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Heartbeat Irregularities

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  • What Your Symptom Is Telling You
As any musician can tell you, every band or orchestra needs a good rhythm section to lay down a solid beat and keep good time. If any of the players are out of tempo or rhythm, the entire band can rush ahead, lag behind or just plain fall apart mid-tune.

You can think of the heart as a little five-piece combo: two upper chambers (the atria) pump incoming blood over to two lower chambers (the ventricles), which pump it back out to the lungs and body. Instead of a drummer, a built-in pacemaker called the sinus node keeps the upper and lower chambers moving and grooving by sending out tiny electrical signals. But if something should disrupt those impulses, the heart's rhythms become inconsistent. If it's abnormally slow—below 60 beats per minute—doctors call it bradycardia. And if it's abnormally fast—over 100 beats per minute—they call it tachycardia.

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Cardiologists call these disturbances in normal heart rhythms arrhythmias, and they can originate anywhere in the electrical pathway from the sinus node to the atria to the ventricles. Sometimes these disturbances are brief, sometimes sustained. Some can be alarming; others pass unnoticed.

"Many arrhythmias arise from external factors such as tobacco, stimulants, illegal drugs and certain medications," says Mark E. Josephson, M.D., professor of medicine at Harvard Medical School and director of Harvard-Thorndike Electrophysiology Institute and Arrhythmia Services at Beth Israel Hospital in Boston. "Some are associated with serious underlying conditions such as thyroid disease, anemia, coronary heart disease or heart failure. But a great many are simply normal occurrences in healthy hearts while sleeping, exercising or undergoing stress or emotion."

When a drummer misses a beat or two or the band plays a bit too loudly, you may not notice or even care. The same is true with heart palpitations—a sensation that the heart is pounding, skipping a beat or throwing in extra beats.

"Palpitations are just electrical misfires, often anxiety or stress-related, that everyone experiences from time to time, and unless they occur with great frequency, they are often harmless and insignificant," says Lou-Anne Beauregard, M.D., assistant professor of medicine at Cooper Hospital/University Medical Center in Camden, New Jersey.

WHEN TO SEE YOUR DOCTOR
You experience skipped beats, extra beats, flip-flops or pounding of the heart several times a week or more.
Your heart fluctuates wildly from less than 50 beats to more than 100 beats per minute.
See your doctor immediately if your heartbeat takes off chaotically at rates well above 100 beats per minute when you're not even exerting yourself.

Physicians are more concerned with other arrhythmias, such as those that originate in the upper portions of the heart. A "sick" or malfunctioning sinus node can produce bradycardias, tachycardias or alternate between the two. An atrium can take off in brief but regular discharges of 200 beats per minute—a condition known as paroxysmal supra-ventricular tachycardias (PSVT). Or it can go into fibrillation—an even faster, disorganized firing from multiple sites in the atrium. This broad class of tachycardias (rapid heart rhythms), which arise from the upper chamber of the heart, are known as supra-ventricular arrhythmias.

"Supra-ventricular arrhythmias are common, treatable and usually benign," says Jeremy Ruskin, M.D., director of the Cardiac Arrhythmia Service at Massachusetts General Hospital in Boston. Occasionally, people with serious heart disease experience supra-ventricular arrhythmias, which can (rarely) degenerate into life-threatening arrhythmias, he says. These life-threatening arrhythmias are those occurring in the ventricles. Ventricular tachycardias can flutter and flap at speeds well over 200 beats per minute and are almost always indicative of underlying heart disease. If the ventricle should fibrillate, the beats become so chaotic that the heart loses all effectiveness and shuts down. Ventricular fibrillation is the leading cause of sudden death in America.

  •  
    Symptom Relief
Keep in mind that the normal heartbeat range is 60 to 100 beats per minute, with some dips into the 40s and 50s being common for well-conditioned athletes. And anytime you find your heart doing the cha-cha when it should be playing a waltz, it's wise to see a doctor to confirm that there's no serious problem. Here are a few things to be aware of.
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Find a distraction. Don't obsess over palpitations; find something to get them off your mind. You're more likely to notice and become anxious over them when you're alone and doing nothing, according to Dr. Beauregard. "People lying awake in bed often have an enhanced awareness, which increases as they absorb themselves in their own heartbeats," she says. Read a book; watch TV. Any new focus will do.
Check your medicine cabinet. The wrong dosage of medication can make your pulse rise or fall suddenly. So can certain over-the-counter products like antihistamines and asthma relievers. But if you are taking heart medication, the change in pulse may well be the desired result. Check with a doctor to see if you should halt, change or maintain your medication.
Cut back on your caffeine. Too many cups of coffee in the morning may lead to palpitations or tachycardias in the afternoon. Limit your intake of all caffeine beverages: coffee, tea and colas.
Practice good clean living. Tobacco and alcohol may not stunt your growth, but they can cause some crazy tachycardias and should be avoided, says Dr. Josephson. And stay away from illegal drugs. "Cocaine and marijuana users are frequent visitors to the emergency room with cases of erratic heartbeats," he adds.
Ask about anti-arrhythmic drugs. Your doctor can tell you whether you need drugs for bothersome heart palpitations. Commonly prescribed medications for managing atrial and/or ventricular tachycardias include quinidine, procainamide, digitalis drugs and beta blockers.
Hire a new drummer. The most effective means of controlling irregular heartbeat is by surgically implanting an artificial pacemaker, which takes over for the sinus node. These devices may be used as permanent or temporary measures to correct the rhythm.

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