By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
What is a heart palpitation? What does it feel like? Are heart palpitations normal? Are they dangerous? These are questions I’ve heard many times over years from patients and web site visitors.
Heart palpitations are a common form of cardiac arrhythmia that drives people into worry mode and to visit their doctor.
Here’s what you need to know: In a healthy heart, irregular heartbeats are rarely a medical cause for concern. They actually occur in about one-third of all normal hearts. In patients with established heart disease, however, they are associated with an increased risk of cardiac-related death.
What Do Heart Palpitations Feel Like?
Here are the details: Palpitations usually involve skipped or extra heartbeats, or a combination of both. We cardiologists refer to them as premature ventricular contractions. PVCs for short. There may be some accompanying lightheadedness and a strange feeling within the chest. Patients have described experiencing PVCs to me as “my heart is flipping over in my chest,” “my heart flutters,” and sometimes, “a pause.”
Are Heart Palpitations Normal? Are they Dangerous?
Short answer: yes, and they can be. PVCs are extremely common, and pretty much everybody has them at some point in life.
Studies suggest that about one-third of men and women without coronary heart disease (CAD) may actually have one or more PVCs per hour. Among patients with CAD, the rate jumps up to 58 and 49 percent, respectively. One 2013 analysis of more than 100,000 participants in eleven general population studies indicates that in the case of frequent PVCs (defined as more than once during a standard electrocardiogram recording or more than 30 over a 1-hour recording) there is a substantial increased risk. The prevalence of frequent PVCs in the studies ranged from 1.2 to 10.7 percent.
Men have an increased prevalence compared to women. The difference is especially higher in men with CAD. PVCs are uncommon in children. Prevalence increases with age.
Frequent heart palpitations along with underlying heart disease should always be evaluated by a cardiologist because of the possibility of triggering life-threatening arrhythmias.
Frequent Heart Palpitations
You might experience heart palpitations at night, when settling down in bed and your body is quieted down. PVCs may even wake you up in the middle of the night or grab your attention when you are walking the dog or working on the computer. They may happen randomly. If they happen frequently enough they scare the heck out of you, and send you running to your doctor or even the emergency room. Some of my patients were having PVCs with every other or every third heartbeat, and experienced anxiety, fear and dread – common emotional reactions for those having what seem like constant heart palpitations.
I remember a middle-aged doctor who once came to see me who was himself experiencing heart palpitations anxiety. I monitored his heart and had him perform a stress test. The results came out negative, to his great relief. He was a classic example of someone healthy who becomes aware of skipped beats, which then triggers worry or panic, and a crescendo of stress hormones. And the more you worry and fret, the more you can fuel the flames of PVCs.
In his case, too much caffeine and the stress of work were triggering PVCs. When he cut back on the java and made an effort to disengage himself a bit from the emotions of his work, his PVCs eased in intensity and frequency.
What Causes PVCs?
PVCs basically mean a misfiring of the bundle of cells that regulate the electrical conduction to the ventricles, the two lower chambers of the heart due to some “irritability” of the heart muscle. Such irregularities can be caused by, or accompany, a number of different medical factors:
- coronary artery disease, heart failure, and heart attacks
- lack of oxygen to the heart
- mitral valve prolapse
- medications such as diuretics, calcium channel blockers, anti-depressants, and anti-arrhythmic drugs
In both healthy and unhealthy people, PVCs are also commonly caused by stress, too much caffeine and alcohol, and deficiencies of magnesium and potassium.
Cardiologists don’t usually get very concerned when PVCs occur in healthy folks. I usually didn’t. We’ll usually suggest solutions related to lifestyle.
Initial interventions often include trying to normalize electrolytes, minerals in your blood and other body fluids that carry an electric charge. Potassium, calcium, magnesium, sodium, and chloride are examples.
Most cardiologists don’t use drugs to treat PVCs unless they are happening frequently on a regular basis (like more than six times a minute), or if the individual is quite symptomatic.
But when PVCs accompany a cardiovascular condition, the solution usually requires treatment for the underlying problem in order to prevent the PVCs from evolving into more complex ventricular arrhythmias, which could be deadly.
My Own PVC Story
Aging is also associated with PVCs. The older you are the more prone you are. I know that first-hand. I myself have had PVCs since about 2008, when I was 61, and I’ve noticed they have gotten a bit more intense over time. Sometimes I may feel a little lightheaded or with a swimming sensation in my head. These episodes happen most frequently when I am traveling, and since I am on the road a good deal, they happen more than I would like. The frequency could reflect a lack of sleep and being out of a routine and my comfort zone.
To be sure, I have monitored the situation carefully and have not found any underlying heart health issues to be concerned about. In 2011, I did an echocardiogram that happily came out negative. If the test were to have shown a damaged heart, then the PVCs, as I mentioned a moment ago, could be an ominous sign. PVCs with a normal heart are just an annoyance. I’m doing the max to counteract them, so I just live with them. As a result of my PVCs, I have cut down on what was basically a glass of wine or two with dinner a few times a week. I’ve always enjoyed that, but I’ve noticed that I have heart palpitations after eating if I’ve had a heavy meal with a bit of wine.
Get Tested to Lessen Heart Palpitations Anxiety
If you start becoming aware of irregular heartbeats occurring more than just once in a while, make a date with your internist or cardiologist. Your physician may order an echocardiogram – a test employing sound waves to analyze the beating action of the heart as well as the function of heart valves. When PVCs are documented, your doctor may seek further confirmation with a Holter monitor, a portable device that records heart rhythm and evaluates the type and frequency of PVCs. As I said before, most PVCs are benign, and doctors do not bring drugs or surgery into the picture unless the PVCs are pronounced and they have to address causal structural problems involving valves, arteries, or heart muscle function.
How to Stop Heart Palpitations
In most cases, the way to try to stop heart palpitations is to support heart rate variability, a measurement which indicates how your body is responding to everyday stressors. High heart rate variability (HRV) indicates a healthy response, while low heart rate variability is linked to the development of heart disease and other diseases.
In other words, you want to balance your autonomic nervous system activity (stress and relaxation). For most people this means engaging in regular stress reduction techniques: introducing practices like prayer, meditation, yoga, tai chi, or breathing exercises into your life. Most any relaxation therapy will be helpful in calming the heart.
- Earthing (Grounding) the body, a magnificently simple way to restore a natural electrical state in your physiology and reduce the impact of stress on your nervous system. You’ll also experience better sleep and less pain in the process. I have had a number of people tell me their PVCs have disappeared or minimized with Earthing.
- Cutting down on caffeine, sugar, alcohol, chocolate, food additives (especially MSG), and colorings, all of which have the potential to trigger PVCs. Even decaf coffee and tea maybe a problem for people who are exceptionally sensitive to caffeine. Green tea has a bit of caffeine in it. If you have PVCs, try avoiding it.
Interestingly enough, through one recent arrhythmia study researchers found “no relationship” between chronic higher consumption of coffee, tea or chocolate and ectopic heart beats.” As reported on Foodandwine.com, I think “the study suggests that maybe it is more about balance in consuming caffeinated beverages on a regular basis. It is well known that acute consumption of caffeine can provoke undesirable cardiac effects; however, this study suggests that the body perhaps may adjust to the chronic consumption of caffeine over time.”
If you’re experiencing PVCs – whether a chronic coffee or tea drinker or not – I still recommend avoiding caffeine to see if it helps.
- If you have a gluten sensitivity, stay away from bread, bagels, crackers, pasta, and other grain-based food items. Gluten can generate PVCs in sensitive individuals. Read labels carefully and even avoid processed foods with gluten as an ingredient.
- The nutritional supplements magnesium (400 mg) and CoQ10 (100 mg) can work like magic against PVCs. Jim Roberts, M.D., an integrative cardiologist in Toledo who co-authored my Reverse Heart Disease Now book, has consistently found a magnesium deficiency among patients with chronic cardiovascular conditions who experience PVCs. He gives all of them a magnesium supplement and their PVCs are substantially reduced or eliminated.
I also suggest omega-3 fatty acids, such as fish or squid oil (1-3 grams a day), L-carnitine (500–1,000 mg daily), and D-ribose (5–10 grams a day). Take the higher amounts if you also have high blood pressure, or more frequent and bothersome skipped beats.
- Minimizing electro-pollution in your immediate environment. That means removing unnecessary electrical devices – lamps, radios, computers, cordless phones, and TVs – from your bedroom or move them as far away as possible. The greater the distance the less chance that the electrical fields from electrical devices can disturb the “electrical circuits” in your body. You may be a person who is more sensitive to these fields and possibly experiencing headaches, insomnia, anxiety, or arrhythmias as a result. Electro-pollution has the potential to disturb heart rate variability, the minutely flexible variations between heartbeats, and provoke PVCs. For more information, visit the EMF section, here at HMDI.
- Minimizing air pollution in your home by using air filters. Air pollution can also impair normal HRV and increase PVCs in healthy individuals.
- Ataklte F, et al. Meta-analysis of ventricular premature complexes and their relation to cardiac mortality in general population. Am J Cardiol, 2013;112(8):1263-70.
- Dave J, et al. Ventricular premature complexes. Published online at http://emedicine.medscape.com/article/158939-overview#a0101
- He F, et al. Acute effects of fine particulate air pollution on cardiac arrhythmia; The APACR Study. Environ Health Perspect, 2011;119:927-32.
- Dixit S, Stein PK, et al. Arrhythmia and Electrophysiology: Consumption of Caffeineated Products and Cardiac Ectopy. J. Am Heart Assoc. 2016; 5:e00250310.1161/JAHA.115.002503. Published online at http://jaha.ahajournals.org/content/5/1/e002503.abstract
- Walansky A. “Coffee Doesn’t Cause Heart Palpitations After All Says Study,” Foodandwine.com, Jan. 27, 2016. Published online at http://www.foodandwine.com/fwx/secrets/coffee-doesn-t-cause-heart-palpitations-after-all-says-study
© Stephen Sinatra, MD. All rights reserved.