January 11, 2013Issue No. 4,192
In This Issue
Public Service Announcements
(1) Walk Leaders
HELPFUL HINT: To get the most participation at your walk it is important that we have the correct walk dates and times on your webpage. Don't forget to drop Liz an email with your schedule! The masses are waiting to see when you walk! (Liz@walkwithadoc.org)
I'm rounding this week and hospital is filled to capacity with patients suffering with influenza or pneumonia. PLEASE, PLEASE, PLEASE join our staff in getting your vaccine - It's not too late.



Good morning! Hope this finds you well and full of enthusiasm with warm weather on the way!
The other day I was walking across our 7th Floor SkyCross (walk connecting WWAD Experimental Kitchen with WWAD Rainforest) when one of the WNSC members (Walk Newsletter Screening Committee - see above) stopped me. I'll refrain from sharing her name, but...she's the 3rd one from the right.
"David, lovely day we're having isn't it? I'm SOOO sorry to bother you but it keeps slipping my mind. Could you tell me again what you do for a living?"
Her words and smile were cool and calm, but her neck and now her face seemed to be turning a little red?
"Dr. 'Smith', you know what I do! Remember you were my pathology professor in my 2nd year of medical...".
She cut me off. The erythema I was initially concerned with was now a strong brick red rapidly on it's way to a deep purple.
A couple of my poker buddies (gastro and derm) were approaching us from 25 feet away.<Oh G-d, so embarrassing!>
This woman makes Judi Dench's 'M' seem like the fairy godmother.
She turned on her heels as I wiped some of her spittle from my chin. I could hear my buddies laughing.
Sooooo, I always fancy the opportunity to fulfill a  request and today we are going to get medical and talk about palpitations.


We see more patients for palpitations than any other concern. In most all situations there is nothing to worry about, but let me take you through my work-up, or at least most of it.

The majority of people we meet with palpitations are having premature ventricular and/or atrial contractions (PVCs and PAC's). Most office patients mention appreciating them primarily in the evening when winding down. They usually last only seconds and they describe them as a "quick flutter", "extra beats", or they mention very brief chest pain.

What causes them?

Let's first share that over 60% of us have these. Circumstances in my experience that may increase their frequency include:

Poor sleep (recent) or sleep apnea, increased stress or anxiety, low potassium levels, mitral valve prolapse, abnormal thyroid levels (T4), and of course tobacco, alcohol, and caffeine (yes, that includes chocolate).

What am I feeling?  

Because there is a premature beat, the heart has longer to fill for the subsequent contraction. In this squeeze it may pump out 50% more blood than on a 'normal' beat. That large ejection of blood can give that feeling of a jolt.

What tests do we order?

Every situation is unique, but one test I always order is an EKG (10 second heart tracing with 12 leads and all the spikes and bumps). Occasionally I will also get a rhythm strip (long EKG)

I routinely order is a 24 or a 48 hour Holter monitor (an all day (or two) EKG).  

In this discussion, we are talking about PVCs/PACs - but I. and your doc, will likely want to make sure it's not another arrhythmia such as atrial fibrillation, atrial flutter, ventricular tachycardia, sick sinus syndrome, etc. If there are cardiovascular risk factors (smoking, high blood pressure, etc.) I will often get an echocardiogram and occasionally a stress test.

How do I get rid of PVCs?

So you've corrected the possible causes and they're still bugging you.    

Honestly, if we determine that the symptoms are correlated to PVC's, most of my patients are relieved and don't want medicines (beta blockers are typical first choice) because they (a) don't like BB's and/or (b) they understand that the side effects may be worse than the symptoms. However, it's not uncommon that the PVC's can disrupt your quality of life and something needs to be done.  

We have also used calcium channel blockers or anti-arrhythmic drugs for those times. 

If these doesn't work and you're still having issues, there is a relatively simple ablation procedure where we go into the heart and zap them.

Ok, thanks for the free consult, Dr. Cardiologist Man. Now I'm good, right?

Nope. Please make sure your doc is aware, because it's not always PVCs/PAC's and they will want to know about them.

What does exercise do for PVC's?

Thought you'd never ask. Exercise lowers stress and anxiety levels and indirectly lowers your PVC's.  It also allows for better sleep and decreased cravings for cigarettes. 


You and your questions are truly important to us. Because we want to make sure you receive the appropriate medical workup, we're choosing not to answer medical related questions via email.  

That said, all of our docs are eager to share their thoughts in person at a Walk with a Doc event.  

For goodness' sake, that's the main reason we're there. 


Thank you
Walk with a Doc is here for you. If you need anything, please email or call us.
Stay hungry, stay foolish, and stay hungry.
This week's walks

I hope that was enough medical stuff for to last for a couple weeks? The WNSC goes on hiatus next week and I'm excited to tell you about our family car trip to Florida.