Should You Worry About Heart Palpitations? A Cardiologist Explains
Many patients come to see me with worry, concern, and even distress over palpitations. When they roll on their left side in bed, or when they're sitting reading, or perhaps before a business presentation, they can feel their heart beat stronger, or faster, or with an irregularity or thud that alarms them.
As a cardiologist, I need a diagnosis to provide the insurance carrier, so we call these events "palpitations." The Latin root is palpare, which means "gentle tap," but in real life it may not be so gentle.
Because palpitations cause a considerable amount of concern and lead to many office visits, I thought it would be helpful to briefly explain heartbeats.
How the heartbeat works
In its optimal state, the top of the heart (atria) and the bottom of the heart (ventricles) beat in perfect synchrony about 50 to 90 times a minute at rest. This is called sinus rhythm and it's the most efficient way for the heart to pump blood.
This process starts at the top of the heart in the sinus node, travels to the middle of the heart (or the AV node), then the electrical wave-front moves on to cause the contraction that sends blood to the whole body.
There are many ways that this ballet can be altered. The top of the heart can fire early, causing a premature atrial contraction (PAC). Or the bottom of the heart can fire, early creating a premature ventricular contraction (PVC).
These can occur once and cause a thud in the chest, but they can also occur in multiples or runs, called atrial or ventricular tachycardia, which can indicate a serious underlying problem.
Another common problem I see is when the top of the heart loses all organization of rhythm and quivers, (some say it fibrillates like a bag of worms), creating atrial fibrillation or AFIB. This is so common that it dominates my hospital and office practice.
When you should be concerned?
All of us have some premature beats at times. In fact, the average person experiences a small number of skipped beats. Sometimes seemingly healthy people experience every other heartbeat as a skip, something called bigeminy, which can make the pulse hard to measure and cause worry that the heart rate is 30 beats per minutes when it's actually 60.
Although most people just need a little reassurance that everything's normal, it's often a good idea to search for root causes, particularly in people with medical issues, athletes, older adults, and those with additional symptoms like dizziness, near blackouts, and shortness of breath.
Some thing to consider:
- Does the patient have high blood pressure?
- Is there an overactive thyroid?
- Is there lung disease such as emphysema?
- Is there an electrolyte imbalance like a low potassium or magnesium level?
- Is the patient experiencing poor sleep or sleep apnea?
- Does the patient have silent heart damage?
Additional factors that could cause irregular heartbeats:
- Anxiety and stress
- Excess alcohol or caffeine
- Medications like inhalers for asthma and cold medications
- Illicit drug use
What can you do?
Consider adopting a diet high in plants and vegetables as the additional potassium and magnesium found in whole plant foods can help skipped beats. And review your patterns of exercise; ultra-exercise like repeated full marathons for example, is associated with a five-fold increased risk of AFIB.
Routine studies that may be needed include an electrocardiogram (EKG), blood work, extended heart monitoring often called Holter monitors, an echocardiogram ultrasound evaluation, and treadmill exercise testing.
In some cases, prescription medication, electrical therapies, and a procedure called ablation may manage or cure the more serious causes of palpitations.
You should see a doctor if you have known heart disease, have associated chest pain, shortness of breath, dizziness, blackouts, or if anyone in your family died suddenly at a young age.
In most other cases, you should expect a brief time to heal and restore balance. Avoid offending medications and stimulants, improve your sleep patterns, and manage stress with yoga, meditation or tai-chi. The ability to use your breath to control the rhythm of the heart (by training the cardiac nervous system) is powerful and a great goal to bring to your mat.
The most helpful measure I offer patients after those approaches is to add magnesium as a supplement. The Western diet is shamefully low in magnesium due to our low intake of fruits, vegetables, nuts and seeds and the deterioration of soil quality with low magnesium content in many produce choices. (In fact, a red apple today has on average 80% less magnesium than an apple 80 years ago because of low soil content of magnesium and other minerals.) Organic produce typically has four to five times the amount of magnesium and other nutrients compared to conventionally-grown fruits and vegetables.
Be cautious taking extra magnesium if you have kidney disease but for most persons 250-500 mg a day of extra magnesium is very safe. Most drug stores carry magnesium oxide which may work great if you are constipated but is poorly absorbed.
I tell patients to buy magnesium taurate, malate, glycinate or citrate, which may require a search at a dedicated vitamin shop. Magnesium taurate works particularly well taken at night as it may stop palpitations, improve bowel regularity, relieve migraines, help PMS, and provide a restful night's sleep. That is a winning formula!
There is nothing new about palpitations and they're even referenced in the ancient Song of Songs: You have made my heart beat faster with a single glance of your eyes.
Thankfully, you don't need to see a doctor for a love-related racing heart! However, in other settings, take a breath, take your pulse, and consider that you might have an easily correctable cause of heart racing.
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