Dear Dr Garner,

I am a 45 year old female in good health. The only problem I have, and it is beginning to worry me, is that from time to time I feel my heart racing and pounding.

I can do all the exercise I want without getting short of breath, but these palpitations are beginning to scare me. Could you tell me what you think might be causing this and what I can do to stop it. Thank you very much. I really enjoy your column and even though I have moved to Phoenix, my sister sends me your column each week.

- Pounding Palpitations in Phoenix

Dear Pounding,

Thank you for being such a loyal Tablet reader. Your question is actually one that I am frequently asked. Fortunately, most palpitations are more annoying than a serious threat to health.
Common causes include:

1. Anxiety, fever and exercise
2. Emotional problems
3. Medication side effects- thyroid pills, caffeine, appetite suppressants, anti asthma medication, nicotine in tobacco, cocaine, and anti depressants.
4. Mitral valve prolapsed (more frequently found in women)
5. Heart disease
6. Overactive thyroid
7. Previous heart attacks that have scarred the heart tissue
8. Heart valve or heart muscle abnormalities
9. An overactive thyroid
10. Problems with the electrical circuit of the heart
11. Abnormalities with the body’s electrolytes, such as sodium and potassium.

The symptoms of palpations that may indicate a serious problem include:

1. Persistent palpitations that feel like pounding, or fluttering
2. Chest pain
3. Dizziness or fainting
4. Sweating
5. Shortness of breath
6. light – headedness
7. Fullness in the throat or neck

If one is troubled by persistent irregularities of heartbeat, a consultation with a doctor is in order. The tests he will do include:

1. Resting electrocardiogram- this gives a picture of how well the heart’s electrical system is working as well as if the heart is beating too slow or fast. The normal heart should beat between 60 and 100 heartbeats per minute.

2. Holter Monitor- this involves monitoring your heart over a period of 24 hours, to determine if there is any evidence of serious palpations, throughout your normal daily activities.

3. Chest x ray- will help evaluative the size of your heart and the appearance of the lungs.

4. Blood test- this will help to evaluate if the chemicals that make up the electrolytes of your blood are in proper balance.

Treatment for heart palpitations depends on the cause. It is important to remember that not all irregular heart beats are dangerous or life threatening. Sometimes the heart is perfectly healthy, but its regular beat is interrupted as a result of emotional upset or stress. In these cases, stress management and healthy lifestyle changes may be helpful.

The treatment for serious causes of heart arrhythmia includes:

1. Medications- help stabilize rhythm- may slow down heart

2. A pacemaker- electrical device which helps regulate the heart beat.

3. Defibrillation- an electrical current is passed thought the heart to correct an abnormal beat.

4. Electrophysiology treatment – catheters are placed into the heart to evaluate for any abnormalities of the electrical system. If found, these abnormal areas can be destroyed and the problem will stop.

As many of you know, February is “Heart Month”. A week ago, we observed “Wear Red to Work Day.” This dedicated to creating a greater understanding of women and heart disease. Too often, women and their doctors assume that having a heart attack is a man’s disease. It has been shown in recent studies that doctors, often ascribe chest pain and other symptoms in women to stress.
Stress can mimic heart attack symptoms, but it’s important that doctors check for physical causes, rather than dismissing symptoms in women as the result of emotions.

Another major study, which women should be aware of relates to heart rate. As I mentioned earlier, the normal heart rate is between 60 and 100 beats per minute. The study found that if a woman had a heart beat that was on the high side (76 beats per minute or more), that she had almost a 40% increased chance of developing a heart attack or heart disease in the future.

More women die from heart disease than men, and it is often difficult to diagnose heart attacks in women due to symptoms which are not always classic, such as chest pain. Women more often experience atypical symptoms such as depression, sleeplessness, jaw pain and extreme fatigue. The possible risk factor of increased heart rate, for future heart disease, may be useful to doctors in their evaluation of women.

I suggest that our female readers check their pulse, and if their rate exceeds 76, then they should talk to their doctor to evaluate what it means and what if anything should be done about it. The rate may be elevated due to medication, emotional issues, obesity, thyroid disease or diabetes among many other causes.

It is a good opportunity to start an exercise and healthy lifestyle regimen, which in turn may improve your heart health. The key thing to learn from this study is that a rapid heartbeat may be a risk factor for heart disease in women. You and your doctor can decide what it means for your personal risk and decide if anything need be done.

I thank you for your question, and hope you schedule an appointment with your physician to verify that your condition is not serious. Enjoy Phoenix, and ask your doctor about an exercise program, which can both improve the tone of your heart, as well as reduce anxiety.

Until next time, have a great week and be well.

* Reprinted with permission of The Tablet