cap_container-leftTop
Online Chat - Irregular Heart Beat: Annoying or Emergency?

Online Chat - Irregular Heart Beat: Annoying or Emergency?

Monday March 26, 2012

Spectrum Health:
Welcome to today’s live chat with Dr. Darryl A. Elmouchi, a fellowship-trained heart specialist. Today, he’ll answer your questions about irregular heartbeats.

Dr. Elmouchi:
Hi, I’m Dr. Elmouchi. Thank you for joining me today to learn more about understanding arrhythmias. While the questions start coming in, I’ll start with a few facts you may not know.

Irregular or abnormal heart beats, called arrhythmias, cause your heart to beat too fast, too slow or irregularly. Arrhythmias are very common and sometimes just an annoyance.

However, they can also cause life-threatening medical emergencies that result in stroke, cardiac arrest, or even sudden death.

The most common arrhythmia is atrial fibrillation (AF) which affects more than 2 million people in the United States. Symptoms of an irregular heartbeat can vary dramatically person to person. In general, the most common symptom is one where a patient feels their heart "flip flop" in their chest.

Comment From Dan:
How do I know if my heart is beating irregularly?

Dr. Elmouchi:
Well, you might have symptoms of flip flopping or racing within your chest. However, symptoms might be milder, such as fatigue, shortness of breath with exertion or lightheadedness.

Comment From Pam:
I first learned about my arrhythmia when I had an episode of extreme shortness of breath and pounding in my chest. It has only happened the one time. I have since been monitored every year. I am wondering what would cause that one episode to be so extreme.

Dr. Elmouchi:
Sometimes rhythm abnormalities can present very dramatically, such as your initial symptoms. However, the same rhythm can recur at a later date with very mild symptoms. Unfortunately, there is not always a rhyme or reason to symptoms.

Comment From Dan:
If other heart problems run in my family, am I more at risk for an arrhythmia?

Dr. Elmouchi:
Yes and No. Many abnormal rhythms are associated with other inherited heart problems such as prior heart attack. Indirectly, if you have a family history of heart attack, you are at risk for a heart attack yourself. If that were to occur, then you would be at risk for arrhythmia. More directly, some rare arrhythmia conditions are directly passed down through families.

Comment From Karen:
The frequency of my irregular heart beat is increasing. It started with once a week, then once a day and now several times a day. Is that a sign that it's an emergency?

Dr. Elmouchi:
All of us have occasional skipped beats. When they become longer lasting, or more frequent, or associated with symptoms other than palpitations, it makes sense to be evaluated. With that said, this is probably not an emergency.

Spectrum Health:
FACT: An arrhythmia (ah-RITH-me-ah) is a problem with the speed or rhythm of the heartbeat (National Institutes of Health).

Comment From Cara:
Should I be more concerned if irregular heart beat occurs consistently with exercise (i.e.- running)? It generally feels like a "fluttering" or "racing" for a few seconds, and will continue periodically for an hour or two post-exercise.

Dr. Elmouchi:
Very often the adrenaline our body produces during exercise leads to more irregular beats. This can unmask a problem that you did not know existed. This should definitely be evaluated further, although is unlikely to be something dangerous given your minimal symptoms.

Comment From Mary:
Possible diagnosis for 19 year old athlete with no history of medical concerns, no current medications, non-smoker, no caffeine; intermittent episodes of irregular pulse 160-170 accompanied by hypertensive episodes 170/100, both during exercise and at rest, lasting 15-20 minutes, 5+ episodes daily, complaints of blurry vision, shortness of breath.

Dr. Elmouchi:
This sounds worrisome. Sudden fast heart rhythms can often be something called SVT (supraventricular tachycardia). However, when you combine this with elevated blood pressures and these symptoms, something more ominous might be going on. I would definitely recommend a more formal evaluation.

Comment From Sara:
My grandma has an arrhythmia. I sometimes feel my heart beat skip or flutter. Am I more at risk with this family history? I also have Type 1 diabetes, if that matters.

Dr. Elmouchi:
This is always a tough one. As I've mentioned, we all have skips and jumps of our heart. Your symptoms sound like this. However, without knowing more, I cannot with certainty rule out a more important condition. Type 1 Diabetes doesn't specifically increase ones risk for having an arrhythmia.

Spectrum Health:
FACT: Millions of Americans have arrhythmias (National Institutes of Health).

Comment From Phillip:
Is Wolf-Parkinson-White (WPW) syndrome a disqualifying condition from high school athletics? What can be done?

Dr. Elmouchi:
Wolff-Parkinson-White syndrome is a condition where you are born with an extra nerve or connection between the upper and lower chambers of the heart. This is associated with abnormal and fast heartbeats. In rare instances this can be life-threatening.

Dr. Elmouchi:
As for high school athletics with WPW... this is generally a condition that would preclude one in pursuing competitive athletics. However, a simple and safe procedure, called a cardiac ablation, can cure you of this condition.

Spectrum Health:
FACT: An electrophysiologist is a cardiologist who specializes in heart rhythms. They study of the electrical impulses of the heart. These impulses control the rhythm of your heartbeat.

Comment From Alison:
I get PVCs and can feel them as a fluttery feeling in my chest....for the past year and a half. As a past runner I have been trying to get back into running. However several times after starting to jog I have gotten left sided chest pain that is sharp deep stabbing pressure that gets worse as I continue to jog and goes away with rest. It was reproducible also. I wore a heart monitor for two weeks after seeing a cardiologist but hadn't jogged the whole time because of my busy schedule while wearing the heart monitor and it didn't pick up anything up abnormal....not even a PVC

Dr. Elmouchi:
PVC's are generally considered a benign finding. These are premature ventricular contractions. Some people can experience these as skips and jumps, but occasionally some people feel chest discomfort with them. Any exertional chest paint needs to be evaluated. Having a normal stress test is very reassuring. You might speak with your doctor about repeating a heart monitor while you exercise just to be sure there is nothing else going on.

Comment From Patricia:
Is there a direct relationship between skipped heartbeats and stress?

Dr. Elmouchi:
Yes and No. Adrenaline leads to more skipped beats in all patients predisposed to them. If stress raises your body's adrenaline level, then yes your number of skipped beats will increase.

Spectrum Health:
Most serious arrhythmias happen in adults older than 60. This is because older adults are more likely to have heart disease and other health problems that can lead to arrhythmias. (National Institutes of Health)

Comment From Julie:
Is fainting a sign of a problem?

Dr. Elmouchi:
The short answer is yes. Most causes of fainting are not dangerous. However, fainting may be the sign of a serious cardiovascular condition. Anyone who faints should definitely have an evaluation by a physician.

Comment From Marie:
Are there any options for the treatment of PVC's? Even though they are mostly benign, they are quite disturbing and often cause a great deal of anxiety.

Dr. Elmouchi:
That is a great point. Yes, there definitely are treatment options for PVC's. A non-life threatening conditions, such as PVC's can be very life altering because of symptoms. For PVC's, we often try mild medications to suppress them. If that doesn't work, we can often perform a catheter ablation procedure where we find the area that is misfiring within the heart and cauterize it. This can be curative.

Comment From Pam:
Does this mean fainting frequently or just once?

Dr. Elmouchi:
Either. A single fainting spell can be the only warning of something more dangerous in the future. It makes sense to be evaluated and if your fainting spell is not worrisome, we will all be relieved. 

Comment From Cara:
If you have arrhythmias when you're younger, but they continue when you get older, do they become more of a concern with age, or put you at higher risk for other problems? Or, are they still generally benign?

Dr. Elmouchi:
Arrhythmias that occur during our youth and continue as we age are often not dangerous. However, mild problems when we are young can occasionally become more problematic as we age. The bottom line is that there are dozens of different types of arrhythmias and until we know what type you have, it is hard to generalize.

Comment From Phillip:
I saw your interview on WoodTV 8 about EKG testing for high school athletes, I wasn't clear why you opposed this type of testing for them. Can you briefly clarify?

Dr. Elmouchi:
It is not that I personally oppose screening EKG's for athletes, it is just that the data at present doesn't support this avenue for screening. A positive EKG in an athlete is more likely to be falsely abnormal than truly abnormal. Further, a negative EKG only rules out a few of the rare causes of sudden death. Given this, routine screening EKG's are not recommended by the American Heart Association, nor Spectrum Health. Rather, at present, we are devoting as many resources as possible to education and getting AED's out in the community. With all of that said, we fully believe that screening via the Michigan High School Athletic form makes sense.

Comment From Guest:
oops....I accidently pushed send early. The stress test showed no problems however they had me walk slowly and increase gradually into a fast walk, never into a jog, which is what I do. I just got your response about asking to wear the monitor while I am exercising. My other question is at what point would a cardiac catherization be considered? What other things would be tested before a cardiac cath? My cholesterol has always been slightly elevated all my life and I'm in my younger 30's with heart disease that runs in my family. Also, would partial thickening of the distal (half) end of the mitral valve lead to the PVC's? That was the ONLY thing wrong with my echo found but I was told it was nothing abnormal at this point. Thanks

Dr. Elmouchi:
A cardiac catheterization is an invasive test that does have a small amount of risk involved. We generally move on to this test when there is significant data to lead us this way. In your personal case, I would speak with your cardiologist about what he/she thinks may be going on and what the next steps are.

Spectrum Health:
FACT: The term "massive heart attack" is often mistakenly used to describe sudden cardiac arrest (SCA). SCA claims about 325,000 lives each year in the United States. (American Heart Association)

Comment From Justin:
If I suspect that I have an irregular heartbeat, what kind of tests would you do to find out for sure?

Dr. Elmouchi:
It depends how frequently you have symptoms. For patients that have symptoms every day, we often will obtain a 24hr heart monitor. For those with symptoms less frequently, we have various monitors that can be worn for up to a month. When we meet someone with very infrequent but potentially dangerous symptoms, we might even implant a monitor under the skin that can record the heartbeat for up to 2-3 years.

Spectrum Health:
FACT: Atrial fibrillation increases the risk for stroke by up to a factor of 5X. (Heart Rhythm Society)

Comment From Bob:
How safe are the meds for atrial fibrillation?

Dr. Elmouchi:
That is a very good question. This is the most common arrhythmia we see. There are various medications we use to treat AF. Some involve thinning the blood to prevent stroke. Others involve slowing the heartbeat down. Finally, others are called anti-arrhythmics. These are used to keep people in normal rhythm. These rhythm drugs have a very small risk of causing potentially dangerous abnormal heartbeats. We are very selective in who gets these latter agents and which ones we give. If chosen carefully, these drugs are quite safe.

Spectrum Health:
FACT: Abnormal heart rhythms are more common in people who are diagnosed with heart failure.

Comment From Justin:
How much does family history play a part in irregular heartbeats? How much is lifestyle? How much is just based on your body and luck of the draw?

Dr. Elmouchi:
It is quite variable. There are clearly arrhythmia syndromes which are genetic. However, the majority of abnormal rhythms are as you say, "the luck of the draw." With that said, certain rhythms are more common in patients with underlying heart disease or obesity which clearly have familial ties.

Comment From Bob:
If the meds do not work, how safe and effective is the procedure you mentioned before, ablation?

Dr. Elmouchi:
An AF ablation procedure is at least 3x more effective than the best medication we have for AF. It is also very safe with less than a 1% chance of serious complications at experienced centers such as ours. However, the procedure is not right for everyone. Here at SH, we do hundreds of AF ablations a year and have very good success. For many people, an ablation is the best option. However, multiple factors, such as the length of time you have had AF and your other medical problems all play a role in if the procedure is right for you.

Comment From Patricia:
Is there a distinct difference between PVC's and atrial fibrillation, or are they part of the same disorder?

Dr. Elmouchi:
PVC's and AF are very different. They both might feel to the person experiencing them like irregular heartbeats. However, in PVC's a small area from the bottom chamber of your heart misfires occasionally. In AF, numerous areas from the upper chambers of your heart fire rapidly. Not only do they originate in different chambers, but they lead to different problems. In AF, the biggest risk is that of stroke. PVC's on the other hand, do not lead to strokes.

Spectrum Health:
FACT: The average adult human heart beats 60-100 times per minute. This equals about 35 million beats in a year.

Comment From Maureen:
My ex-husband passed away due to Sudden Cardiac Arrest. Do I need to be concerned with SCA in my teenage athletes?

Dr. Elmouchi:
Quite possibly yes. There are some causes of cardiac arrest that are clearly hereditary. If we know what your ex-husband died from, we could aggressively screen for this condition in his children. This would be very helpful and hopefully reassuring.

Spectrum Health:
FACT: About 30% of people will faint over the course of their lives. About 18-20% of those people had a cardiac cause for fainting.

Comment From Pam:
As I mentioned earlier I am monitored every year. I have been told my PVC's are benign, so why does the Dr. have me do this every year? What is he looking for?

Dr. Elmouchi:
A small number of PVC's is considered normal. Sometimes we see a large number of PVC's, but symptoms are pretty minimal and the heart looks normal on other studies. In these cases, we will often follow the number of PVC's on holter monitoring over time to ensure the number doesn't increase dramatically. Very high numbers of PVC's, tens of thousands per day, can occasionally lead to weaking of the heart muscle. We are obviously trying to stay ahead of this.

Comment From Bob:
Are all the electro physiologists at spectrum experienced in doing ablations?

Dr. Elmouchi:
Currently, there are 5 board certified electrophysiologists at Spectrum. We are all experienced at performing ablation procedures. With that said, we each have particular areas of emphasis.

Comment From Lisa:
I am a very active 41 year old that works on our farm...everything is hand done...no tractor. I have been short of breath now with mild activities which has now turned into even if I am talking. I have uncontrollable b.p. And on meds. And find when my b.p. Lowers to where it should be my heart rate sky rockets even without activity. At what point should I be alarmed by this?

Dr. Elmouchi:
You should be alarmed now. Shortness of breath with exertion can be the sign of a serious heart problem. When that progresses to occurring with something as non-taxing as talking, you should be evaluated right away. Your HR going up dramatically might be a primary problem, but also might be a result of another problem with your heart or lungs.

Comment From Betty Clark:
My husband has been having a lot of trouble this winter with A-fib. He had it occasionally for years but it is almost constant. He has been in the hospital and ER in Florida and in ER once at home and was supposed to go last week again but we came home and gave him his medicine. He had a quadruple bypass eight years ago and is allergic to some of the meds used to treat it. We are concerned that maybe he has blockages again. He is on coumadin.

Dr. Elmouchi:
AF is not a sign of specific heart blockages. With that said, people with blockages are more likely to develop AF. Sometimes our goal in AF is to restore normal rhythm. However, that is not always best or necessary. In your husband’s case, it sounds like another evaluation by his cardiologist would be a good idea.

Spectrum Health:
FACT: Serious arrhythmias can often be successfully treated. Most people with arrhythmias are able to live normal lives. (National Institutes of Health)

Comment From Lisa:
I have been worked up for several things. I do have connective tissue disease, mild pulmonary hypertension, had a lung bio

Dr. Elmouchi:
font face="Arial">I am hoping they have looked at your heart closely with an echocardiogram and a stress test. Lung disease can definitely lead to the problems you are experiencing, but it is always important to have a thorough heart evaluation.

Comment From Mike:
I had a cath ablation in January for SVTs and I have PVCs that were monitored. I am now scheduled for a follow-up echo cardiogram. What is the purpose of the echo follow-up? 

Dr. Elmouchi:
Without knowing your specific case, I cannot say for certain. Often with PVC's we will periodically check echocardiograms to ensure that the heart pumping function is normal.

Comment From Amy:
Hi! I'm 26 and very active. I experience the sensation that my heart is "skipping a beat" a few times a week, sometimes for just a minute or two and other times for several minutes up to an hour. My heart rate doesn't seem to be elevated (~70bpm resting) when this occurs. I don't ever feel these when I'm exercising of after exercising, most commonly when I've been sitting for a long period of time. When this occurs I most often feel like I need to take deep breaths, but never any chest pain. I am currently on hydrochlorothyazide and have been for a few years... although I admit that I am not 100% compliant with taking it every day. Does HBP medication have any effect on the fluttering? I also don't notice a difference in frequency/occurrence with or without the consumption of caffeine. When/should I see a MD for this?

Dr. Elmouchi:
Your palpitations sound most consistent with skipped beats. As I stated earlier, these are usually not dangerous. Medications can occasionally affect the fluttering. Hydrochlorothiazide usually doesn't affect extra beats unless it leads to low potassium. Caffeine almost always makes extra beats more frequent. It is very reasonable to mention these symptoms to your doctor.

Comment From Betty Clark:
Our doctor's office is working on making an appointment with your office. He went for stress/echocardiogram tests last week but they couldn't be done because heart rate was 180.

Dr. Elmouchi:
With a heart rate of 180, it sounds as if he needs more potent rate lowering AF medications. A stress test isn't possible with heart rates this fast.

Dr. Elmouchi:
Thank you for taking the time to learn more about arrhythmias. An arrhythmia may be present all of the time or it may come and go. You may or may not feel symptoms when the arrhythmia is present. Or, you may only notice symptoms when you are more active. 

It’s also important to recognize the warning signs of an arrhythmia and call your doctor right away if you notice any of them:
Chest pain
Fainting
Fast or slow heartbeat (palpitations)
Light-headedness, dizziness
Shortness of breath
Skipping beats - changes in the pattern of the pulse
Sweating

Spectrum Health:
If you’d like more information about Dr. Elmouchi, please view his profile on the Spectrum Health Physician Finder webpage. To schedule an appointment, please call 616.885.5000.

Spectrum Health and the Meijer Heart Center offer the only comprehensive heart rhythm program in West Michigan and have more heart rhythm patients than any other hospital in Michigan. If you’d like more information about arrhythmias, please visit our Heart Rhythm (Electrophysiology) page.

cap_container-rightTop
Print Email
  Decrease (-) Restore Default Increase (+) Adjust Text Size
tile_container-left
About Spectrum Health Social Media Site Map iGive
tile_container-right