Palpitations (cont.)

How are palpitations managed?

Palpitations without associated arrhythmias and heart diseases may not require specific treatment. Patients are often advised simply to reduce emotional and physical stress while monitoring their symptoms.

Palpitations resulting from premature contractions (PACs and PVCs) often require no specific treatment. The frequency of premature contractions can be reduced by stress reduction, quitting smoking, and reducing caffeine, and alcohol consumption. High blood adrenaline levels can lead to premature contractions, while stress reduction helps to lower blood adrenaline levels. For patients with persistent palpitations and premature contractions, medications, such as beta-blockers, can be used to block the effect of adrenaline on the heart, thus reducing premature contractions. Examples of beta-blockers include propranolol (Inderal), metoprolol (Lopressor), and atenolol (Tenormin). Side effects of beta blockers include worsening of asthma, excessive lowering of heart rate and blood pressure, depression, fatigue, and impotence.

Atrial fibrillation treatments can be complex and involve

1. reversing the factors that cause atrial fibrillation such as fever, high thyroid hormone levels, and low oxygen levels in blood,
   
   
2. slowing the heart rate with calcium channel blockers such as verapamil (Calan), beta blockers such as propranolol (Inderal), and digoxin (Lanoxin),
   
   
3. preventing strokes by using blood thinners such as warfarin (Coumadin) in patients considered to be at high risk of strokes as a result of atrial fibrillation,
   
   
4. converting atrial fibrillation to normal heart rhythm with medications such as quinidine (Quinaglute, Quinidex), procainamide (Pronestyl), disopyramide (Norpace), or amiodarone (Cordarone), or electrical shock,
   
   
5. preventing recurrence of atrial fibrillation with medications such as amiodarone, catheter ablation procedures such as pulmonary vein isolation, or implantation of pacemakers or defibrillators
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For further information, please read the Atrial Fibrillation article.

The most important causes of ventricular arrhythmias (ventricular tachycardias and fibrillations) are heart attack, inadequate oxygenated blood to the heart muscle (ischemia), and scars from previous heart attacks. Therefore, treatment of the coronary heart disease is important in managing patients with ventricular arrhythmias. For patients with persistent ventricular tachycardias, medications such as propanolol (Inderal), sotalol (Betapace), and amiodarone (Cordarone) are used. In patients with life threatening ventricular fibrillations, implantable defibrillators are considered. Implanted defibrillators can sense the onset of ventricular fibrillation, and deliver a jolt of electrical impulse to the heart to convert it back to normal rhythm.

In patients with arrhythmias associated with significant heart muscle or valve disease, correction of the underlying heart disease is important. Patients with severe aortic stenosis can develop heart failure as well as serious ventricular arrhythmias. Treatment of the aortic stenosis by valve repair surgery (valvuloplasty), and/or by surgical valve replacement can alleviate these problems.

Some patients who suffer palpitations also have periods of dizziness or loss of consciousness (syncope). These patients are sometimes evaluated by heart electrical specialists called "electrophysiologists." A more detailed study of the heart's electrical system can be performed by these specialists who use devices to stimulate areas of the heart to detect abnormal electrical pathways.

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