What's causing my palpitations?
Dear DrRich:
I am a 30 year old mother of two
and I have been having heart palpitations for the past 5 years. They started
when I was pregnant with my first. Since then, I have brought this problem to my
PCP's attention and have worn a Holter monitor for 24 hours. The results of this
were, as I remember, inconclusive. I have these palpitations about 6 to 8 times
a week, more commonly when I bend over. I am wondering if it is normal for an
otherwise healthy person to begin experiencing these seemingly out of the blue?
Are they dangerous? Should I pursue
this again with my PCP? Any information would be greatly appreciated!
Yours truly,
A
DrRich replies:
Dear A,
"Palpitations"
are a symptom, not a diagnosis. A palpitation is an unusual awareness of the
heart beat. Most commonly,
palpitations are associated with a heart arrhythmia.
Whether
or not the palpitations are worth worrying about, therefore, depends entirely on
which heart arrhythmia is causing the palpitations.
In 99% of the time in young healthy people such as yourself, the
arrhythmias producing the palpitations are entirely benign - but nonetheless, it
is important to prove that.
A
Holter monitor is a good way to document whether an arrhythmia is causing the
palpitations, and which arrhythmia is the culprit.
But to accomplish this during a Holter test, a) the patient must
experience the palpitations during the test, and b) the Holter tape must be
examined for the precise moment that the palpitations are perceived.
If either of these things does not happen, the Holter is useless.
So
you need to go back to your PCP and find out precisely what arrhythmia you have
(if you have one at all.) He/she
should be able to give you a definitive answer.
Otherwise, the Holter was useless and needs to be repeated until the
answer is found.
Often
in this situation, a patient won’t have palpitations frequently enough to
guarantee that symptoms will occur during the 24 hours of the Holter test.
In these cases, patients can be sent home with a 30-day event monitor.
This is a device that records your heart rhythm on a continuous loop of
tape. When you experience symptoms,
you push a button to stop the recording right then, and transmit the recording
of the heart rhythm during symptoms to the doctor by phone.
The 30-day event monitor is an excellent way of correlating symptoms with
the heart rhythm, and is effective more often than the Holter.
Once
again, the odds you have an arrhythmia that will turn out to be a serious
problem are very low. But check it
out (again.)
Here
is a brief article describing the Holter monitor
and 30-day event monitor.
Best of luck,
DrRich
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