Family Health: When your heart skips a beat

Flutters, flip-flops, skipped beats – these are some of the ways people describe a common medical occurrence: heart palpitations. You might also feel these irregular heartbeats as a pounding or racing of your heart.

These symptoms are usually harmless and don’t need treatment. They may be brought on by triggers such as stress, smoking, caffeine, alcohol or lack of sleep, and nearly everyone feels them at some time. Certain medications and over-the-counter products also can cause irregular heartbeats, so ask your doctor or pharmacist to review everything you take. Avoiding these triggers can sometimes relieve your symptoms.

In some cases, though, heart palpitations are not harmless. An irregular heartbeat can be a danger signal for people who have heart disease, a family history of serious arrhythmia or sudden cardiac death, or an abnormal heart valve. In these cases, you should see your doctor right away, and if palpitations make you feel dizzy or faint, or if they are accompanied by chest pain, unusual sweating or shortness of breath, you should call 911. These symptoms can mean you have a serious heart arrhythmia.

If your doctor suspects that your palpitations may be serious, you may have some of these tests to diagnose the problem:

  • An electrocardiogram, or EKG, is a painless test that records your heart’s electrical activity. An exercise stress test is an EKG that’s done while you walk or jog on a treadmill.
  • An echocardiogram uses sound waves to show your heart in motion. It shows the size and shape of your heart, and how well it pumps blood.
  • A transesophageal echocardiogram transmits the sound waves through your esophagus, or throat, to get closer to your heart. These tests show very clear moving pictures of your heart.
  • Blood tests can show if you have a problems with your thyroid gland, which can sometimes cause heart palpitations.
  • Portable heart monitoring. A Holter monitor is a device that you wear for one or two days. It records your heart’s electrical activity continuously while you go about your usual activities. An event monitor is similar and can be worn for extended periods to detect symptoms that happen only occasionally. Some tiny heart rhythm recorders can be inserted under the skin on your chest.

If testing shows your palpitations are not serious, you may not need treatment other than avoiding the activities that trigger the problem. In some cases, doctors recommend medications called beta blockers, which slow your heart rate. Other medications can help palpitations caused by thyroid problems.

For some more serious arrhythmias, doctors may recommend one of these therapies:

  • Cardioversion. This delivers one or more low-energy electric shocks to the outside of your chest to restore a normal heart rhythm.
  • Pacemaker. If your heart beats too slowly you may need this device. Pacemakers are implanted under the skin near the collarbone, with a wire or wires extending to the heart. They send electrical signals to the heart to make it beat at a steady rate.
  • Implantable cardioverter defibrillator. People who are at risk for a condition called ventricular fibrillation, or another called ventricular tachycardia, may need this implanted device. These conditions can reduce your heart’s pumping ability so much that it endangers your life. ICDs monitor and pace your heart, and deliver an electric shock to restore normal rhythm when necessary.

Having an irregular heart rhythm can be frightening, especially if you need an implanted device. But the latest pacemakers and ICDs are very effective, and they give most people an excellent outlook for an active life.