Counseling Sheet

I have palpitations. Is my heart going to stop?

"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 24 hour 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% 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% 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. 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 physician.

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.

In summary, most palpitations are entirely innocent and require only reassurance and exercise. Sustained irregular heart rhythm, however, should be investigated by a health professional.