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A Frightening Feeling

Arrhythmia – by definition a condition in which the heart beats with an abnormal or irregular rhythm.  Often it is difficult for people to describe what this problem feels like – a “skip,” a “pause,” a “hard beat,” and sometimes words just fail to convey the strange feeling of an arrhythmia. It is very common reason to see a cardiologist, and it’s no wonder – these feelings from the heart frighten us.


But fortunately most cardiac arrhythmias are not life threatening, and can be controlled by medication.  If the symptoms of “palpitations” are very rare, often just reassurance is all that is needed.  But the cardiologist needs to look at these symptoms for the perspective of whether or not this symptom does represent, or is a “marker” for a serious heart problem.


Heart arrhythmias can originate from the upper chambers of the heart, the right and left atria, or from the lower chambers, the right and left ventricle.  Those coming from the left ventricle, the heart’s most important chamber, can be the most serious. Often the cardiologist can tell the chamber of origin of an arrhythmia by looking at an electrocardiogram; the problem is that if the arrhythmia is rare, it may not appear on the EKG that is attached to you for only about a minute.


So when someone goes to the cardiologist for palpitations, the doctor must determine if there is a problem with one of three parts of the heart – the heart muscle itself, one of the four heart valves that separate each of the heart’s chambers, or the blood supply to the heart through the heart’s own arteries – the coronary arteries.  In addition to carefully obtaining the history, examining the patient, and obtaining an electrocardiogram, a check of basic laboratory tests, especially electrolytes like potassium, is mandatory. 


If there is a possibility that there is a major problem with the heart, then an echocardiogram or even a stress test might be indicated.  Often times placing a monitor on a patient for a few days or even up to several weeks is necessary to try to document the type of arrhythmia that is occurring. Once all the data are obtained, then a decision can be made regarding medication or further testing.


There is one type of cardiac arrhythmia that has become very common in recent years, especially in people over the age of 60 – atrial fibrillation.  This is a condition where the left atrium begins to beats over 300 times a minute!  Fortunately, because of the way the heart’s electrical system is built, not all of these beats get through to the lower chambers of the heart. 


But often the heart will beat 100-150 times a minute (normal is about 70 beats a minute at rest), and people will note the palpitations, chest pain, shortness of breath, or dizziness.  Strangely, sometimes patients will not notice anything – the atrial fibrillation is diagnosed when a doctor feels someone’s pulse and notes that it is very fast and irregular.


Atrial fibrillation does create another potential even more serious problem.  When the heart beats that fast, the flow of blood in the left atrium is not very fast.  Slow moving blood can clot.  If a small blood clot in the heart just remains there, there is no problem. 


But if a piece of blood clot breaks loose and enters the arteries leaving the heart, it can end up in one of the arteries to the brain, and cause severe damage to the brain by occluding the blood supply – it can cause a stroke.  For this reason, many (but not all) patients with atrial fibrillation require not just medication to try to control the heart rhythm, but also anticoagulants, “blood thinners,” to reduce the risk of stroke.  Fortunately, there are now several new anticoagulants that are very safe and effective in reducing the stroke risk. 


People who have “palpitations” are common.  But careful evaluation by a cardiologist can determine whether or not medication is required or not, and reduce the risk of serious potentially life-threatening arrhythmias as well as the mental stress burden of feeling these funny skipped beats in the heart.

Dr. Arnold Meshkov

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