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Doctors' Answers to "Frequently Asked Questions" - Heartbeat

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Heart Arrythmia Medication Concerns   [posted  12/10/98]
Question: 1). Why does the Sectral supress the arrhythmia some of the time and not other times? I do not tolerate Lopressor as my arrhythmia is very rate dependant (50-60s) and Sectral doesn't lower my rate so much. I drink no caffeine, I sleep well now. I can't figure this out. I am an RN but I had never heard of this before. 2). What are the risks of an ablation? Success rate? I am debating doing this. I have never had long runs of VT, never passed out, just very short of breath with the frequent PVCs, short runs.

Answer: Probably because they originate from a different site or the drug is in reality only partially successful. This is pretty common with most of the antiarrythmic drugs. Risks of an ablation are pretty small if performed by someone with some experience. Risks would center around occasional excess voltage that would damage functioning heart muscle, damage that would result in a pacemaker, etc. As you describe it, you would probably be a good choice for ablation. But, see someone who has been doing it for awhile.

Concerns About Heart Medication Interactions [posted  11/24/98]
Question:  I have been taking atenolol 100mg daily for PSVT. I am 37 yrs old. Except for a couple of breakthrough episodes of tachycardia a year, the atenolol is well tolerated. About 3 months ago I began having palpitations. They occur mostly at night or when I bend over quickly or get in positions where I "scrunch" my stomach. My cardiologist suggested that I start taking Cardizem daily with the beta blocker to control the skipped beats. I have read a lot lately about the side effects of clacium channels blockers. Are these two classes of drugs normally prescribed together? And are there any side effects I should be concerned about when a calcium channel blocker is prescribed with a beta blocker? I also have acid reflux and take 800mgs. of Tagamet twice a day.

Answer: Before I wasted a lot of time taking medications, I would see an electrophysiologist to see if your conduction problem can be fixed by cardiac ablation. This is a catherization which uses radio frequency waves to damage the offending conduction fibers. Very common now and most cities have one or two available. However, the beta blocker and calcium channel blockers can be used together without problems other than blood pressure lowering and pulse lowering. Side effects of the ca channel blocker will be constipation and swollen feet. Other side effects are drug specific and there are about 10 in the class all a little bit different. Are you sure that your symptoms bending over aren't your reflux? Sounds possible. Anyway, see an electrophysiologist.

Irregular Heartbeat [posted 10/1/98]
Question: I can relate to the 27 y/o woman concerned about proceeding withcatheter ablation to correct WPW. I am now 27 and had the surgery one year ago. I was hesitant at first, but given family history of heartdisease and the panic I felt during bouts with palpitations, it seemed the logical choice. I had my surgery done at Loyola University Medical Center in Maywood, IL (just outside Chicago.) The electrophysiologist I saw there was EXCELLENT., having performed the procedure many times before. My entire stay was only overnight, with the procedure itself only taking a few hours. My only follow up care was taking an aspirin a day for 3 weeks following and to recheck my EKG at my cardiologists office 1 month later. I "passed with flying colors" and am symptom free. I just want to reassure this woman that the procedure is painless and effective. The other neat thing is the fact that I have absolutely no scars. By using the catheter, the incisions are minute and heal well. I actually went out to lunch with a friend in the afternoon the day I was discharged from the hospital. I know each individual case varies, but I want people to know that there are those of us that couldn't imagine life without having gone through with the procedure.

Answer: Thanks for the input. Like you I have several patients whose lifes are complely different(for the better ) after this procedure. There is a risk and I think it depends on how disabled or how controlled your life is by the arrthymia. Generally, worth doing if in competent hands.

Heartbeat [posted 7/17/98]
Question: What are the effects of having a unusually slow or fast heartbeat? Why do the lungs fill up with fluid when congestive heart failure occurs?

Answer: Depends a lot on the individual. For example, healthy runners often have heart beats in the 40s without symptoms. In general, we don't get too excited about slow beats unless the person has symptoms (dizziness, passing out, etc.) this usually happens below 50 or 55 depending on their age and blood pressure. Fast heart rates are usually treated above 110 or so to reduce symptoms. The effect of rapid beating long term has a minimal effect on the heart, less than you would expect, but does limit the patients a great deal. The lungs fill with CHF due to increasing pressure in the lungs (back pressure in essence) from the heart.

Irregular Heartbeat
Question: My daughter is 31 weeks pregnant with her 2nd child. The 1st pregnancy was normal. She has no history of medical problems except for mild asthma. She uses an inhaler on occasion but very seldom. She does not drink or smoke and the only drug used is Tylenol. She also had no caffeine except for an occasional soda. She has recently begun to experience shortness of breath and assumed it was her asthma because change of seasons and cold weather are her bad times. She went to her regular doctor's appointment the other day. The baby is fine but she has an irregular heart beat. She has never had this problem before. Is this dangerous? How will this affect her and the baby during labor and delivery?

Answer: The most common cause of dyspnea during pregnancy is mechanical. This is due to difficulty in contracting the diaphragm downward due to the impingement of the gravid uterus. That is, the diaphragm can't be pulled down due to the size of the baby in the uterus. I doubt that the irregular rhythm is causing her problem unless she has new atrial fibrillation. Irregular beats usually don't cause problems unless they are sustained. There are other causes of dyspnea including occult pulmonary emboli, cardiomyopathy of pregnancy, etc. All of these occur, but are unusual. Pulmonary tests will sort this out.

Question: How fast does the heart beat?

Answer: Usually between 60 and 95 beats per minute. In athletes it may go as slow as 38 and will beat to 160 or so from exercise. Faster rates than 160 are possible, but are pathologic and due to electrical abnormalities.

Heartbeat While Sleeping
Question: My mother in law is 60+ and overweight. Recently while she sleeps her heart beats rapidly and would wake her up in the middle of the night. Will the problem be caused by an incorrect sleeping posture, or more to do with her weight problem?

Answer: Several possibilities, but, the most potentially serious is sleep apnea. The patient is usually heavy and will occlude their airway during the evening on several occasions. During these spells, the oxygen level drops and the heart is irritated due to low oxygen. Fatal arrthymias are common during this setting. She should see a sleep specialist and be seen in a sleep lab for an evaluation for sleep apnea-very important!

Racing Heart
Question: I'm 23, and I have a problem with my heart racing. I went into the emergency room and they said it was palpitations. But it keeps on happening? Now I get short of breath all the time(but I think it's because I smoke even though I have cut down from Menthols to lights and 1 pack from 2), I start to sweat, my arm starts to spasm at the bicept, and I get light headed or my body starts to tingle on my left side like as if I was having a heart attack. I just don't know what is wrong with me. I also space out and my mind gets foggy. It's really scaring me. Can you help me please?

Answer: Have you had a heart monitor during the process? If it is normal then it is not a racing heart. However, a stomach or gallbladder problem can often look like a cardiac problem -this will need to be checked out. Lastly, it may represent a panic attack. These usually start in the twenties with a family history being common. You will need to get a cardiac monitor during one of the spells to decide if it is your heart or not.

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