Rapid Heartbeat, Palpitations

Posted By  CCF Cardio MD-SGM on December 15, 1997 at 11:05:22:

In Reply to: Rapid Heartbeat, Palpitations posted by Chris  on December 06, 1997 at 21:29:23:

: I have experienced palpitations 3-4 times/year for as long as I can remember.  The past 3 weeks, I have had one to several daily. Six days ago, I experienced one where the "pause" after the "flutter" lasted much longer than usual, followed by an incredibly loud and painful beat.  A few days following, I had a very scary situation at work where it started as a normal, albeit stronger than usual flutter.  This time it became more of a grinding feeling, seemed very loud and lasted in the area of 7-8 seconds.  I really didn't think it would beat again.  It was very scary and I came close to passing out (although that could have been from fear).  I have been undergoing a lot of stress at work the past six months, that has really escalated the past couple of months.  I am off work for a few days, and the palpitations have subsided, but I have a very loud (and I think) rapid heartbeat. Sometimes it feels as though its beating around the middle of my throat. I have had an EKG, thyroid, and  anemia test (awaiting the results). I use an inhalor for asthma (Berotec) which I have cut down substantially in the past 4-5 days in case that is aggravating the condition. No caffeine, cigarettes or alcohol. Does it sound like anxiety or stress brought these on? I am feeling very tense, jumpy, and a little depressed (not my nature at all) but wonder if that isn't because I don't know what is wrong with me. I am undergoing a Holster and Echogram to rule out any serious problems but am concerned about the constant and racing heart, despite that fact that I can't pinpoint the cause for my racing heart!  Thanks in advance and any info would be appreciated.

[CCF Cardio MD-SGM]

_
Dear Chris,
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.
It sounds like you're undergoing a thorough evaluation for these symptoms.   If the holter monitor shows premature atrial contractions and the echocardiogram is normal,  then the treatment for this is largely supportive... namely reassurance that nothing serious is wrong, and you are at no increased risk of adverse events.  If the holter shows that you're experiencing episodes of atrial fibrillation, which is a more serious atrial arrhythmia, then your doctor can advise you on medical therapy for this condition that should decrease its incidence.  Some common medications are beta-blockers.  Other causes of palpitations can be detected by the holter and possibly by electrophysiologic testing using a catheter that is placed into the heart through the veins in the groin.  This catheter-based technique, if indicated by the Holter results, can not only diagnose, but sometimes treat and cure these arrhythmias.  
However, the most likely cause of your symptoms(I'm assuming that you don't have any history of known heart disease) is PAC's, or premature atrial contractions.  As I mentioned above, this is a benign condition.   Saying it's not harmful doesn't make it go away, but if in fact this is the problem, you need to understand that it's not dangerous.   I recommend you discuss the findings of  the Holter and Echocardiogram with your doctor in order to arrive at the appropriate plan of action.
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.