A Change of Heart

Are skipped heartbeats something that could trip you up?Valentine’s Day might set some Granite State hearts aflutter, but if love isn’t the reason for changes in your pulse, racing or missed beats can be scary. Like many body parts, our heart pleases us most when we are blissfully unaware of it and it just does its job, pumping away. But palpitations, or sensations of an abnormal heartbeat, are very common, experts say.Feeling a rapid or fluttering heartbeat, or one that seems to be skipping beats, can indicate serious trouble or can be harmless, depending on the surrounding circumstances. “In someone who has no other underlying cardiovascular disorder, palpitations tend to be benign,” says Peter J. Dourdoufis, DO, FACC, a cardiologist at Atlantic Cardiology Associates and Portsmouth Regional Hospital. But if the patient has other cardiovascular problems, palpitations can be a cause for concern. “That’s why we’re frequently asked to see patients with palpitations – to make that assessment,” he says.Indeed, “palpitations are worth discussing with your physician,” says Connor J. Haugh, MD, FACC, a cardiologist and director of the Electrophysiology Laboratory at Catholic Medical Center’s New England Heart Institute in Manchester. Signposts that will help guide your physician as to the urgency of your cardiac condition include other medical issues that you have, whether the palpitations make you feel light-headed or short of breath, how frequently the palpitations occur and their duration, he says.Pulse provokersA variety of triggers can bring on palpitations, including caffeine, over-the-counter medications that contain stimulants and emotional stress. Excessive alcohol intake is also “a major offender for causing palpitations,” Dourdoufis says.Palpitations can also become a patient concern simply because the patient’s heart rate awareness changes; there’s an increased consciousness of and focus on the heart’s action, says Haugh. “It’s enough to give people a kind of sensation that things are different,” he says. Regardless, “if patients are having palpitations that are disruptive to them – if palpitations make the patient feel unwell or are bothersome, then I think those are worth evaluating,” says Haugh.One of the most crucial facets of unraveling palpitations and what precipitates them is determining if the patient has an arrhythmia, which is an abnormality or disturbance in the heart’s regular rhythm. “Palpitations are what the patient experiences; arrhythmia is the actual medical or pathologic process that happens within the heart” that can cause palpitations, Dourdoufis says. In other words, palpitations are a symptom, and an arrhythmia might be the root problem or cause of the palpitations.There are multiple types of arrhythmias, ranging from the harmless to life-threatening. In some cases, “mechanical or electrical issues with the heart can create the arrhythmia that can cause the symptom of palpitations,” Dourdoufis says. Sometimes simply getting older brings on arrhythmia: about 10 percent of the population over 70 has a type of arrhythmia called atrial fibrillation, he says. So, just with age, lacking any other cardiac problem, you can develop an arrhythmia, he says.Reining in a racing heartFor patients experiencing palpitations, doctors typically try to determine whether an arrhythmia is the culprit. Doctors usually want to know if there is an underlying arrhythmia, the type of arrhythmia that they are dealing with and the danger level presented by an arrhythmia. The patient might undergo noninvasive tests such as an electrocardiogram or heart ultrasound or other procedures to assess heart strength. “People who have weak heart muscles have higher risk for having dangerous, life-threatening arrhythmias, while people that have normally functioning hearts are much less likely to have life-threatening arrhythmia,” says Dourdoufis.If a patient has a non-life-threatening arrhythmia, often all that is necessary is reassurance from the doctor, Dourdoufis says. “What I tell patients typically is, ‘You have a non-life-threatening arrhythmia. The palpitations might be bothersome for you, but they will not shorten your life; they will not cause you to have a heart attack or sudden death.’ In that situation, I’m managing a symptom, but I’m not lowering your risk of sudden death. Any medication I put you on would be just to manage the symptom.”If the patient is comfortable knowing that he or she will still have palpitations, but is not in real danger, often the reassurance is all that is needed. Other patients, while knowing that their palpitations are not life-threatening, are still very much bothered by them, feeling that they limit their activity and possibly bring about some shortness of breath or dizziness, Dourdoufis says. “At that point we start different medications. So, it’s a tiered approach,” he says, that begins with reassurance, progresses to medication if reassurance is not enough, possibly followed by – if medications fail or the patient becomes intolerant of medication side effects – more invasive procedures.If a more hazardous arrhythmia is causing palpitations, the scenario can get more complicated. The most common type of arrhythmia, atrial fibrillation, is an irregular rhythm driven from the heart’s upper chamber. “That’s initially treated with medicine,” Haugh says, “often including some medicine to reduce blood clot risk, either aspirin or Coumadin or other blood thinners.” If medication results are not satisfactory, of course, the patient’s treatment options would expand.Another form of arrhythmia that doctors often see is supraventricular arrhythmia, Haugh says, or “SVT” for short, which is akin to faulty wiring, or at least superfluous wiring. “SVT is an arrhythmia where the electricity that drives your heartbeat circles around on itself” because of an extra connection between the upper and lower heart chambers, he says. SVT is often treated with a catheter-based procedure called an ablation, which uses a specially-tipped catheter that emits radiowaves “to knock out that extra connection,” Haugh says.New technology is making some treatments more effective and safer, Haugh says, with shorter procedure times and lower complication rates, which should be welcome news to the millions of arrhythmia patients in the United States. NHBothered by the beats?Sometimes palpitations and arrhythmias are caused by a structural or mechanical problem that is present at birth, and age increases a person’s risk of abnormal heart rhythms for sure. But in terms of preventable risk, adopting heart-friendly habits like regular exercise, a good diet and effective stress management “definitely help,” says Peter Dourdoufis, DO, FACC, Atlantic Cardiology Associates in Portsmouth. Avoiding common precipitating factors, such as over-the-counter stimulants and excessive caffeine and alcohol intake, can also prompt a more soothing beat.