Palpitations

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Palpitations , arrhythmias, dropped beats, tachycardia, SVT

Description: usually we do not feel our heart beating (except with exercise or with a fright). Palpitations describe when we feel the heart and it seems to be beating abnormally - dropped beats, irregularly, too fast or occasionally too slow. Some irregular dropped beats are common and usually quite harmless, but persistent irregularity, fast or very slow rates should be discussed with your doctor. There can be many causes for palpitations. Women around menopause time often experience palpitations which are nearly always quite benign.

What your doctor can do

Investigations.

  • Confirm what the abnormal rhythm is with an ECG, or a Holter monitor which is an ECG recorder worn for 24 hours to see what the rhythm is.
  • To identify any possible cause for the palpitations: an echocardiogram, blood tests or stress ECG.
  • More serious palpitations may require electrophysiological testing where flexible wires are placed in the heart through the veins to localise the origin of the abnormal rhythm

Drugs

  • There are a number of drugs used to treat palpitations, but many of the more effective ones can have quite severe adverse effects – discuss all of these with your doctor or cardiologist. Drugs you may be asked to take include: beta blockers, flecainide, amiodarone, calcium blockers, digoxin, rythmodan. It is best to control palpitations without needing to resort to long term drug therapy if possible.

Procedures

  • Cardioversion: an electric shock is used under general anaesthetic, to return the rhythm to normal. (click here)
  • Electrophysiological therapy: catheters placed in the heart which can ablate (destroy) the cause of some heart abnormal rhythms.

What you can do :

Lifestyle

  • First make sure you understand what the palpitations mean and if they are serious or just a nuisance. Reassurance can often make them disappear
  • Then relax and stop worrying, because stress creates adrenaline which makes palpitations much worse.
  • Study to see if anything precipitates them such as vigorous exercise, some foods, coffee, cigarettes, severe stress. If you can find a cause, try to avoid it.
  • Routinely it is best to try stopping alcohol and caffeine ( coffee, tea, sports drinks etc) for a while
  • Palpitations are very common around menopause, and some hormonal treatment may be all that is necessary to control them. (We prefer to recommend bio-identical hormones rather than synthetic HRT).
  • Regular gentle exercise can sometimes reduce the incidence of palpitations.

Specific palpitations:

Dropped beats or short runs of irregular or rapid heart beats - these are extremely common and almost everyone gets them.   Doctors call them ectopic beats, as as long as they are not frequent or cause you symptoms other than the irregular feeling, they are almost always quite benign and you dont need to worry about them.  The more you worry, the more you will get.   They almost never suggest any form of  heart disease, and have nothing to do with heart attacks.     If they are frequent your doctor can arrange for an ECG or Holter monitor to check them.   They are extremely common in women around menopause (and perhaps men at about the same age too.)   When they happen, ignore them, take a few deep breaths or relax, but dont worry.

Atrial fibrillation - here the atria contract irregularly causing a more rapid and irregular heart beat.   Drugs ( digoxin, calcium channel blockers (verapamil, diltiazem)) are given to slow the heart rate.   There is also a risk of clots forming in the heart chambers so antiocagulants ( warfarin or dabigantran) are prescribed.  NB these clots can be life thsvtreatening (heart attack, stroke) and anticoagulants are essential therapy for most patients in atrial fibrillation.  Cardioversion is often tried (see video above) to return the heart rhythm to normal.

Supraventricular tachycardia (SVT) -  where the heart suddenly starts beating rapidly and regularly.   This is not dangerous as the heart beats like this with exercise.   It frequently starts and stops spontaneously, but can sometimes needs drugs ( adenosine, beta blockers, amiodarone) to bring it back to normal, or even cardioversion (see above) to bring it back to normal.   Occasionally there is an abnormal pathway in the heart which causes the SVT ( WPW or LGL syndromes), and your doctor should do  an ECG at rest and sometimes other tests to make sure this is not present because it can be fixed with a relatively simple catheter operation.
The supine Valsalva manoeuvre - lie with your  feet raised, take a deep breath and strain down for as long as you can, then resume normal breathing.  This often stops the SVT.

Nutritional supplements –

  • A good multivitamin/multimineral will make sure that the heart has all the nutrients and minerals it requires.
  • Omega 3 fish oils,1–2 grams daily, can have a rhythm-controlling effect, and may also reduce the risk of the more serious rhythm disturbances that can cause a cardiac arrest.
  • Magnesium (and calcium). Magnesium is essential to keep the heart rhythm regular, therefore we use 800–1,000mg daily in all our patients with palpitations.
  • CoEnzyme Q10 can improve the energy supply to the heart and may help some people with palpitations - try 100mg/day for a few weeks and see if it helps.
  • Others - some suggest trying L Carnitine, Hawthorne but I know little evidence that these help, however they are unlikely to do any harm

The Nutritional supplements I use and recommend to my patients

For my patients with palpitations I recommend - USANA - Essentials, Biomega, Active Calcium plus, Coquinone -

Other therapies

There are a number of other therapies which you might like to look at.  They have not been specifically included with this disease because some are a form of treatment which is applicable to most diseases and many focus on the mind, body, spirit, and the universe. These include - acupuncture, Ayurvedic medicine, energy healing, homeopathy, naturopathy, prayer, visualisation and some people with this condition might like to look at these topics (I have described them more fully on another page on this website click here .) With my personal experience and reading, I do not think that I can comment of whether one or a number of these might help.    They fit well with most conventional and complementary treatments and I suspect some or even all of them can be extremely powerful - if performed by an experienced practitioner.    My only caveat is that if in the course of one of these therapies, you are given potions or herbs, do check with your health practitioner that they will not interfere with other treatments or drugs you are receiving.

Nutritional supplements

I believe in today's world that nutritional supplements are so necessary as to be an essential component of any form of both prevention and treatment. Not only is today's food lacking in nutrients because of the way it was grown and processed, but also most of us make the wrong choices in diet. It is virtually impossible to obtain optimal levels of most of the vitamins, minerals and other nutrients although many people try to do so, and even then fresh produce is not available all year round. *There are many quality supplements available on the market, including –Thorne, NFS, Douglas Labs, Xtend Life, True Star Health, USANA, and Metagenics. There are others, but do your due diligence before choosing one. USANA Health Sciences has added a new adjunct to its multivitamin and multi mineral called CellSentials. These are a patented blend of phyto-nutrients which they believe affects cell signaling and growth, and increases the production of preventative antioxidants within the cell. These should add to the value of the multi, so these are the multivitamin/mineral preparation I recommend.