Posted by CCF Cardio MD-SGM on October 17, 1997 at 17:17:16:
In Reply to: heart palpitations posted by J. L. Anderson on October 17, 1997 at 10:45:30:
: My question pertains to possible insidious and subclinical causes of periodic heart palpitations.
: Is this symptomatic condition becoming more prevalent? What new diagnostic techniques are available to
: define causative agents or clinical conditions previously undefined which
: are contributing to a marked increase in the incidence of idiopathic heart paplpitations in the
: population at large? Clinically speaking, what is the established protocol in
: step-by-step elimination of traditional causes for this condition, and what new data on previously unrecognized
: contributing factors, diseases or sensitivities is now available?
: Thank you for offering this service to the public, and for adapting this new technology and electronic medium for
: the good of the community at large.
: Until that time,
: Jim
: anderson
: janderson@saltspring.com
_____________________________________________________________________
Dear Jim,
Heart palpitations refer to a premature contraction of the heart that is sometimes perceived as an uncomfortable sensation by individuals. Palpitations can be due to either supraventricular causes(arising from the atria, or upper chambers of the heart), or ventricular causes(arising from the ventricles, or lower chambers). In both cases, an irregular, premature electrical impulse is generated, and the ensuing contraction of the heart is sometimes perceived by the patient. Premature beats can occur in association with a variety of stimuli including potassium and magnesium imbalances; the excessive use of tobacco, alcohol, caffeine, or diet pills; and exercise. They can also occur following a heart attack, and tend to reflect the degree of ventricular dysfunction and possibly the extent of untreated coronary artery disease. Finally, the incidence of premature beats increases with age and is associated with male sex.
I gather that you've been diagnosed with this condition, but don't know whether your premature beats are supraventricular or ventricular. Regarding the former, treatment is supportive... namely reassurance, since no therapy improves outcome, and medicines are known to cause side-effects that outweigh the benefit of therapy. Regarding ventricular premature beats, or PVC's, I would note the following: In the absence of structural heart disease(coronary artery disease, history of myocardial infarction--heart attack, or left ventricular dysfunction--heart failure), no particular therapy is indicated for the same reasons I mentioned above. In the presence of structural heart disease, it would be important to consult a cardiologist to carefully weigh the pros and cons of starting medication to attempt to reduce the incidence of premature beats, measure blood chemistries, and consider electrophysiologic testing-- especially if the PVC's increase in frequency or cause runs of ventricular tachycardia.
Regarding your question of prevalence, I would say that enhanced surveillance has an uncanny ability to increase the apparent prevalence of any condition. For example, if we didn't order ECG's and holter monitoring to check for PVC's or arrhythmias, it would be no surprise if we didn't discover these problems. Thus, I do not believe the prevalence has increased in recent years, but simply that detection has been more vigilant. One exception to this is the population of Americans who are older, on average, than in the past, and who have survived heart attacks. These individuals may indeed have an increased prevalence of PVC's, but this is due to the aforementioned causes, and not to some insidious, unrecognized stimulus. From the above discussion, I hope I have illuminated the general protocol for evaluating this condition.
If you are seeking a second opinion or further evaluation, an appointment with one of our cardiologists can be arranged by calling the Cleveland Clinic at 1 800 CCF-CARE. Information provided in the Heart Forum is intended for general medical informational purposes only. Actual diagnosis and treatment of any particular medical condition can only be made by your family physician.
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