Heart Palpitations

Heart Palpitations

Getting Back the Beat

Betty Hughes, a 45-year-old homemaker from Wilkes-Barre, Pennsylvania, looked toward the store entrance. Her husband was supposed to pick her up, but his car was nowhere in sight.

She began to tap her foot in annoyance, her heart skipped a beat, and then she dropped dead.

Very rarely do the heart's occasional flutters, skips, flip-flops, leaps or pounding rhythms indicate a serious problem in women under 45 unless they have underlying heart disease, such as coronary artery disease, a previous heart attack, serious valvular disease, problems with the heart muscle or rare congenital syndromes.

But every once in a while someone like Betty Hughes, who had a history of heart palpitations, gets into trouble. The heart's electrical system short-circuits, the heart quivers frantically, and the person drops dead.

That's why any heart palpitations that are accompanied by dizziness, shortness of breath or chest pain--all indicators of underlying diseases that can turn simple palpitations into a life-threatening condition--should be checked by a doctor, says Marjorie S. Stanek, M.D., director of the Cardiac Stress Laboratory at Einstein Medical Center in Philadelphia. And so should any palpitations in which the heart begins to race and flatly refuses to stop.

When Hearts Flutter

Serious rhythm disturbances are more likely if you have had previous heart problems or if there is a family history of fainting or sudden unexplained death (particularly if it occurs at a relatively young age). If you have any concerns, discuss them with your doctor, who can prescribe treatments to stabilize your heart rhythms.

Palpitations that are unaccompanied by the symptoms described above, stop almost instantly or happen only once in a while can often be ignored, adds Dr. Stanek. However, if your palpitations annoy you, see your doctor. You can have a checkup to rule out serious conditions and get medication to relieve your symptoms.

Palpitations--which are really nothing more than a forceful pulsation of the heart, an irregular rhythm or a faster-than-normal heartbeat--occur in 20 percent of all adults during any given 24-hour period. There's also a condition called arrhythmia in which these palpitations may not be felt.

In younger women without underlying heart disease, heart palpitations are usually caused by stress, over-the-counter medications, caffeine, cigarette smoke or alcohol, explains Dr. Stanek.

Occasionally they're caused by thyroid disease or by any activity that is particularly exciting or anxiety-provoking, including sex.

Three's the Charm

Most of these palpitations are caused by premature contractions, says Dr. Stanek. The heart beats once, then beats a second time prematurely. That gives the heart a split second longer to fill up with blood before the third beat, so when that beat comes, the increased blood in the heart makes it contract more forcefully. And although most people describe the feeling as a "skipped beat," says Dr. Stanek, it's that third, extra-forceful contraction that actually grabs their attention. Palpitations are also felt when the heart beats faster than normal or if its rhythm is irregular.

Frequently palpitations can be prevented simply by avoiding circumstances that are known to encourage them, says Dr. Stanek.

Read the ingredient label. Two flutter-triggering substances (which are frequently tucked away in unexpected places) are epinephrine in over-the-counter nose drops, cold remedies and allergy medicines and caffeine in coffee, chocolate and aspirin compounds.

Alcohol, which can be found in a cough syrup as well as a wine glass, also encourages palpitations, adds Dr. Stanek. So do prescription diuretics that flush out potassium along with excess fluid.

If your doctor has prescribed any type of medication to help eliminate excess fluid, says Dr. Stanek, check with her to see whether you need to supplement your diet with potassium.

Stay in shape. If you have been forced to sit or lie around for a while, chances are that your body will become deconditioned and any activity will require your heart to work harder, which may cause palpitations, says Dr. Stanek.

"I had one patient who was pregnant. She was worried about losing the pregnancy because she'd had lots of miscarriages in the past," she says. "So she was confining herself to bed. She wasn't even getting up to turn the television on. Then one day she got up to walk--to go to the doctor's office or the store or something--and she had terrible palpitations."

The cause? Flabby muscles making the heart work harder, says Dr. Stanek.

The key here is to stay in shape if at all possible, she says. Even if you're in the hospital, do your best to stay active. If your doctor allows it, walk up and down the halls, back and forth to the bathroom or around your bed if that's what it takes to keep your heart in shape.

Keep calories above 1,000. Many doctors are concerned that very-low-calorie diets--typically, diets of less than 1,000 calories a day--may cause the life-threatening irregular heartbeats that you may be trying to prevent with a weight-loss diet, says Janis S. Fisler, Ph.D., associate research cardiologist at the University of California at Los Angeles. Commercial diet programs such as Jenny Craig, Weight Watchers and Nutri-System that keep your calories above 1,000 are all fine, says Dr. Fisler. Dieting on your own is fine, too, she notes, as long as you check with a doctor first and keep that 1,000-calorie marker firmly in mind. And, adds Dr. Fisler, weight loss should never exceed one to two pounds per week unless you are under the supervision of a physician.

Beating at Double Time

One type of palpitation that appears commonly in young women with no heart disease is paroxysmal supraventricular tachycardia, a condition in which the heart slams into double-time.

"These episodes may last from minutes to several hours," says David J. Wilber, M.D., professor of medicine and director of the electrophysiology lab at the University of Chicago. "While these episodes are rarely life-threatening, they are very uncomfortable and may be associated with dizziness and fatigue."

There are several simple maneuvers that can be performed to cut off these attacks. Squatting, coughing, breath-holding, or "bearing down" as during a bowel movement are often effective. Occasionally other measures, such as gagging or splashing cold water on the face, may help. If the attack continues despite these measures, and particularly if you feel light-headed or short of breath, you should seek prompt medical attention. A simple injection of medication, either in the emergency room or your doctor's office, is virtually always effective in stopping these more recalcitrant episodes.

It is important to consult your doctor to confirm that a heart rhythm problem is responsible for your symptoms. If these attacks are frequent or troublesome, there are several oral medications that can be taken on a daily basis to prevent further episodes. There is also a nonsurgical procedure that can permanently cure the rhythm disturbance. In this procedure, called catheter ablation, a catheter is used to cauterize the tiny area of heart muscle that's causing the rhythm problem.