Palpitations: simple steps for those at low risk for heart disease

By Dr. Jacobson, D.O.

The April 2020 edition of HealthWatch focused on heart palpitations, noting the following details:

Palpitations—awareness of atypical heartbeats, usually accompanied by a disagreeable sensation—are common and not often a cause for serious concern.
Underlying causes are broadly divided into cardiac (caused by a problem with the heart itself) and non-cardiac.

Cardiac palpitations are more common in the elderly, who have a higher incidence of heart disease or other diseases—such as diabetes, hypertension or kidney disease—that can directly cause heart damage.

Non-cardiac causes are more common in younger individuals and involve an endless list of conditions that can stimulate a normal, healthy heart to beat faster or erratically. Anxiety and panic disorder cause about one-third of non-cardiac palpitation cases. Other contributors include low blood sugar swings (especially in diabetics), medications, infections and thyroid or other organ problems.

I received the following communication from a member:

I saw your article on heart palpitations. Earlier this year I began experiencing daily heart issues: no pain or tingling—just sensations such as quivering. I especially notice them at night when I hug my pillow. I’m a healthy, 50-year-old mom of three, with minimal stress. I’m not overweight, and I have no family history of heart problems. The doctor’s office recommends an in-office EKG, which isn’t too costly, but the suggested heart monitor would be almost $1,000. Could you please advise if I should wait and see if this goes away, or if I need to have my symptoms checked out? Is it normal for palpitations to go on for months?

Dr. Jacobson’s response: Palpitations are quite common and account for as many as 10 percent of visits to primary care clinics. They can persist for months and even years.

Given that you’re a healthy 50-year-old, the likelihood is relatively minimal that your palpitations are caused by a structural disease of the heart or other organ. When we use EKGs and event monitors to test patients with symptoms such as yours, we typically don’t find anything, conclude the condition is not serious, and tell them not to worry. In that light, you can take the following simple, inexpensive steps to evaluate symptoms on your own:

Whenever you have palpitations, check your pulse—either in your wrist, elbow or neck—to confirm that what you’re feeling is truly a fast or irregular heart rhythm. Many people feel like their heart is beating irregularly, only to find that it is actually beating normally when the pulse is checked. This is especially true when anxiety or nerves are involved.

Log your symptoms. I suggest using something basic, such as a monthly calendar on your refrigerator. Rate your symptoms on a scale of 0 to 3:

0 — a perfect day without any palpitations

1 — only mild, rare symptoms

2 — moderate symptoms

3 — severe, constant and/or distressing symptoms

Review the previous 12-24 hours for clues as to what might be triggering dysrhythmias. The heart accelerates in response to increased stimulation from the sympathetic “fight or flight” nervous system: nerve endings in the heart can stimulate organs through the release of stress hormones (catecholamines) such as adrenaline and cortisol. Assess whether anything was different about your day—what you did, what happened, what you ate or how you felt. Were you upset or stressed? Did you eat something different or an unusual amount of a particular food? Low blood sugar and food sensitivities can also trigger adrenaline or cortisol release. Note possible causations on the calendar, and see if you discover any patterns.

Consider a trial magnesium supplement. Magnesium is a positively charged ion that functions as a counterbalance to calcium. Magnesium is a smooth muscle relaxant and tends to calm hyper, excited nerve channels. It’s used during childbirth and is the treatment of choice for eclampsia—a condition during pregnancy that involves very high blood pressure, kidney damage, central nervous system excitation, and possibly even seizure activity.

If your symptoms persist or worsen, it might be time to consult with a family physician, internist or cardiologist.

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