Readers Wednesday

This is a call to anyone who reads this blog and would like to share about their own experience with heart palpitations.

How long have you had them?
Do you have any tips for long time sufferers?
What do you do when you get a bad case?

I would looove to hear back from any of you!

Remission

Many people that have chronically suffered with heart palpitations know that for whatever reason sometimes we get a break and don't suffer from them as much. Some people say they had them for several years straight after a stressful event in their lives. Then they go away, only to return many years later. I've never been fortunate not to have been bothered by them for years at a time, but I definitely have weeks and months where I won't have any sensation of them. Right now I'm in my brief remission. It could be because I'm currently taking pretty good care of myself with exercise and healthy eating. Or I could attribute it to finding my groove with motherhood and still finding time to do things I enjoy. Whatever it is, I'm reveling it. I'm accepting this time of remission with joy but not expecting it to continue indefinitely. One day (hopefully not too soon), life is going to throw me a curve ball. And most likely my body will respond with palpitations. But "the dance in my heart" is always a good indicator that I need to slow down and relax. And the cycles of arrhythmia and remission will repeat itself. I have learned to take solace in the knowledge that whatever discomfort I may be feeling, one day soon the palpitations will pass.

Pregnancy and PVCs

Many women have their first episodes of heart palpitations during pregnancy. This is understandable in that the state of pregnancy causes significant shifts in blood volume (which peaks at 28-32 weeks) and also puts a new stress on the heart that may bring out a tendency for rapid heart action that was not manifest prior to pregnancy. The stroke volume of the heart increases and under the influence of progesterone, the heart can beat irregularly occasionally. After the pregnancy, the patient may not experience palpitations or may begin to see palpitations occur under other stressful circumstances. There certainly doesn't need to be anything wrong with the heart in order for palpitations to occur during pregnancy. But of course, if the palpitations are accompanied with dizziness or shortness of breath, or if the mother has had some history of cardiac problems, she should be seen right away.

My experience? I was sooo nervous about getting pregnant because I feared what it might do to my heart. I got myself so worked up with anxiety that the first trimester was a real nightmare. In fact, I experienced quite a few scary episodes at night while I was asleep. I went and saw my electrophysiologist and I wore a holter monitor for the rest of my first trimester. So if you do experience palpitations during your pregnancy, be sure to mention it to your doctor because they might also want you to wear a holter monitor. I think wearing it gave me reassurance and peace of mind because I don't think I ever experienced nighttime arrhythmia the rest of my pregnancy. As my pregnancy progressed I do remember experiencing the occasional flip-flop but no more or less than my non-pregnant state. And through contractions, drugs, epidural, and pushing (for 3 hours!), my ticker was fine. I was a little nervous about postpartum because I was physically and emotionally exhausted, but at that time, my heart was just doing a happy dance. I was so proud of myself for giving birth to the most beautiful little girl. And the things that I feared (not getting enough sleep, dealing with a newborn, etc.) weren't even an issue when given the privilege of taking care of one of God's children.

Female's Heartbeat with PVCs after energy drinks and coffee

And to keep with yesterday's topic about drinking too much caffeine, check out this crazy YouTube video. Make sure you turn up the volume pretty loud so you can hear her heartbeat. I hope she lays off the energy drinks in the future.

Signore Antonio Maria Valsalva

I love that I have the emotional and fiery temperament of an Italian. Of course, my husband loves to point out that I'm really only one quarter Italian, but in my eyes, I'm 100%. Perhaps my personality makes it so I have more run ins with palpitations than the chillaxed kind of person.

But Dr. Gary Francis, director of the coronary intensive care unit at the Cleveland Clinic Foundation, thinks that the solution to relieving palpitations may be in doing a maneuver that was developed by none other than an Italian.

Forcible exhalation against a closed airway was originally described as a method for inflating the Eustachian tube, and its diagnostic use has been attributed to Antonio Maria Valsalva (b. 1666- d.1723). Francis says that a similar move may help in derailing palpitations. Dr. Francis says that the next time you start experiencing heart palpitations you may want to try the Valsalva's maneuver. Pinch your nose and close your mouth. Then blow out while keeping your nose and mouth shut. The built-up pressure in your nose and mouth can force your heart back into its normal rhythm.

Hey, it's worth a try. Grazie Antonio!


[Precautions: The Valsalva maneuver should not be performed by patients who have severe coronary artery disease , have experienced recent heart attack, or have a moderate to severe reduction in blood volume.]

Cough It Up

If your drum isn't giving you a steady beat, start coughing. Cough during your next heart palpitation episode. The force of the cough will sometimes get a heart back on its regular track, says Robert March, M.D., associate professor of cardiovascular surgery at St. Luke's Medical Center in Chicago. A good cough can break the pattern of the palpitation.

[I know that I instinctively start to cough when I start to experience them. My husband always knows when I'm getting them because I'll start coughing abruptly. And forget about having time to cover my mouth with my sleeve. Ha!]

Please don't confuse this with "cough CPR" or the attempt of a conscious person to forcefully start coughing to maintain blood flow to the brain during a heart attack. Coughing to alleviate heart palpitations is only recommended during brief arrhythmia.

From the American Heart Association website (http://www.americanheart.org/presenter.jhtml?identifier=4535):

The American Heart Association does not endorse "cough CPR," a coughing procedure widely publicized on the Internet. As noted in the 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, the American Heart Association DOES NOT TEACH THIS AS PART OF THE CORE CURRICULUM IN ANY COURSE.

During a sudden arrhythmia (abnormal heart rhythm), it may be possible for a conscious, responsive person to cough forcefully and maintain enough blood flow to the brain to remain conscious for a few seconds until the arrhythmia disappears or is treated. Blood flow is maintained by increased pressure in the chest that occurs during forceful coughs. This has been mislabeled "cough CPR," although it's not a form of traditional resuscitation.

Why isn't "cough CPR" appropriate in CPR training courses?

"Cough CPR" should not be routinely taught in lay-rescuer CPR courses, because it would complicate teaching traditional CPR. It would add information that's not generally useful in the prehospital setting. In virtually all lay-rescuer CPR courses, the finding that signals an emergency is the victim's unresponsiveness. This signals the rescuer to begin the "A, B, C's" of CPR. Unresponsive victims will not be able to perform "cough CPR."

Are there situations when "cough CPR" is appropriate?

This coughing technique to maintain blood flow during brief arrhythmias has been useful in the hospital, particularly during cardiac catheterization. In such cases the patient's ECG is monitored continuously, and a physician is present.

During cardiac catheterization, patients may develop sudden arrhythmias. If a life-threatening arrhythmia is detected within the first 10 to 15 seconds and before the patient loses consciousness, a physician or nurse may tell the patient to cough. Repeated, forceful coughing can help the person stay conscious until the arrhythmia disappears or is treated.

Therefore, the usefulness of "cough CPR" is generally limited to monitored patients with a witnessed arrest in the hospital setting.

AHA Recommendation

The best strategy is to be aware of the early warning signs for heart attack and cardiac arrest and respond to them by calling 9-1-1. If you're driving alone and you start having severe chest pain or discomfort that starts to spread into your arm and up into your jaw (the scenario presented in the Internet article), pull over and flag down another motorist for help or phone 9-1-1 on a cellular telephone.

Drinking for Life

One of the first things you'll hear when your doctor diagnoses you with heart palpitations is to cut out all caffeine. Some people even claim once they cut out coffee, they never had any heart problems again. I had never been a huge coffee or Coke drinker so I knew I couldn't blame caffeine on all my heart palpitations, but I knew it contributed to some. I remember when I was in college, I loved getting a cafe au lait from a local coffee shop. Well, it took one night of experiencing the dance in my heart and I swore I would never drink coffee again. And I haven't. I also try to stay away from soft drinks but I do sip an occasional one for special occasions. But my rules are never drink a Coke when I'm experiencing high levels of stress or late at night. We were in the midst of packing up our apartment and moving into our first home and we knew it was going to be a long night before we had everything ready for the movers. I remember it was a little after midnight, I was worn out from teaching that day, and I thought it would be a good idea to get a little energy boost by drinking a Coke. I guzzled it down and no sooner had I just put the empty can down when my heart paused and let out a hard THUMP. I was tired, I was stressed, and I had just consumed caffeine. Not a good combination.

Another thing that is usually recommended is to eliminate alcohol. I try to limit my alcohol consumption to a small glass of red wine (since it's suppose to be good for your heart) once a week or so. I also like to reward myself for working out and staying healthy with an occasional mixed drink. But that's all. Of course, if you notice heart palpitations after drinking alcohol, put the drinks away.

Previously I mentioned that one of the things I do when I start getting palpitations is to immediately drink a glass of water. A lot of times we are dehydrated and don't even know it. And you've heard it time after time, but I'll repeat it. Make sure you are getting the recommended amounts of water every day, especially in the summer. "Eight 8-ounce glasses of water a day" is a good rule of thumb.

Alternatives to water? While sugar IS something you want to minimize, I would choose small amounts of natural sugar any day, over foods sweetened with high fructose corny syrup or artificial sweeteners like aspartame, saccharin and sucralose (Equal, Nutrasweet, Sweetn'Low, Splenda, etc). The following are some healthy alternatives to water. If you have other suggestions, let me know, as I love trying new healthy drinks.

-Water with lime or lemon or cucumber.
-Decaffeinated hot or iced tea with honey, agave nectar, or lemon
-Green teas (even if you choose decaf you'll still experience some of the healthy antioxidant benefits)
-Smoothies: My favorite recipe is very simple. 1/4 cup apple juice, 1/4 cup water, 1/4 cup blueberries (or other favorite fruit), 1 scoop (10 mg) whey protein powder (vanilla flavored). Blend together and enjoy. This is a perfect snack because it contains 1 block of protein and 1 block of carbohydrates.
-Vegetable juices (Hey Mom, my taste buds are finally tolerating these!)
-Fruit juices (but I always dilute them with at least 50% water)
-Fizzy water (or in Italy it's known as "con fizz") such as Pellegrino