The "Beat" And What Happens when it Falters?

BFP Magazine

Cardio-vascular Health

Heart Disease, Palpitations

The "Beat" And What Happens when it Falters?

By Dr. W. Gifford Jones

July 11, 1999

Have you ever felt your heart skip a beat? And then worry it's associated with heart disease? During a normal lifetime the heart beats 2.5 billion times. But sometimes the heart rate slows, races, becomes irregular or has episodes of palpitations. What causes these changes? And when should you consult your doctor?

The majority of people are rarely aware of the beating of their heart. But suddenly a rhythm disturbance occurs and all else is put aside. You listen intensely to the beat of your own heart.

Studies show that concern about palpitations is one of the prime reasons for consulting the doctor. Or for a speedy visit to the emergency department.

Most people describe palpitations as "skipped beats". Or they have the feeling of an "extra beat". Other patients tell of the sensation that their heart stops, starts up, pounds, jumps or races. Still others say their heart beat is irregular, rapid or that there is a fluttering sensation in the chest.

What are palpitations? The heart, for normal functioning, is dependent on electrical impulses. Each beat is stimulated electrically in the upper chamber of the heart known as the atrium. This signal then travels through a part of the heart known as the atrial©ventricular node (AV node).

It then enters the lower half of the heart, the two ventricles, which then pump blood to the lungs and the rest of the body.

But sometimes these electrical impulses get short©circuited and bypass normal pathways. This causes either an irregular rhythm or a rapid heart rate.

"Sinus tachycardia" is the term applied to the most common cause of a rapid heart rate. Emotion, exercise, lack of oxygen, hyperthyroidism and infections can cause this condition. Patients may be aware of a fast heart rate or forceful throbbing in the chest.

Sinus tachycardia does not start and stop suddenly. Rather, it comes on gradually and tapers off once the cause of the tachycardia is removed.

"Paroxysmal tachycardia", on the other hand, starts like a 100 meter racer and falters just as quickly.

Ô 0*0*0* A variety of drugs can cause the heart to race. Drugs to treat asthma that cause dilation of the airway and nasal decongestants can trigger a racing beat. Tobacco, cocaine, caffeine in coffee and tea have been associated with rapid heart beat.

Emotion has a major effect on cardiac rate. Anyone who has been concerned about passing a final examination has experienced tachycardia when the adrenal gland pumps out extra adrenaline.

But are palpitations or tachycardia a sign of heart disease? These symptoms do not in themselves indicate that heart disease is present. Nor are they always related to a particular type of rhythm disturbance.

In a small number of patients an irregular heart rate may indicate an underlying cardiac problem. And it may increase the risk of coronary attack or stroke.

So what should you do if you become aware of an abnormal heart rate? Take note of whether the heartbeat is fast, slow, or irregular. And whether the onset was sudden or slow, of short or long duration, and whether it was associated with physical activity. This information can provide diagnostic help to your doctor.

If your heart skips a beat now and then it's usually not an emergency. But be sure to mention this to your doctor during a routine checkup.

But when an irregular heart rate is combined with frequent episodes of palpitations, rapid heart rate, fluttering in the chest, dizziness and shortness of breath, don't hesitate to seek medical attention.

It's also prudent to seek immediate attention if you have already been diagnosed with a heart problem, suffer from hypertension, diabetes, high cholesterol or have a family history of coronary disease or stroke.

To pinpoint the diagnosis doctors request an electrocardiogram. It may also be necessary for the patient to wear a 24©hour cardiac monitoring device called a Holter monitor to determine the cause of the cardiac irregularity.

How palpitations and irregular rhythms are treated depends on the cause. Sometimes all that is necessary is to reassure the patient that there's no serious heart trouble present.

Other patients may need drugs called beta©blockers, digoxin or calcium channel blockers to help regulate the heart's rhythm. And if you're still smoking, drinking 10 cups of coffee a day and overweight these habits have to be eliminated. A healthy lifestyle will often ensure that the "beat" goes on and on 2.5 billion times.

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: He can be reached at

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