Good morning! It’s been a beautiful week, right?I was taking part in a COVID webinar earlier this month when the question to the group was “What cardiology issues have you seen most during the pandemic? There was broad agreement that the answer was palpitations (in the office) atrial fibrillation (in the hospital). As cardiologists, we see more patients for palpitations than any other concern. In almost all situations there is nothing to worry about, but let me please take you through my work-up or at least some of it.
The majority of people we meet with palpitations are having premature ventricular and/or atrial contractions (PVCs and PACs). Most office patients mention appreciating them primarily in the evening when winding down. They usually last only seconds and they describe them as a “quick flutter”, “extra beats”, or they mention very brief chest pain. Chest pain that understandably may feel very concerning.What causes them?Let’s first share that over 60% of us have these. Circumstances in my experience that may increase their frequency include:Poor sleep or sleep apnea, increased stress or anxiety (fortunately none of that in 2020/21), low potassium levels, mitral valve prolapse, abnormal thyroid levels (T4), and of course tobacco, alcohol, and caffeine (yes, that includes chocolate).What am I feeling?  Because there is a premature beat, the heart has longer to fill for the subsequent contraction. In this squeeze, it may pump out 50% more blood than on a ‘normal’ beat. That large ejection of blood can give that feeling of a jolt.What tests do we order?Every situation is unique, but one test I always order is an EKG (10-second heart tracing with 12 leads and all the spikes and bumps). Occasionally I will also get a rhythm strip (long EKG).I may order is a 24 or a 48 hour Holter monitor (an all-day (or two) EKG). In this discussion, we are talking about PVCs/PACs – but I, and your doc, will likely want to make sure it’s not another arrhythmia such as atrial fibrillation, atrial flutter, ventricular tachycardia, sick sinus syndrome, etc. If there are cardiovascular risk factors (smoking, high blood pressure, etc.) I will often get an echocardiogram and occasionally a stress test.How do I get rid of PVCs?So you’ve corrected the possible causes and they’re still bugging you.  Honestly, if we determine that the symptoms are correlated to PVC’s, most of my patients are relieved and don’t want medicines (beta-blockers are the typical first choice) because they (a) don’t like BB’s and/or (b) they understand that the side effects may be worse than the symptoms. However, it’s not terribly uncommon that the PVCs can disrupt your quality of life and something needs to be done. We have also used calcium channel blockers or anti-arrhythmics for those times. If these don’t work and you’re still having issues, there is a relatively simple ablation procedure where we go into the heart and zap them. That is very rare for PACs/PVCs.Ok, thanks for the free consult, Dr. Cardiologist Man. Now I’m good, right?Nope. Please make sure your doc is aware because it’s not always PVCs/PAC’s and they will want to know about them.What does exercise do for PVCs?Thought you’d never ask. Exercise lowers stress and anxiety levels and indirectly lowers your PVCs. It also allows for better sleep and decreased cravings for cigarettes.  You and your questions are truly important to us. Because we want to make sure you receive the appropriate medical workup, we’re choosing not to answer medical-related questions via email. That said, all of our docs are eager to share their thoughts in person at a Walk with a Doc event. For goodness’ sake, that’s why we’re here.*As we thaw out from the pandemic, more and more walks will be starting as the restrictions lift. Please stay tuned to Walk with a Doc to find out when your bear is coming out of hibernation. Unfortunately, due to sheer volume, we are not currently able to respond to individual calls about when your walk will restart.**The webinar listed below has about 20 more spots but we will have to cap at 100. We’ll start on the 30th by bringing up some frequently asked questions to grease the skids but these usually evolve to dozens of really good questions from the studio audience. That’s my favorite b/c I think we learn the most from others.If I don’t see you on the 30th, have a great week.David