event monitor, had a stress test with nuc med testing and a tilt table test all of which shows nothing. Both the electrophysiologist and my primary physician say to increase my salt intake saying it's not my heart. In the mornings I have to wait at least 5 minutes sit to stand before getting out of bed. The cardiologist hasn't a clue either. There is family heart problems both atrial and mitro valve & heart disease. So I am a mystery with no answers to my condition!4 MsM They should do an ultrasound of your heart. That shows if the valves are working correctly.1 Y2A Make sure to be tested for Vestibular Vertigo.2 Ebenezer Since this followed an infection, I hope for you that this will improve in time. It sounds like your docs assessed you for dysautonomia, and by recommending the uptake in salt, they are acknowledging that you have some mild form of it. Diagnosing you with anxiety was not helpful-I'm sorry you're having to deal with that.1 Serenity Heather- Sorry for your situation. It's terrible to have problems with your heart a lot of times the Dr's like to blame the patient labeling them with anxiety and panic! Instead of just saying they don't know what's wrong.2 Lee After years of taking statins I would get dizzy when using a creeper. As a mechanic this is problematic to say the least. I would have to roll out from under a vehicle to prop myself up sitting on the creeper for several minutes while the room tilted and whirled round and round. Walking to the toolbox for the right size wrench one could easily mistake me for a staggering drunk. Read an article here about vitamin D being made from cholesterol and started taking 10,000 unit tablets three at a time. Not dizzy anymore. Oddly enough I could lay down in bed without any such problems and getting out of bed was also a non-issue. Flat on my back on a creeper was like a ride at the carnival. Best of luck, Heather. Deborah I have had SVT for three years. I have learned a lot since this condition started. 1. I need to take 100 mg. Magnesium Glycinate to keep the episodes at bay. 2. I need to stay hydrated. 3. Never bend over forward at the waist with a full stomach. Being low on magnesium, dehydrated, and having an irritated stomach are the conditions that set me up for these events. I called the paramedics when I had my first real run to get it on the EKG and get a sure diagnosis. It was expensive but saved me a lot of future testing and a lot of worry. To get my episodes to stop I drink a big glass of cold water, take a magnesium pill, and the lie down on my left side and think to myself, "Breath deep and slow down your heart rate." I always convert back to normal rhythm within five minutes. This has worked everytime. Before I discovered this, I would try to use vasal vagal maneuvers and they never worked. They just made me more anxious. I think you have to concentrate on slowing down your heart so it can find it's normal electrical path. Before I discovered this, my episodes would last 15 to 45 minutes, so I'm glad to have the improvement. If all keeps working as it is now, I will never have to go through the huge prohibitive cost of ablation. 3 Sherry Thanks for the tip of taking magnesium! I also avoid caffeine as that is a huge trigger for my SVTs. sherri ... You are the only person I have heard mention of the problem with bending over. It seemed to happen to me most often from bending over after I had eaten taco's. I, like the girl in the article was pretty much told I was crazy. The palpitations started when I was a kid. I was on the swim team and sometimes when I dove into a particularly cold lake it felt like my heart just seized up. I mentioned it, but I guess no one knew what to do with that information from me; they didn't understand. Then through my late teens, twenties and thirties I was told it was stress, just an anxiety attack and a cardiologist even told me it was harmless and I could run a marathon while it was happening and I would be fine. Finally one day the palpitations kicked in and nothing I tried would kick it off, so I went to a different hospital and God was with me that day, because this Dr. knew. He was actually mad that so many other Dr.'s let me walk around like a ticking time bomb (those were his words). He explained that heart beats over 220 bpm could cause strokes, if I was driving I could pass out and kill myself or others, etc. He sent me to an electrophysiologist. She told me after the surgery that my heart rate was up to 500 bpm because while they are in there they have to stimulate the heart somehow to go off rhythm so they know exactly where they need to burn. The operation improved my life drastically. It didn't totally fix it, but now if it kicks out of rhythm it's for a short time and it's rare, usually from something startling me out of sleep and when I am really tired. Reagan's Man ... Whenever I would consume a coke or other caffeinated drink or two late in the day and/or in the evening, in the morning I would wake up with an irregular heartbeat. It stopped when I stopped having drinks with caffeine in them. 7 Loretta You have the ones most likely the doctor described as considered 'normal' for some people. I have them too. Have had them for about 40 years! Caffeine, artificial sweeteners & stress are big causes of the type I have (& you most likely). I do, like another person who commented, take magnesium daily. Sherry Yep. I have to completely avoid caffeine as it will trigger an episode for sure. Jingle Cat 2 Are palpitions like a butterfly fluttering in your chest? patchwork.... They can feel like that, or like your heart is jumping a bit. Kirstin... I had palpitations once due to a drug interaction. Luckily for me, stopping the medication was all it took to clear my problems up 100%. For me, it did feel kind of like that, but also I felt very on edge. Uneasy, like something was wrong. I'm not sure how much of that was due to the palpitations and how much was due to the medication, though; I was effectively getting a stimulant overdose. NOTOWN KID The Key fact here that is lost in the story was her First 2 Docs said it was "in her head" here lies the basis for most medical short comings. Stupid Doctors, some who should never have been allowed to graduate and pass the tests. What do you call a Doc who was last In their class and only barely scored enough point to pass the tests? Doctor that's what. And people believe everything they say because they are a Doctor. Don't trust them only a small number are worth a darn.8 C Charlene 7 hours ago 0 1 All you need to do is read sign out front it says PRACTICING PHYSICIAN they don't know either there just PRACTICING. THEY MEAN NO HARM BUT DONTKNOW EVERYTHING. I have had 2 heart attacks 10 stents with a bad cholesterol of 77 I lost 70% of bottom of my heart from attacks now I'm experiencing low ejection fraction ratio of 35/30 which means my heart isn't contracting or squeezing out enough blood also it beats twice instead of once so pumping in or enlarging my heart. I left hospital scared to death just waiting to take my last breath not a good way to live !!!! I am currently seeing Electrophysiology doctor who may install a deflibultor told not to swim which I did several times a week well I've to decided swim take my meds eat right foods basically live right but live no more sitting on side lines waiting for doom 1 Laura... Ditch the docs. Get/stay at proper weight. Start moving such as walking, slowly if needed and Pilates. Ditch processed food and chems. Eat clean and nutritious with some reasonable treats thrown in. I have EF of 17. This is not based on a scale of 100 but about 57. I ditched the drugs, including 2 BP drugs even though my BP is excellent, said no to the bi-ventricular defibrillator. It can be scary on your own but I was more afraid of the idiot cardiologists. I take no meds, cleaned up eating as a form of rebellion-controlling what I could in other words, and without dieting found that weight fell off when I quit eating out and ditched processed foods. Needed to lose 20-25 from a 5'8" frame but lost 40. This has been stable for four years now. I look much better and feel great. They will kill me if I let them.-1 W WenchOtheWest ... There is a very simple explanation and cure in most cases. As with mine, it was caused by a magnesium deficiency. I would strongly suggest first taking a magnesium supplement to see if it helps before trying anything else.5 Loretta My cardiologist said magnesium is very "heart healthy" & I've been taking it for years now. So you are right. Problems like this are very difficult to diagnose, but I'm thankful this young athlete continued to pursue doctors until she found one that was intelligent or cared enough to help her! I know several people, including my 87 yr old step-mom, who have had the ablations & are doing GREAT! 1 Barbara ... My week-old infant son went into tachycardia and was diagnosed with Woff-Parkinson-White Syndrome, also known as WPW. At the age of 4, he had an ablation to sever the electrical connection, as has been fine ever since, thank God. Also thanks to the intern from Duke University who recognized the symptoms and led to the correct diagnosis.8 ElF I had the same problem for years, and the doctors were looking at cardiac ablation. Turned out to be a magnesium deficiency. I take 250 Mg of Magnesium Taurate every morning, and I've not had but a random palpitation in nearly 5 years. Elizabeth ... Tachycardia can also accompany a condition called Postural Orthostatic Tachycardia Syndrome, a form of autonomic dysfunction. It can be diagnosed using a tilt table test. Many people with arrhythmias get written off as having anxiety, but these conditions aren't psychological and are treatable.6 Way thyroid, nutrition 2 Sherry Great article. I'm fortunate that my doctors have all taken me seriously when I've brought up my PVCs and then I was also diagnosed with SVT a couple of years ago. I have to avoid caffeine as I'm extremely sensitive to it and it'll trigger SVTs like nothing else. I see in the comments that folks take magnesium, so I'm going to try that. When an episode strikes, I try to relax, take deep breaths, and thankfully it seems to resolve itself pretty quickly. I may seek the ablation at some point as I know three people who have had that done with great results.1 Autumn I have had these since I was 10...unless you are in an active palp doctors disregard...I was in my 50's before ending up in the hospital where they gave me a shot to stop one...HR at the time was 225...after another episode I ended up in ER with congestive heart failure - by the time I arrived in the ER the palp had stopped so - again it was disregarded...I always wondered why doctors just don't admit they have no idea...these are not flutters...when you can see your heart beat through your shirt it is not a flutter...and BTW - women HAVE hearts! 6 izzy I had this actual precedure about 2 years ago at Jersey Shore Hosptial, Neptune, NJ. All symptoms are gone. I watched the procedure on you tube when I came home from the hospital, glad I didn't see it before. Might have chickened out. I was told it wasn't a life threatening issue I would "stroke out" first, comforting? No. If given the choice to make again, sure I would do it again. Helped that my doctors were really great guys! 1 P PINKPANTHER ... Mitral Valve Prolapse can also cause palpitations....7 Roxann... Afib can cause this also, I have had 2 ablations in 2 years and the Dr said it could still return if the heart heals itself where the heart was burned. Mine did thus the second ablation. My Dr. is now performing a new breakthrough procedure where they now freeze instead of burn.5 Granny Annie... palpitations encompass more than a fast heart rate. They include any kind of irregular beat, but most irregular heart beats have a technical name, like PVC or PAC or others. If you are not having an actual episode while the doctor is listening to your heart, or while you are having an EKG, the doctors basically just wave it away, call it anxiety or stress, too much caffeine, etc. I started having PAC's when I was just out of high school. Doctor could never catch them. Years passed, they got worse, I had two Holter monitors attached at different times and of course no episodes until they were taken off and I was on my way home. FINALLY at age 50 I was having a severe episode of PAC's, and went to the ER while it was occurring and was diagnosed with AFIB. I take a beta blocker now and warfarin, and am so relieved that it was nothing more serious (not that AFIB isn't serious), but at least now I see a cardiologist regularly 1. Renee D Magnesium Malate and potassium took care of it for me. Used to scare the hell out of me. 1 Shane... Let's remember to thank god. Without him, none of this would be possible! (heavy sarcastic tone) I it can also result from an under/overactive thyroid. In fact, one of the key symptoms of a thyroid issue is palpitations.1 JB 3 This article makes is sound like only the SVT's are dangerous. So a series of skipped and/or irregular beats that make you feel like you're going to pass out is OK? It's only the rapid beats that are a problem? If true, that's a relief. I've always been told not to worry about it. Some of the oldest, longest-lived people in my family had them. But sometimes when I'm having them, I wonder if my rhythm is ever going to correct itself or if this time will be the end!!! Hate that sensation!!! 2 Post Comment Private Reply Ignore Thread
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