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Monthly Archives: August 2014

Definition

Palpitations are marked by sudden feeling of your heart pounding or racing with varying qualities of fluttering, skipping, or any abnormal sensations.

palp2

They can occur at any time during a person’s normal daily routines. A person can have palpitations in the chest as well as neck and throat. They may or may not be related to the heart and are often not life threatening.

 

Causes

  • Emotions: anxiety, stress, fear, panic
  • Physiological reponses: Exercise, Pregnancy
  • Substance: Caffeine, nicotine, illegal drugs (cocaine, amphetamines)
  • Certain medical conditions: overactive thyroid, anemia, shock, hypoxemia, hypoglycemia
  • Certain medications: asthma inhalers, decongestants, over the counter drugs that can act as stimulants (cough/cold medicine), herbal/nutritional supplement, beta blockers, thyroid and antiarrhythmic medications

 

Heart related palpitations

If a patient has significant risk factors for heart disease, existing heart disease, irregular heart beats (arryhthmia), abnormal heart
valve, then the palpitation may be caused by a problem with the heart.

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Complications of palpitations from heart problems

  • Fainting: If your heart beats rapidly, your blood pressure may drop too much too fast and lead to loss of consciousness.
  • Stroke: If palpitations are due to atrial fibrillation, a condition in which the upper chambers of the heart quiver instead of beating properly, blood can pool and cause clots to form. If a clot breaks loose, it can block a brain artery, causing a stroke.
  • Heart failure: Having an arrhythmia such as atrial fibrillation for a prolonged period can lead to heart failure. Controlling the rate of an arrhythmia is very important to preventing it.
  • Cardiac arrest: Rarely, palpitations can be caused by life-threatening arrhythmias and can cause your heart to completely stop beating effectively.

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When to call your doctor?

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If the palpitation accompanies discomforting symptoms of dizziness, pain, shortness of breath, tightness, unusual sweating then you should set up an appointment.

 

How are palpitations diagnosed?

  • Patient interview: Your doctor will take your past medical history, history of present illness, review your medications, and review your diet
  • Physical examination: Your doctor will listen to your heart and lungs.
  • Screening Tests: electrocardiogram (EKG), stress test, chest X-ray, echocardiogram(heart ultrasound), ambulatory cardiac monitor
  • Confirmatory tests: If an underlying heart problem is suspected patients will be put on electrophysiology study or cardiac catheterization.

 

How are palpitations treated?

clean-bill-of-health-doctor-giving-the-thumbs-up

If it’s not related to the heart and you are generally healthy:
No treatments are needed. You should identify any particular
food, medicine, or activity that induce palpitations and either
avoid them or have alternative choices.

 

If it is related to your heart:

eat-healthy-exercise
The doctor will prescribe a treatment plan that includes lifestyle modifications such as diet and exercise and medication.

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If the heart has a serious problem the doctor will make a
decision to resolve the underlying heart problem through more invasive methods such as implantations to restore normal rhythm or surgery if necessary.

 

How to prevent palpitations?

Limit or avoid

alcohol, caffeine, tobacco/nicotine, medications that act as stimulants, activities that appear to be associated with palpitations

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Start and do more

exercise (one prescribed by your doctor), maintenance of your blood pressure and cholesterol level through proper diet or medication if necessary, reduce your stress level (through activities such as journaling meditation, yoga, tai chi), and if palpitations do occur try not to pay too much attention to them once any serious causes have been ruled out.

Tai Chi palp11

 

References

  1. Cleveland Clinic – Arrhythmia: Heart Palpitations (Cleveland Clinic) http://my.clevelandclinic.org/heart/disorders/electric/palpitations.aspx
  2. Heart palpitations http://www.mayoclinic.org/diseases-conditions/heartpalpitations/basics/definition/con-20034780

What is an aortic dissection?

The aorta is the biggest artery in the body.  It originates from the left ventricle and supplies virtually every part of the body with oxygenated blood.  A dissection is a tear of the innermost layer of tissue of the vessel.  This causes blood to flow into the middle layer of tissue and damages it causing it to become weak.  This is different from a ruptured aorta because there isn’t a hole in the vessel where blood can escape out.  Aortic dissection is often a surgical emergency that requires careful management.

Aortic dissection can be acute or chronic

Acute dissection – Symptoms or dissection occurring within the last 14 days

Chronic dissection – Symptoms or dissection occurring after the 14th day

It is also important to differentiate bewteen omplicated vs. un-complicated aortic dissection

Complicated aortic dissection – patient has developed a rupture, malperfusion syndromes refractory pain or rapid aortic expansion.

Un-complicated – do not exhibit the above features

How do we classify aortic dissections?

We classify aortic dissections based mainly on where the tear is and if/where it propagates.  There are two widely used protocol for classifications; The DeBakey classifications and The Stanford classifications.

The DeBakey Classifications

  • Type I – propagate from the ascending aorta, extend to the aortic arch, and commonly, beyond the arch distally.
  • Type II – confined to the ascending portion of the aorta.
  • Type III – limited to the descending aorta.

The Stanford

  • Stanford type A – involve the ascending aorta
  • Stanford type B – Do not involve the ascending aorta

Below is a third way to classify dissections but only applies to dissections of the descending aorta.

  • Type 1 – no identifiable intimomedial tears in the descending thoracic aorta.
  • Type 2 – one or more intimomedial tears in the descending thoracic aorta and there is no tear at or distal to the level of the celiac artery.
  • Type 3 – intimomedial tears involving the abdominal aorta (with or without concomitant tears in the descending thoracic aorta).
  • Type 4 – intimomedial tears distal to the aortic bifurcation (with or without concomitant tears in the descending thoracic and abdominal aorta).

 

Uri M. Ben-Zur, M.D., F.A.C.C. completed a residency in internal medicine and fellowships in interventional cardiology, clinical cardiology, and clinical electrophysiology.  He currently practices at the The Paulette Tashnek-Wagner Cardiovascular Institute of Greater Los Angeles located in Tarzana, CA.

 

Aortic Dissection. Digital image. Wikipedia. N.p., n.d. Web. <https://www.mdguidelines.com/mitral-valve-prolapsehttp://en.wikipedia.org/wiki/Aortic_dissection>.

Mitral Valve Prolapse

Background Info:

Mitral valve prolapse (MVP) is the most common heart valve disorder in America.  The mitral valve controls blood flow between the upper and lower chambers on the left side of the heart while the tricuspid valve controls the right side.  Blood normally only flows one direction in the heart, from the upper chamber into the lower chamber.  This allows the heart to beat as efficient as possible.  In mitral valve prolapse, the valve flaps don’t work properly. Part of the valve can then protrude back into the upper chamber of the heart.  If the valve is deformed enough blood can flow in the wrong direction causing what is called a regurgitation.  If enough blood is moving back into the upper heart chamber, it can lead to heart failure.  This condition ranges in severity from no more than a benign heart disorder to requiring open heart surgery.

MVP
Symptoms:

People with mitral valve prolapse most often do not have symptoms. If symptoms do occur, they may include one or more of the following: Shortness of breath, lightheadedness, fatigue, chest pain, anxiety, irregular heartbeat, palpitations, and fainting,  In mitral valve prolapse, usually the severity of the symptoms does no correlate to the severity of the disease.  Therefor it is important to undergo evaluation and be followed regularly by a cardiologist after a diagnosis of MVP is made.

Physical Exam:

Mitral valve prolapse creates a heart murmur that can be heard through a stethoscope.  The murmur is created when there is abnormal or turbulent blood flow.  In this case that is when some of the blood refluxes back into the upper heart chamber.  When the mitral valve protrudes backward, it may produce a clicking sound. Both murmurs and clicks are signs of MVP.  An echocardiogram is the test we usually use to confirm the diagnosis. You may also be asked to wear a Holter monitor for a day or two to record the electrical activity of your heart.

Treatment:

In most cases, no treatment is necessary. Although no longer routinely recommended, you may need to take antibiotics prior to some dental and medical procedures. This is to prevent heart infections. If symptoms include chest pain, anxiety, or panic attacks, a beta-blocker medication can be prescribed. Ask your doctor whether you may continue to participate in your usual physical activities. If the valve is function poorly enough, surgery may be warranted.

 

Uri M. Ben-Zur, M.D., F.A.C.C. completed a residency in internal medicine and fellowships in interventional cardiology, clinical cardiology, and clinical electrophysiology.  He currently practices at the The Paulette Tashnek-Wagner Cardiovascular Institute of Greater Los Angeles located in Tarzana, CA.

Mitral Valve Prolapse. Digital image. MD Guidelines. N.p., n.d. Web. <https://www.mdguidelines.com/mitral-valve-prolapse>.


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