Arrhythmias

Arrhythmias

When Your Heart Skips a Beat

When was the last time you felt the pitter-patter of rapid or quirky heartbeats inside your chest? Maybe it was just moments before you presented a report at work. Or during a rigorous workout at the gym.

Welcome to the world of arrhythmias, which are disturbances of your heartbeat's normal rhythm.

Your heart may be the ultimate workaholic, beating about 100,000 times a day, year after year, decade after decade. If you had a schedule that rigorous, you'd occasionally blip, bump and jump, too. Fortunately, your heart is smart enough to kick back only briefly. Most of the time, almost faster than you can feel it, the heart sets itself on course, and life goes on as if nothing had happened.

But as we get older, those idiosyncrasies of the heart can sometimes become more than just a harmless nuisance. Certain forms of arrhythmia can sap your energy, leaving you feeling weak and timeworn. On occasion, big disturbances in the heart's rhythm can threaten the heart itself. "In general, when arrhythmias begin later in life, they should be investigated much more carefully and treated more seriously," says Marianne J. Legato, M.D., associate professor of clinical medicine at Columbia University College of Physicians and Surgeons in New York City and author of The Female Heart.

The Plaque Connection

Let's put things in perspective: No matter what your age, the vast majority of ticker tremors aren't a sign of impending doom. "At some time in our lives, everyone has extra beats," says Gerald Pohost, M.D., director of the Division of Cardiovascular Disease at the University of Alabama School of Medicine in Birmingham. "And certainly, the vast majority of these extra beats are harmless."

But if you develop coronary artery disease--in particular, the buildup of plaque, which consists of fatty and other deposits that can play a role in a heart attack--then those arrhythmias might need a little more attention. If plaque deprives your heart of the blood and oxygen it needs, your heart might shake and shudder with arrhythmias that are potentially more serious and may even be life-threatening.

Luckily, premenopausal women have some extra protection against heart problems because our bodies produce the sex hormone estrogen, which guards the heart against disease. As a result, women lag about ten years behind men in the development of hardening of the arteries. But all good things must come to an end. After menopause, women rapidly catch up with men as their estrogen is reduced to a trickle. So as we age, we have a greater chance of heart disease, heart attack and potentially serious rhythm disorders.

If you have had a heart attack, your doctor may have cautioned you that your injured heart muscle is more likely to cause anarchy in the heart's routine electrical impulses, possibly producing dangerous abnormal beats called ventricular arrhythmias. When this happens, the heart can accelerate from a jog to a supersonic sprint, beating at a frantic, chaotic pace of perhaps 150 to 300 times per minute instead of the normal 60 to 100. At its worst, this condition can deteriorate into such serious quivers and quakes that the heart will no longer pump blood adequately--and sudden death may be the result.

This scenario might make you anxious. But don't panic. Remember, most irregular heartbeats are pretty routine--and if you take control of your health, you may reduce your chances of experiencing both the harmless and the more troubling fidgets and flickers in your heartbeat.

Righting Your Rhythm

Since many of the most worrisome heartbeat irregularities are closely intertwined with coronary disease, probably your best defense against those unwanted shivers and shudders of the heart is to prevent problems such as heart attack in the first place. Even if you've experienced palpitations, you might be able to keep them to a minimum through lifestyle changes. Here are some ways to do that, either by preventing them altogether or by cutting down on their frequency.

Snuff out smoking. Too many women--about one-fourth of the female population--smoke. And as a group, we're starting to smoke earlier. These cigarettes are increasing our risk of heart disease and of certain types of irregular heartbeat. But if you nix the nicotine in your life, your heart will have an easier time keeping a steady beat, says Richard H. Helfant, M.D., vice chairman of medicine and director of the Cardiology Training Program at the University of California, Irvine, Medical Center and author of Women, Take Heart.

Learn some stress busters. Now that more women than ever before are climbing the corporate ladder, there is a greater number experiencing job-related stress. Add to that the tension brought on by women's other roles--wife, mother and homemaker--and it's no wonder that some women feel that they're buckling under the pressure.

Many experts believe that stress plays a role in the development of coronary artery disease as well as contributes to arrhythmias. To take a bite out of stress, try lots of exercise, warm baths, massages and creative hobbies, says Fredric J. Pashkow, M.D., medical director of the Cardiac Health Improvement and Rehabilitation Program at the Cleveland Clinic Foundation in Cleveland and co-author of The Woman's Heart Book.

Avoid the java jitters. One British study of 7,300 people found that nine or more cups of coffee can make some hearts skip beats. Some smaller studies suggest that lesser amounts of coffee may have similar effects, particularly in those people unaccustomed to drinking lots of caffeine. Play it safe: If you're prone to arrhythmias, go easy on the caffeine.

Imbibe with caution. Even if you don't consume alcohol regularly, don't think you're out of harm's way. Binges of heavy drinking--six or more drinks in a day, according to one U.S. study--can increase the risk of very rapid heartbeat associated with an irregularity called supraventricular tachyarrhythmia. Some doctors call this syndrome holiday heart because it often happens in people who consume more alcohol than they're used to during the holidays.

Professional Beat Keepers

Arrhythmias might be the farthest thing from your mind when you go to the doctor for a physical exam. But with an electrocardiogram--a test that measures the smoothness of your heartbeat--she could confirm a rhythm disorder. She may also diagnose arrhythmias if you show up at her office complaining of palpitations and light-headedness. You have several options when more than lifestyle changes are required to control a seriously irregular heartbeat.

Medications are one. "Medications are able to control many arrhythmias and their symptoms. Some of the newer drugs are quite effective," says Dr. Pohost. These medications can usually relieve you of the fear of sudden death by stabilizing the electrical activity of the heart, but they must be carefully chosen by your doctor, since they may cause side effects of their own, including aggravated arrhythmias, gastrointestinal upsets and low blood pressure. In many cases, people end up taking these drugs for the rest of their lives.

Your doctor might also recommend an implantable cardiac defibrillator. Your doctor will insert this battery-driven device right into your chest or abdomen, where it will monitor your heartbeat. If the beats become dangerously fast or chaotic, it will zap the heart with a shock that might feel like a slap or a thump in the chest. This is meant to startle your heart back to normal activity.

How successful are these devices? One study found that among 650 patients (average age 60 years), the implantable defibrillators kept 60 percent of them alive for at least ten years. The researchers estimated that virtually all of them would have died without this high-tech hardware.

When your heartbeat just won't shape up, doctors have another hi-tech option, called catheter ablation, at their disposal. This treatment is reserved for particular types of rhythm disorder that may be resistant to other therapies. It is particularly useful for conditions in which the abnormal heartbeat originates in the heart's upper chambers. It involves threading a thin tube through one of your veins and into the heart.

Once this catheter is properly positioned, a mild radio-frequency current is activated to kill tiny areas of the heart tissue that are causing the arrhythmias. By destroying cells in a section no bigger than one-fifth inch in diameter, this procedure eliminates the wacky impulses that cause certain types of high-risk arrhythmias.