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PalpitationsOverview The heart is a two stage electrical pump. The upper chambers of the heart, the atria, (single=atrium) collect blood from the body and pump it into the lower chambers, or ventricles. There is a little delay for the ventricles to fill, and then they pump the blood back to the body. For this to happen in a coordinated fashion, the heart has its own electrical system Specialized electrical cells imbedded into part of the muscles in the atrium generate the electricity and act as a pacemaker for the heart. About 60-80 times a minute; this pacemaker (the sinoatrial or SA node) fires and sends electrical signals to all of the atrial muscle cells allowing them to fire at once, generating the first half of a heart beat. Electricity also travels to the ventricles but is held up for a split second in the junction between the atrium and ventricle at the atrio-ventricular node to allow the ventricles to fill with blood. Then the signal travels through electrical bundles to allow all the muscle cells of the ventricles to fire at once, causing the second half of the heart beat, and pumping blood to the body. There is then another split second when the electrical system resets itself to get ready for the next electrical impulse and heart beat. Palpitations occur when a person can feel abnormalities in the normal beating of the heart. These palpitations can be an isolated extra beat, or they can run together and last for prolonged periods of time. Each part of the heart has the potential to be irritable and cause an extra beat to occur. As well, short circuits in the electrical conduction system of the heart can cause "runs" of abnormal firing. Every muscle cell in the heart has the potential to generate an electrical signal that can spread outside the normal electrical pathways and bundles to try to generate a heart beat. If the SA node fails, then other cells in the atrium try to take over. If they fail, then the AV node can take over but at a lower rate of about 40 beats per minute. And as the final backup, the ventricle itself can generate electricity but at a much slower rate of about 20 beats per minute. Types of Palpitations Almost everybody has extra heart beats, and most people are unaware that they occur. Every muscle cell in the heart has the potential to generate an electrical signal that can spread outside the normal electrical pathways and bundles to try to generate a heart beat. Many extra beats are normal variants and can be nothing more than an occasional irritant, but others can be dangerous - either acutely or chronic. Extra beats that originate in the atrium tend not to be as serious as those that come from the ventricle. One way of classifying extra beats is to decide if they are happening occasionally or if they are clustered in runs. PACs and PVCs Premature atrial contractions (PAC) are just as the name describes. The pacemaker or SA node in the atrium decides to send a signal out before the heart is quite ready, and while it conducts normally and the heart beats, it is felt as a slight flop in the chest. A similar situation can occur with the ventricle if it becomes a little irritable and generates an extra beat, or premature ventricular contractions (PVC). This beat fires the ventricle when there is little blood in the heart to pump, and again a flop or thump can be felt by the patient. PACs and PVCs in isolation are a normal variant. Supraventricular Tachycardia (SVT) If the electrical system in the atrium becomes irritable, it can cause the upper chamber to beat very fast, 150 beats or more per minute. The AV node senses each beat and sends it to the ventricle which itself responds with a beat. Because the electricity is generated above the ventricle and then passed down, the whole group of disorders is classified as supraventricular tachycardia (supra= above, tachy=fast). Some supraventricular tachycardias are normal response to situations. In times of stress, when the body wants to send more blood and oxygen to the body, like with exercise, trauma or illness, the heart rate rises in response to adrenalin that is secreted by the body to meet its physiologic demand. Because all the beats come from the SA node, this is called sinus tachycardia. Some supraventricular tachycardias occur because of short circuits in the electrical conducting pathways in the atrium and cause the heart to beat fast without apparent cause. Paroxysmal supraventricular tachycardias (PSVT) occurs without warning and may last for seconds to hours. Specific types of paroxysmal supraventricular tachycardias have been identified because of recognized inborn wiring errors. One such type is Wolfe-Parkinson-White syndrome (WPW syndrome). For more please read the Spraventricular Tachycardia article. Atrial Fibrillation and Flutter Atrial fibrillation and atrial flutter occur when all the cells of the atrium start acting like pacemakers, and this barrage of electricity does not allow the atrium to have an organized contraction. Instead, it jiggles like a bowl of jello. Many of these electrical signals are passed on erratically by the AV node to the ventricle, and it tries to respond as best as possible, leading to a rapid, irregular heart rate. There are a couple of complications with this rhythm. Since the atrium does not get a unified electrical signal, it does not pump. This allows blood to settle in the crevices of the atrium, and blood clots can form. They, in turn, can break away and travel in the bloodstream to block the circulation at other sites, causing strokes and other vascular problems. Moreover, without the atrium beating, blood flows by gravity into the ventricles and approximately 15% of the heart's ability to pump blood to the rest of the body is lost. For more, please read the Atrial Fibrillation and Atrial Flutter articles. Ventricular Tachycardia and Fibrillation Ventricular tachycardia (V Tach) is a potential life threatening situation where the ventricle starts firing quickly on its own. When people have coronary artery disease, the heart muscle can lack enough blood supply and become irritable. The electrical system doesn't tolerate this well and causes this abnormal heart rhythm. This rhythm may or may not allow the ventricle to beat in an organized way. Ventricular fibrillation (V Fib) is not compatible with life since the ventricle has lost its ability to beat in an organized fashion and cannot pump blood to the body. This rhythm is what often causes sudden death after a heart attack. Causes The heart needs its normal environment to work well. If there are changes within or outside of the body, the heart's electrical system can be affected. From within the body, abnormal levels of electrolytes like potassium, magnesium, and calcium can cause palpitations. Anaemia and hyperthyroidism are also a potential causes of palpitations. We live in a very chemical world, and many of the substances we put into our body appear to be adrenalin to the heart, and thus makes it irritable. Common stimulants include: caffeine, tobacco, alcohol, over the counter medications: pseudoephedrine found in cold preparations and some herbal medications, including ma huang illicit drugs, cocaine being the most prevalent, although PCP and marijuana, among others, can cause palpitations as well. The use of some prescription medications needs to be monitored, since their side effects can cause palpitations. Asthma medications like albuterol inhalers or theophylline and thyroid replacement medications are common causes of palpitations. Times of stress can increase adrenalin levels in the body and cause rapid heart beats. These are physiologic and may be due to exercise, illness, or emotional stressors. Specific types of palpitations may be due to structural abnormalities in the heart. Narrowing of the coronary arteries that causes a decreased blood supply to the heart muscle can cause irritability and abnormal heart beats like premature ventricular contractions, ventricular tachycardia, or ventricular fibrillation. Structural wiring abnormalities can cause paroxysmal supraventricular tachycardias or Wolfe-Parkinson-White syndrome. Symptoms Palpitations are a symptom in and of themselves. They can be associated with an isolated skipped beat sensation or, if the palpitations are prolonged, there can be a feeling of fluttering or fullness in the chest. Prolonged episodes can be associated with chest pain, shortness of breath, sweating, and nausea and vomiting. Some types of heart rhythm problems can cause lightheadedness or even passing out (syncope). Self-Care at Home Since there are numerous types of palpitations, the treatment is usually specific to the diagnosis. In those people with a yet undiagnosed palpitation, minor lifestyle changes may help minimize symptoms. These include stopping the use of caffeine, alcohol, and over the counter cold medications. Patients with palpitations should try to keep a journal of when, where, and what circumstances surround their palpitations. They should learn how to take their pulse and document their pulse rate, whether the palpitations occur in isolation or in a pattern, and what associated symptoms exist, including light-headedness, nausea, sweating, chest pain, or shortness of breath. Chest pain (or any other signs of heart attack including jaw pain, indigestion, or extreme fatigue), shortness of breath, or passing out should prompt the patient or a family member to call 999 and seek medical attention immediately. Massage with calming aromatherapy oils on a regular basis can help the sufferer. Essential oils with calming properties include Chamomile Roman, Lavender, Neroli, Rose and Ylang Ylang. Out of this list of essential oils Ylang Ylang is probably the best one to help to slow the rapid over beating of the heart. |
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