Most Frequent Causes of Palpitations

1. Exercise
2. Stress
3. Anxiety or fear
4. Smoking
5. Alcohol
6. Too much coffee, tea or carbonated drinks
7. Diet pills
8. Nose decongestants
9. Inhalers for asthma
10. Anti-depressive medication
11. Certain illnesses such as anemia
12. Certain heart diseases (arrhythmia)
13. Thyroid problems
14. Menstruation
15. Lack of B vitamins
16. Low levels of blood sugar
17. Diabetes out of control

What cause is bothering you right now???

site: The Diabetes Club

The Good, the Bad, & the Ugly

Have you ever experienced heart palpitations when something exciting happens? Last night, my hubby won a major award at the Austin Chamber of Commerce Awards. He and his friend started a small company called PrimoDish and they beat out some serious competition to win the 2011 Austin Business Award for Technology in the Small Business category. I was so happy for him that my heart skipped for joy! That's the good kind of heart palpitations.

Skip to 12 hours later. After waking up still tired and then having to present a speech at my church's Annual Women's Meeting, taking care of a grumpy toddler, receiving some discouraging news about a friend, and dealing with with a nasty tension headache, I laid down on my bed only to experience a series of skipped beats. I'm sure I was in bigeminy for a minute or so before I switched positions and the palpitations diminished. Needless to say, those are the ugly kind of heart palpitations.

As Seen on The Doctors

I was flipping through the channels this afternoon and (to my delight) caught a short segment about heart palpitations on the television show The Doctors (aka America's Medical Dream Team).

They had a young woman on the show named Sarah who complained of heart palpitations along with feelings of her heart racing, being unable to catch her breath, and feeling faint without actually fainting. The young woman was visibly quite scared.

The Doctors mentioned that the woman had an underlying cause that was most likely attributing to her heart palpitations. Want to take a guess of the cause?

If you guessed Mitral Valve Prolapse, you're right! I've talked a little bit about MVP before on my blog, but here's a crash course if you can't remember. Mitral valve prolapse (MVP) occurs when the valve between your heart's left upper chamber (left atrium) and the left lower chamber (left ventricle) doesn't close properly. When the left ventricle contracts, the valve's flaps bulge (prolapse) upward or back into the atrium. Mitral (MIE-truhl) valve prolapse sometimes leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation.

Dr. John Kennedy on The Doctors, said that most likely the regurgitation was "tickling" or "irritating" Sarah's heart and thus the heart palpitations.

Sarah wore a 24 hour holter monitor and completed a 30 day event monitor for prognosis. The results were that even when she was palpitating she overall had a normal sinus rhythm. Sarah was going to be okay.

The Doctors urged her to lower her stress levels whether it be "trying a yoga class" or "reading a book."

Disclaimer: When watching The Doctors, if you are a woman, you may want to use caution when looking at Dr. Travis Stork (a former Bachelor on ABC's The Bachelor). He has been known to make a woman's heart start palpitating.

If you drink alcohol (even just a little)...

you may want to check out this article from the Metro in the UK.

By now most of us know the effects of heavy alcohol consumption on the heart, but this is the first time warnings have been attached to moderate drinking.

It's a bit tricky though when you think about consuming a glass of red wine, like I did on Valentine's Day. It's a pretty well known fact that red wine has some amazing components such as flavonoids and other antioxidants in reducing heart disease risk. And sometimes a glass of red wine may help us to relax and relieve stress. So in that way I'm at less of a risk for experiencing heart palpitations if stress is my usual culprit. My thought. If an occasional glass here or there doesn't bother you, then I think it's okay. But if even a sip gets your heart a dancin' I'd think you'd want to avoid drinking altogether. Of course, check with your doctor.

We interrupt this program...

for the BEST article on heart palpitations that I've ever read!!! No kidding. I'm so excited to share this letter from a real medical doctor. It's long but well worth it!!! (My favorite part? The comparison of PVCs to an awkward dance.)

Thank you to www.pvcgroup.webs.com for sharing it!

To Those Concerned With Heart Palpitations
(Letter from MD)

I want to start by talking about a very special part of the human anatomy that does not seem to appear in the collective messages I've reviewed; The VAGUS nerve. The vagus nerve, also referred to as the 10th cranial nerve, is appropriately termed a "mixed" nerve. It provides a sort of two-way communication of nerve impulses back and forth between the brain and the pharnyx,larynx, esophagus, stomach and associated abdominal viscera(basically, your throat, windpipe, your tummy and guts), the heart, lungs and several more complex but irrelevant body organs or functions. The vagus nerve is the longest and most complex of the cranial nerves in the body.



The key point here is to make note that this nerve involves the "heart," the "lungs" and basically the whole digestive system of your tummy and intestines. Now let's pair that with some real specific and limited physiology about the heart and its rhythm.

We also need to bring clarity to some of the medical jargon being talked about by many of you in your messages. The term PVC, or Premature Ventricular Contraction, is just one of many arrythmias and not necessarily isolated to what many term as "palpitations." When we speak of palpitations, what we really mean is the presence of "ectopic" beats(heartbeats where there should not normally be)and the precise induction of these beats is felt by us as dancing of our heart or a flutter sensation in our chest, the prominence or intensity of which is determined by the precise moment of the extrabeats in proximity to the most recent beat and the upcoming beat or contraction of the heart ventricles or atria. Think of it in relation to your memory of your worst date, where the guy you're with has no rhythm whatsoever but wants to impress you with all the right moves and clumsily tries to introduce his own dance-step into your otherwise smoothly flowing and natural pace with the music.Depending upon his rather untimely entry, he can cause awkwardness that either simply causes you to quickly pause and regain your rhythm or literally trip you repeatedly until you're forced to leave the dancefloor. Well, the same holds true for the heart in our example. The extra beat, or palpitation might come at a point that's subtle, or it might be at a point where the heart stumbles repeatedly until normal sinus rhythm is regained. Now let's get to "why" palpitations occur.

The heart has a natural pacemaker called the sinoatrial node among several less distinct and similar pacers, which is stimulated by guess which nerve? You guessed it; The VAGUS nerve.

The vagus nerve helps regulate the heart in comparison to other functions taking place with other areas and is doing its job right now in each and every one of us. In fact, the variability of your heart rate during inspiration and expiration of your lungs is an effect of the vagus nerve. We've all noticed that when we take a breath in, our heart tends to beat just a little faster and when we breath out, a little slower. It's an entirely normal bodily function and is connected to the need by the body's system to respond to the environment.

Now that we kind of have a little medical background under our belts, let's take one of the complaints by many of you regarding the proximity or timely appearance of palpatations and indigestion. Remember that we said the vagus nerve is linked to both the tummy, the throat and the heart. Let's assume that we've eaten meal and it's caused us to experience some gastrointestinal discomfort, or in other words, gas. The irregular presence and activity by your tummy and intestines stimulates, more appropriately irritates, the vagus nerve which sends a rather inappropriate signal back along the pathway to guess where? That's right! The heart. Move to the head of the class. The heart is busy pacing away regularly and is relatively unconcerned with all the food you poured into your tummy, when all of a sudden in comes a signal from the vagus nerve because it has been inappropriately stimulated and tells the heart to beat. Well, just like our bad date example, the signal to beat is rather untimely and awkward but the heart has to accept it and respond. The result is extra beats that make the heart feel like it is stumbling. The degree to which it stumbles oftentimes depends upon the extent to which the vagus nerve is irritated and the relative state of indigestion present as the causitive agent.

There is most often no pain assoicated with this occurrence because it is not the result of a lack of blood or oxygen that creates the palpatation, but rather just a simple additional electrical impulse or series of impulses. Pericardial pain, or pain adjacent to the heart, can sometimes accompany palpatations or exist exclusive of any arrythmia, but is not necessarily considered pathologic or harmful to us. Remember that we're dealing with inappropriate electrical impulses and muscle tissue other than the heart that is partially innervated by the vagus nerve and can respond inappropriately, causing a jabbing or shooting pain than many describe as a "catch" in their chest. We'll talk more about chest pain in a bit.

Let's discuss the sensation that some of you described as a warm flushing sensation of your face and perhaps other body areas that accompanies the palpitations. Recall our anatomy lesson. The vagus nerve stimulates many areas of the body in response to our environment or internal conditions caused by the outside environment, ie. a meal that produces indigestion. The vagus nerve provides all of us with a stable process called vagal tone. This tone or stability keeps us in a state of balance so to speak with our environment. In response to environmental cues or situations, that tone or stability changes to prepare for what may be required. You've probably all seen a guy that makes your heart "skip a beat." Ever wonder why that phrase ever came about? Think for a moment. If you've ever been emotionally overcome, your heart races or feels like it pounds in your chest, we begin sweating, our blood pressure rises, we feel nervous and at some point our face is overcome by a warm flushing sensation that we attribute to nervousness or embarrassment. Well, guess what nerve plays a very big role in that entire process?
Right Again!!! The VAGUS nerve.

The above scenario would be a case of increased vagal tone. Well, if there's an increase, there's likely to be a case of decreased vagal tone as well. Indeed there is. decreased vagal tone can make us weak, nauseated, tremble, and even faint. It happens in cases of being excessively startled or frightened. Other conditions, such as diabetes can cause decreased vagal tone, but for our purposes we'll stick to conditions that by what I've read from all of you are non-disease provoking conditions, with the exception of one individual with Mitral Valve Prolapse but we'll touch on that in a bit.

Anyway, the point is that our body doesn't always accurately recognize proper environmental cues and the vagus nerve doesn't always know when and how to act. In other words, it misbehaves once in a while as a result of inappropriate stimulation. All sorts of things make the vagus nerve act out, including stress, anxiety, depression, illness and even ideopathic causes(origin or cause is unknown). In fact, there is work going on right now using electrical vagus nerve stimulation to treat depression, anxiety and even seizures.

And here's a little extra for those who cough when experiencing a palpitation. Recall your anatomy lesson again. Remember we said the vagus nerve stimulate the pharnyx, larynx, bronchi and esophagus. Well, what do you know. Those are exactly the processes involved in the cough reflex. So when the vagus nerve inappropriately stimulates the heart and causes a palpitation it also stimulates in some cases the cough reflex. How about that!

So we begin to see that the cause for palpitations and the palpitation itself is not a life-threatening occurrence at all. It concerns us for several reasons. First, it has to do with our heart and hey, that's the thing that keeps us alive basically. Big concern! Secondly, we've been bombarded by all the medical revelations and awareness about heart disease. But a case for heart disease does not make for every condition the heart demonstrates, especially palpitations. If you've ever had a cramp in your hand from typing too much, it probably never gave you pause to think you might not make it, so to speak. You reason in your mind that the cramp is caused by repetition fatigue and you need to take a break, massage your hand and rest momentarily. Well, palpitations can be considered sort of a cramp and nothing more. Under stress and other factors we talked about, the vagus nerve gets irritated or fatigued and acts out. Just because the heart is affected, doesn't mean that you've got heart disease or vascular problems that are looming. They're annoying,
worrisome and even frightening, but knowing where they come from and why will help go a long way in knowing that they are non-injurous and if we respond appropriately, will subside and we can go about our lives with far less worry.

Let's touch on anxiety for a moment. Anxiety, and depression too, can definitely cause a state of dysfunction in many areas of our body. Many patients who have these disorders are exhausted from constantly presenting themselves to the medical community with real and valid symptoms of pain, fatigue, bowel problems, vision problems, tinnitus or ringing in the ears, difficulty swallowing, excessive saliva, dry mouth, sore or sensitive tongue, and many many more troublesome circumstances only to have repeated tests all return normal. How can that possibly be?!! It's there, we feel it, we experience it, we hate it. Why doesn't the test confirm that it's there? How frustrating is that????

Well, here's some news that should make you feel a bit less frustrated and even comfort you. Most all tests are based upon the algorithmic, or sequential processing, of certain symptoms and signs that are all conclusive of various disease and illness. When someone with anxiety, depression or other condition that has somatic features (felt physically)undergoes these tests, the components that underlie the actual diseases which have similar symptoms simply does not add up and no presence of the actual disease is evident. So it's a case of false identity, sort of like having a biopsy of a mole that turns out to be benign. Looks like cancer, but is not cancer. Well, that same thing can happen to us with regard to all sorts of disorders and diseases. They look similar in presentation, but one reveals true disease and the other a nonpathologic condition or illness. So the next time your doctor tells you he can't find anything wrong, be glad for that much at least. Many people get far worse news!

So with regard to depression and anxiety, these conditions impart disturbance upon body functions. I suppose you're already guessing that the vagus nerve is not exempt from those circumstances and you're exactly right. So when you have an episode of anxiety, rest easy when you have a palpitation or two, or three or even four. The vagus nerve is irritated and needs a break or to reset. No problem whatsoever and you needn't worry any longer that a palpitation is sure indication of worse things to come. Nothing else happens. Just an extra heartbeat or two where there should not normally be. What a relief!!!!!

And the caveat I promised to the one individual with Mitral Valve Prolapse, your heart condition, while not necessarily life-threatening at all, does predispose you to panic disorder which I'm sure you are probably already aware.

Okay, so now we know what these palpitations are and what causes them. What the heck do we do about th'em? Well, there are several techniques that can help. Firstly, let me say that if a run of palpitations makes you feel faint or weak, don't panic and try to make it somewhere less embarrassing. Be safe and think smart. Squat to your knees or sit down until the feeling subsides. No sense in cracking open your skull by trying to make a mad dash for privacy. Anyone can feel faint and people in your company will always rally to your aid more often than not. So relax. The conditions will quickly pass and you'll be back to yourself in a jiffy.

Secondly, if you sense indigestion and gas, discomfort and bloating when the palpitations are present, try merely changing positions which often causes the distention to realign from its offending position proximal to the vagus nerve.

If you're pregnant, well indigestion or gestation. It doesn't matter. What's important to realize is that both conditions represent a temporary rearrangement and limited space downstairs. That means proximity or closeness to the nerve receptors of the VAGUS nerve and you're going to get palpitations when conditions are right.

As for the palpitations themselves, taking slow, deep breaths repeatedly will typically cause the palpitations to cease. Recall your anatomy lesson. The vagus nerve stimulates the lungs as well as the heart, so this purposeful stimulating of intention-breathing will often interrupt the irritation signal.

If you're experiencing tachycardia(racing heart), then if a fountain or bathroom is nearby, apply cold water from your hands to your face and while holding your hands against your face, press gently, repeat GENTLY, on your eyes. This will invoke what is termed the "dive reflex" and will cause your heart rate to decrease in most cases. Regardless, tachycardia, like palpitations is not harmful in of itself, just a bit unnerving.

The key in all cases is to do your best to remain calm and rational. Know from our little lesson what it actually taking place and that you'll be fine.

Finally, we'll save a lot of space here by simply stating that with regard to any of the conditions either described or that you're experiencing, do not substitute a support group for responsible notification of your symptoms to your personal primary care doctor. We live in an age where medicine is oftentimes scoffed at by many who fail to realize the benefits they expect. Yes, it's true that medicine is not a perfect science, but neither are human beings. It is difficult at best to create perfection from imperfection. But even so, we all must give recognition that many thousands of people are being cured of certain cancers that just a decade ago would have meant their demise. Simple penicillin saves hundreds of thousands in third world countries that would otherwise perish from infection.

So don't become discouraged that medicine doesn't find something wrong with you. Feel blessed that they don't have less encouraging news for you. I exist in an occupational environment where disease and illness is very concentrated. It is of great joy and optimism that I can walk from conditions such as those to the sanctuary of my private life and know that I'll return tomorrow.

You too, all of you, need to be thankful that your condition is benign and that you have the power of influence over its effects.

So kick up your heel, give a shout, grab the keys and your husband's credit cards with the highest limit and PREPARE TO SHOP! Those pesky palpitations are but a mere nuisance and you have the rest of your life to live, so get busy and do the voodoo that you do best!

best regards and good health. Feel free to write if you care to and I'll do my best to answer, but no promises.

and this is for all the attorneys circling overhead who strive for a willing plaintiff, or even an unwilling one.

THIS COMMUNICATION REPRESENTS OPINION BASED UPON MEDICAL FACTS AND IS IN NO WAY INTENDED TO REPLACE OR SUPPLANT THE NEED FOR PERSONS TO DIRECT THEIR MEDICAL NEEDS AND INQUIRY TO THEIR PERSONAL FAMILY DOCTOR REGARDING THEIR HEALTH.

Broken Record

Although I was born in 1980, I do have many memories of listening to music on LP records. And with the ballads of Patsy Cline or the rock of Sgt. Pepper's Lonely Hearts Club Band, came the inevitable popping sound as the needle met a scratch mark. If the needle jumped outward to the groove it just finished playing, it would repeat in an infinite loop, serving as the simile for things that continuously repeat ("like a broken record"). Sometimes I feel like my heart palpitations are like this "broken record." It's like for whatever reason, the pacemaker hits a groove and gets stuck. So my heart will be dancing in a perfect beat, and then the stressors of life scratch my vinyl heart. The pacemaker tries to make up for the missed beats and jumps ahead. And if I don't relax, my heart will start skipping in an infinite loop. Then I get up and take action (just like I did when I had to pick up the record player's needle and manually move it forward) such as deep breathing or a brisk walk, and then my heart goes back to its steady beat.

Oldie But Goldie by Dr. Gott

The Nevada Daily (Feb. 18, 1991)

Click on the article to read the full article

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.

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

MVP & PVCs

All these abbreviations are starting to make me loopy. Ha!

I recently returned to a support group that I was a member of many years a go when I was still learning how to cope with my palpitations. Over 10 years a go, after finally getting up the courage to see a cardiologist, I was diagnosed with Mitral Valve Prolapse (MVP) after a routine cardiac ECHO (aka cardiac ultrasound). MVP is an abnormality of the mitral valve leaflets, or supporting chords. It is a well-recognized, clinical entity with a reported prevalence of 4% to 18%. MVP is frequently associated with a myriad of symptoms. The term MVP syndrome refers to the occurrence of symptoms unexplainable on the basis of the valvular abnormality. (That always seemed strange to me.) Common symptoms include: chest pain, fatigue, palpitations, lightheadedness, shortness of breath, anxiety/panic attacks, headaches, low exercise tolerance, and mood swings. Hello, all of the above, ME! I was glad to get a name for what I was experiencing and even more glad to find out that it wasn't suppose to kill me. I knew early on that my valve was floppy but my doctor didn't think I would ever have to have valve replacement surgery. The doctor just mumbled something about taking antibiotics before going to the dentist. I joined mvpsupport.com soon afterward and participated with others like me who had been diagnosed with MVP and its strange symptoms. The woman who started the support group, Lorelei, was a long time sufferer and had even written a book on the syndrome. For awhile, the support group had been a life line for me but eventually I felt like I no longer needed as much help and I gradually stopped coming to the site. A few years a go, I switched cardiologists and after doing another cardiac ultrasound, he determined that it looked like I didn't even have MVP! I didn't understand how at one time I had it and now I didn't. Also, if I didn't have MVP why did I have all its classic symptoms? Fast forward to today. I stumbled upon my old support group website today--only it looked very different. The moderator and creator, Lorelei, had left an important message.

Here is an excerpt of what she had written:

Times are changing; technologies are changing -- it's not surprising to find our health affected by these changes.

My journey with Mitral Valve Prolapse began 18 years ago, and in that time I've had multiple visits with cardiologists and had multiple echocardiograms confirming my diagnosis. Fast-forward all these years later and now cardiologists have more advanced machines and improved knowledge about the heart. I was just told that I actually do not have Mitral Valve Prolapse afterall.

Did I ever have it? Who knows. Or maybe it's just so mild that it's not labeled as Mitral Valve Prolapse, since only those patients who have severe prolapse are now considered to have the condition. Any case that's less severe is "not something to worry about," I'm told. I asked my cardiologist, "When you say my echocardiogram was 'normal', do you mean that the MVP is just so mild that it's nothing to worry about? Or do you mean there's nothing there at all?" Her response was that everyone's valve leaks to some degree, and it's perfectly normal. Not really an answer to my question, but the end result is the same: I don't have Mitral Valve Prolapse.
Here is So where does this leave me?

I've written a book about my experience with MVP; I've been running this web site for 13 years; I've provided this online support group for years as well. What service am I providing to all of you -- how can I be of any use -- if I don't even have the condition myself? My motivation is now gone. For this reason, I'm stepping down from my MVP soap-box.

What does this mean for you, you may be asking? Well, for starters, I will be taking down my web site. However, the message boards will remain. Too many of you have found a "home" here and I don't want to take that away.

--Lorelei

Too many people had found a home! Did you catch that? There are so many people out there like me that have had this strange diagnosis and felt the effects of its mysterious syndrome. There are a lot of confused souls out there who have heart palpitations and fatigue and anxiety and no proper diagnosis. You would think that if it is true and technology is more advanced and doctors know more about the heart then we would know more about why we suffer with real physiological (read--not psychological, as some would like us to believe) symptoms. I hope one day science and medicine will get to the bottom of this strange and complex disease.

What Causes Heart Palpitations?

Here is a list of possible causes:

* Ischemia (restriction of blood supply)
* Certain medicines such as digoxin, which increases heart contraction
* Myocarditis (inflammation of heart muscle)
* Cardiomyopathy (heart muscles disease)
* Myocardial contusion (v-fib)
* Hypoxia (deprivation of oxygen)
* Hypercapnia (CO2 poisoning)
* Mitral valve prolapse
* Smoking
* Alcohol
* Drugs such as cocaine
* Caffeine
* Tricyclic antidepressants
* Magnesium and potassium deficiency
* Calcium excess
* Thyroid problems
* Chemical (electrolyte) problems in the blood
* Heart attack
* Adrenaline excess
* Lack of sleep/exhaustion (aka having a newborn-ha!)
* Stress

Remember, if you have occasional extra beats, but you are an otherwise healthy person, there's generally no reason for concern, and no treatment is needed. If you have frequent symptoms or you have underlying heart disease, you may need treatment to help you feel better and treat underlying heart problems.

A Little Clarification

When people say they are experiencing heart palpitations it can mean many different things. Some people (my mom for example) think of palpitations as feeling as if your heart is pounding or racing (tachycardia). You may simply have an unpleasant awareness of your own heartbeat. When I refer to heart palpitations in my blog, I'm usually referring to a sensation of a skipped or stopped beats. Sometimes they feel like a flip-flop or a flutter. Of course, your heart does not stop. A premature ventricular contraction (PVC) or a premature atrial contraction (PAC) is simply the heart's ventricle or atrium prematurely contracting before the normal electrical discharges arrive from the SA node (or pacemaker of the heart). Immediately after a premature contraction, the electrical system of the heart resets. This resetting causes a brief pause in heartbeat (as the heart refills with blood). It's usually the normal after beat (and sometimes it can feel very strong) that one feels and not the actual pause. Also, it may be useful to note that it is very hard to distinguish a PVC or PAC unless a trained technician is watching your heart palpitations on an EKG. Some people claim they can tell a difference between the sensations of a PVC or PAC, but I generally cannot.

The intensity and frequency of my PVCs differ greatly. Sometimes I feel single mild misbeats. These I have learned to live with. Other times, I will have one really strong one that I can feel in my chest, throat, or neck. These sometimes make me feel a bit queasy or short of breath. A lot of times, these intense single palpitations cause me to panic causing my adrenaline to surge and my heart to race (but I attribute this to the anxiety and not the actual palpitation). Sometimes, I go into bigeminy where one PVC occurs after every normal beat, in an alternating pattern, or trigeminy where one PVC occurs after every two normal beats. These have usually only occurred when I was dealing with a major life stressor (like a loss of a job or continual lack of sleep). Going into bigeminy or trigeminy is no fun for me. But supposedly there are thousands of people (especially older people) that experience bigeminy and trigeminy on a daily basis and can't even feel them! There is no prognostic difference between the PVCs that are felt by the patient and those that are not. Obviously the symptomatic PVCs are of more concern to the patient because they can be annoying and distracting. Beyond that, the PVCs are all the same, prognostically. In most patients who are otherwise healthy, PVCs on a Holter are of little prognostic value regardless of whether they're experienced or not.

And the million dollar question? How many is too many heart palpitations? According to a Cleveland Clinic doctor, generally in a normal heart there is no "maximum limit" to PVCs; although in someone with underlying heart disease, doctors are somewhat more concerned if they are occurring more that 6 times a minute.