I have Palpitations
What is palpitation?
"Palpitations" are usually described as a "thumping," "fluttering," "racing," and
often as "skipped beats," when describing the pulse or the heart beat. They are
often the source of great anxiety in many people; some are afraid that their "heart is going to stop."
Most of the sensations described as palpitations are actually extra beats, usually
described by physicians as premature ventricular or atrial contractions. They can
be diagnosed clinically in most cases by the physician, and easily if an electrocardiogram
is obtained. Sometimes 24hour monitoring with the mobile Holter monitor is required to
pin down the actual nature of the arrhythmia.
PVCs are "premature ventricular contractions." They are "extra beats," originating somewhere
in the ventricles, whereas the normal heartbeat originates in the sinoauricular (SA) node of the
atria. PACs-premature atrial contractions--originate in the atria, or upper chambers of the heart.
In 90 percent of cases these extra beats are not dangerous and have no special
significance. Everyone has them at some time or other. If you do Holter monitoring of 1000
normal people for 24 hours, nearly 100 percent of them will have anywhere from a few to
several hundred premature contractions, many occurring during sleep. Most people do
not even notice them, even during the day.
Is it dangerous?
Some people, who are anxious or very conscious of their hearts, will note every one of them
and become even more anxious, thinking the heart is "skipping beats," or that it may stop. The
feeling of "skipping" comes about because there is often a pause after an extra beat while the
normal rhythm "catches up." A number of large, long-term studies have been done on people
with premature contractions indicating their harmlessness. They may be caused by anxiety, by
loss of, or lack of sleep, by smoking, alcohol, and especially the use of caffeine and other
stimulating drugs. Much of the time, they are simply termed "idiopathic;" i.e., without any known cause.
Treatment involves correcting any of the known causes; after that, there is not really much that can
be done. Vigorous exercise may abolish them, whereas many people get so worried about them
that they are afraid to exercise. Sometimes the various hawthorn berry extracts, and some of the
magnesium compounds, may be helpful. But the main thing is reassurance that they do not indicate
heart disease, and are harmless.
The only time that they may be a problem is in serious known heart disease, such as following a
severe heart attack where the heart is markedly weakened. In these cases, very frequent, "multifocal"
(originating in several different areas of the ventricles) may be an ominous sign, and may trigger off a
serious or occasionally fatal arrhythmia.
Another cause for palpitations may be more significant. When persons report skipping and very
irregular heartbeat, it may signify the beginning of atrial fibrillation. This arrhythmia occurs when
the heartbeat becomes quite chaotic in the atria or upper chambers of the heart; impulses are
transmitted very irregularly to the ventricles or lower chambers, so that the heartbeat is very irregular
and oftentimes quite rapid. Atrial fibrillation may be either paroxysmal, in which case it comes and
goes, or else it may be sustained. Persons with atrial fibrillation should be under the care of a
Usually it is easy enough to distinguish between palpitations caused by premature contractions
and atrial fibrillation. However, there are times when premature contractions are so frequent that it
may be difficult even for a trained medical person to distinguish the true cause. In these cases, an
electrocardiogram will tell the story.
To sum up, most palpitations are entirely innocent and require only reassurance and exercise.
Sustained irregular heart rhythm, however, should be investigated by a health professional.
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