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.
