Most of us are blissfully unaware of the heart’s steady thump as it contracts and relaxes nearly 100,000 times a day.

Sometimes, though, you may notice that your heart has unexpectedly started to race or pound, or feels like it has skipped a beat. These sensations are called heart palpitations. For most people, palpitations are a once-in-a-blue-moon occurrence. Others have dozens a day, some so strong that they feel like a heart attack.

Most palpitations are caused by a harmless hiccup in the heart’s rhythm. A few reflect a problem in the heart or elsewhere in the body. Sorting out worrisome palpitations from the harmless ones isn’t always easy. Doctors can be quick to attribute them to anxiety, depression or some other emotional or psychological problem. Although sometimes that’s exactly right, it’s important to first rule out harmful heart rhythms and other physical causes.

Cause Of Heart Palpitations

Palpitations are extremely common. Although most people shrug them off, they worry countless folks enough to consult a primary care physician or cardiologist. Different people experience palpitations in different ways. You might feel as though your heart is fluttering, throbbing, flip-flopping, or pounding, or that it’s skipped a beat. Some people feel palpitations as a pounding in the neck; others as a general sense of unease.

Some palpitations appear out of the blue and disappear just as suddenly. Others are linked with certain activities, events or feelings. Exercise and physical activity can generate palpitations, as can anxiety or stress. Some people notice palpitations when they are drifting off to sleep; others, when they stand up after bending over. The list of possible causes is long.

Trouble from above. Some palpitations are the result of premature contractions of the atria. When the heart’s upper chambers contract a fraction of a second earlier than they should, they rest an instant longer afterward to get back to their usual rhythm. This feels like a skipped beat, often followed by a noticeably forceful contraction as the ventricles clear out the extra blood they accumulated during the pause. These premature beats are almost always benign, meaning they aren’t lifethreatening or a heart attack in the making.

Trouble from below. Early contractions of the ventricles, the heart’s lower chambers, can also cause palpitations. Single premature ventricular contractions, or a couple in a row, aren’t usually a problem, unless they are accompanied by symptoms such as fainting or shortness of breath. Runs of them one after the other, though, are worrisome because of the possibility that they might degenerate into the deadly cardiac chaos known as ventricular fibrillation.

More Causes Of Heart Palpitations Including Scar Tissue

Problems with the heart’s timekeeper, called the sinus node, can cause palpitations. Another possible source is a breakdown in synchronization between the upper and lower chambers. Scar tissue in the heart from a heart attack or other injury can lead to palpitations, as can valve problems such as mitral valve prolapse.

Palpitations come and go. They are usually gone in the doctor’s office. That makes pinning them down a joint effort. One of the most helpful pieces of information is your story of how your palpitations feel, how often they strike, and when. The more details you can marshal, the better. When you have palpitations, try to gauge your heart’s rhythm (is it fast or slow? regular or irregular?). Do you feel lightheaded, dizzy, or out of breath, or do you have chest pain? Are you often doing the same thing when they occur? Do they start and stop suddenly, or fade in and out? Your description of your general health, what you eat and drink, the medications you are taking — don’t forget to mention herbs and supplements — and your family history are also essential.

A physical exam can reveal telltale signs. When listening to your heart, your doctor may hear a murmur or other sound suggesting a problem with one of the heart’s valves, which can cause palpitations. He or she may also find a thyroid imbalance, signs of anemia, low potassium, or other problems that can cause or contribute to palpitations.

An electrocardiogram (EKG) is a standard tool for evaluating someone with palpitations. This recording of your heart’s electrical activity shows its rhythm and any overt or subtle disturbances, but only over the course of 12 seconds or so. Your doctor may want to record your heart rhythm for longer to identify the cause of the palpitations.

Most of the time, the exam and EKG don’t turn up any problems. If your palpitations aren’t accompanied by dizziness or other symptoms, if you don’t have a valve disorder or other structural problem with your heart, and if sudden death or other problems aren’t lurking in your family tree, that usually means the palpitations aren’t signs of impending doom.

If your palpitations come with chest pain, your doctor may want you to have an exercise stress test. If they come with a racing pulse or dizziness, an electrophysiology study using a special probe inserted into the heart may be in order.

What to do About Heart Palpitations

Searching for an underlying cause of palpitations holds out the possibility of halting them. The solution may be as simple as cutting back on caffeine or correcting anemia or a low potassium level, or as complicated as a procedure to destroy a small patch of cells inside the heart that gives rise to erroneous beats. Often, though, even the most thorough search doesn’t turn up a fixable cause.

Drug therapy isn’t necessarily required. Sure, there are several medications that beautifully suppress premature atrial or ventricular beats. But they tend to have unwanted side effects, and can cause more serious rhythm problems. Several older studies have shown that they may even shorten life compared with no treatment. For some people, a beta blocker or anti-anxiety medication can ease the problem without causing a new one.

If you have unexplained palpitations, start with the simple things first: Try cutting back on caffeine, or giving it up altogether, to see if it is contributing to the problem.

Stress and anxiety are two other key triggers of palpitations. A two-step approach can help here. Meditation, the relaxation response, exercise, yoga, tai chi, or other stress-busting activities may help keep palpitations away. If they do appear, breathing exercises or tensing and relaxing every muscle group in your body can ease the panic or anxiety spurred by palpitations that sometimes feeds into creating more of them.

Although doctors often say not to worry, it’s hard to follow that advice when your heart is pounding in your chest and you’re afraid the “big one” is imminent. Talking about your experience with others in the same boat can be very helpful. The Internet is rife with support groups.

To learn more about “Heart Palpitations – What Can You Do?” click here.

Keep on tickin!

I spent the first 33 years of my life with a heart murmur resulting from a congential heart disorder known as a bicuspid aortic valve.

Now? After successful heart valve replacement surgery… Guess what? No more more heart murmur!

However, given my history, I am very sensitive to any questions I receive about heart murmurs. Although most murmurs do not results in heart valve surgery, some do. That said, taking preventative steps to minimize the risk of heart valve damage is critical.

Earlier today, I received an email about heart murmurs and loratadine. The questions read, “Can Loratadine cause a heart murmur?” and “Does Loratadine affect Aortic Stenosis?”

So you know, Loratadine is the generic name of popular antihistamine that is more readily known as Claritin. The product is made by Schering-Plough and is consumed in tablet or liquid form.

Intrigued and concerned by the possibility that Loratadine affects aortic stenosis and causes incremental heart valve damage, I did some quick research.

As for heart murmurs, loratadine, aortic stenosis and the possible complications of taking the drug, my research turned up very little clinical information.

However, at a very interesting site, RiskyBloodPressure.com, I learned some very interesting information. The site notes about Loratadine that, “Further testing is needed but it could be that Claritin may act as a vasoconstrictor, which means that the drug narrows blood vessels. If so, the drug can raise blood pressure in the body. If the blood flow in your system has already been compromised with conditions such as high cholesterol, heart disease and high blood pressure, Claritin should be avoided until you can seek further advice from your doctor.”

Pretty interesting, right? What does that tell us? In my opinion, it tells me that you should chat with your cadiologist if you are taking Loratadine and you have a heart problem. Better safe than sorry.

Anyways, I hope that helps us all learn a little more about heart murmur, loratadine, and potential loratadine affects aortic stenosis.

Keep on tickin!

It was six months after my aortic and pulmonary valve replacements (known as the Ross Procedure).I was back at work sitting at my desk when….

All of a sudden, my heart felt like it was flip-flopping and beating upside-down in my chest. Literally, my heart started doing a foreign dance. It was one of the weirdest feelings.

Then, it was gone. My heart returned to its normal beat. Sixty seconds later, I was on the phone with Dawn, the nurse of my cardiologist, Ben Rosin at Torrance Memorial Hospital. Dawn was pragmatic. She asked me to describe the sensation.

After we chatted for a little bit, Dawn was convinced it was nothing serious. She told me to call her if the heart palpitations continued. She said, “As for heart palpitations, what you can do, there really is nothing right now unless it becomes very frequent. So you know Adam, most people have heart palpitations every once in a while – even if they did not have heart valve replacement surgery.”

Guess what? Dawn was right.

In fact, Harvard Medical School just released an interesting story on heart palpitations in the Harvard Heart Letter. Here is a snippet from the story:

Palpitations—the sensation that the heart has started to race or pound, or feels like it has skipped a beat—are usually caused by a harmless hiccup in the heart’s rhythm. Sometimes, though, palpitations reflect a problem in the heart or elsewhere in the body. Sorting out worrisome palpitations from harmless ones isn’t always easy, reports the September 2007 issue of the Harvard Heart Letter.

So you know, heart palpitations are extremely common. Different people experience them in different ways. You might feel as though your heart is fluttering, throbbing, flip-flopping, or pounding, or that it has missed a beat. Palpitations can appear out of the blue and disappear just as suddenly. Or they might be linked with certain activities, events, or feelings. Some of the most important pieces of information that can help your doctor in pinning them down is how palpitations feel, how often they strike, and when they occur.

Some palpitations result from premature contractions of the heart’s chambers or malfunctions of a heart valve. But a patient physical exam and electrocardiogram often don’t turn up any problems, which can be frustrating to the patient — especially after surgery. If your palpitations aren’t accompanied by dizziness or other symptoms and if you don’t have a valve disorder or other structural problem with your heart, that usually means palpitations are benign.

• The Harvard Heart Letter suggests that if you have unexplained palpitations, start with simple steps to help alleviate them. Cut back on caffeine, smoking, and alcohol; avoid over-the-counter decongestants, eat and drink regularly, get enough sleep, and find a way to relax if you are stressed. In some cases, your doctor may recommend medications or a procedure to correct errant electrical signals in the heart.

Well I hope this helps explain a little more about heart palpitations after surgery.

Keep on tickin!

I just received an email from Roger, a recent Ross Procedure patient and reader of my book. Roger raises some interesting points, so I thought I would include this as an email bag blog. Roger’s comments and questions are:

I am now 20 weeks post op and I just had my annual physical today with my family dr. BP 116/70, heart rate in the 70s, blood work good so that all seems reassuring. I am back to running about 3.5 miles at a 10 min pace. Per your suggestions, I have been monitoring my heart rate while running and trying to keep that in the 150 range.

It seems like I improve slowly but steadily. The doctor did say that I have a heart murmur which he said is perhaps normal after this type of surgery but he has never seen a Ross patient, so I was curious if you have a murmur or if you know whether that is a normal situation.

I remember one time you mentioned to me that you still listen to your heart so I figured you would know. Your feedback is appreciated as I am obviously still very paranoid that something is going to go wrong. I feel like I am about 85% back to “normal” feeling. How long does it take to feel completely recovered?

My Response To Roger…

Let me start with a virtual “high-five”! It must feel great to be running again. And, it seems, given your age and recent heart surgery, your system is definitely healing and responding to your desire to recover from your Ross Procedure operation.

From prior emails, I know you can go into the “Something Is Wrong Here!” mode, right? But, let me assure… If something was wrong, I highly doubt your cardiologist or surgeon would encourage you to walk 3.5 miles, let alone, run 3.5 miles.

That said, I know what it is like to be paranoid by the “What’s Wrong Here?” mentality that dominates patient’s brains during the recovery. FYI, it’s been 21 months since my Ross Procedure and I still sometimes think “something is wrong” with my heart.

As for the heart murmur you mention above, I too had a tiny murmur following my aortic and pulmonary valve replacements.

From what my cardiologist told me, that is common. If I remember right, Dr. Rosin told me that the tiny murmur may be caused by sutures around the new heart valve. Interesting though. My murmur has since gone away. Maybe that will happen to you as well.

Regarding your final question, “How long does it take to fully recover from open heart surgery?”

That is a toughie. I would encourage you to go back and re-read the beginning of Part IV of my book. The process of healing is very personal. In a recent survey I just completed, some patients feel fully recovered after eight weeks. Some patients feel fully recovered after sixteen weeks.

Me? I didn’t feel fully recovered until I entered the Pacific Ocean with my surfboard. That was 435 days after surgery!!! For me, that was the moment that I considered my recovery complete! If you would like to read about that moment, I memorialized it in this blog about surfing after heart valve surgery.

One more point, I felt even more recovered when I Scuba dived during my honeymoon in Fiji a few weeks ago.

That said, you may want to create some form of milestone to help you during this process. If you were to complete one physical activity that would signify your recovery completion, what would it be????

Let me know. I would love to support and encourage you.

Keep on tickin!

Leading up to my heart valve surgery, I had always been active and athletic. From soccer to surfing, I really enjoy sports. Mostly, I think I like being outside. But, I also like the endorphin rush after a good run, swim or hike.

Adam Pick At Cardiac Rehab Class
(Torrance Memorial Hospital, California)

Interestingly enough, I was never really interested in monitoring my heart rate during the first 35 years of my life. Then… I had my open heart surgery.

Guess what? From then on, I became a little more interested in the pattern of my heart beats. I really became good at heart rate monitoring during my second month in cardiac rehab. Thanks to the excellent help of Debbie, Karey and Socorro at the Torrance Memorial Cardiac Rehab Clinic, I was able to get a solid understanding of how and when to (i) increase my heart rate and (ii) decrease my heart rate.

To help me, I purchased an inexpensive heart rate monitor. I believe you can get heart rate monitors at most sporting stores (Sport Chalet, Big Five) or Wal-Mart. I just looked at Amazon. If you want, click below and you will be taken straight to Amazon’s heart monitor section.

• Heart Rate Monitors At Amazon.com

I think my heart monitor cost $40. From what I hear, you should not buy an expensive model. Most of the monitors (e.g. Polar) all use the same technology.

Keep on tickin!