Heart palpitations – causes and symptoms of the epidemic of the XNUMXst century

Proven content

Seemingly innocent palpitations may be a symptom of an often fatal disease, known as the epidemic of the XNUMXst century. – Therefore, any disturbing change in heart rhythm must be consulted with a doctor – says prof. Łukasz J. Szumowski head of the Department of Heart Rhythm Disorders, Institute of Cardiology in Anin.

– Is heart palpitations dangerous?

– Yes. If we feel palpitations, it is worth visiting your family doctor or cardiologist. The basic examination is an interview, auscultation of the heart, measuring the pulse and EKG.

– But everyone experiences heart palpitations.

– Our hearts beat steadily at a rate of 60-80 beats per minute. During sleep, the frequency is lower and amounts to 40–60, and during exercise it increases to 90–180 beats per minute. The heart also beats faster when we are afraid, nervous or excited. Then we say it knocks, but it beats steadily. However, in the case of atrial fibrillation, they tremble 400-600 per minute, and the rhythm of the ventricles, or colloquially the heart pump, is irregular and may vary from 50 to 190 per minute. Patients experience this as palpitations. Therefore, any changes in the heart rhythm, not caused by an emotional state or exertion, should be consulted with a doctor. Unfortunately, atrial fibrillation can also be too slow or even normal heart rhythm and patients do not feel that they have arrhythmia.

– Does any palpitations that are not caused by an emotional state or due to exercise mean that we have atrial fibrillation?

– Not. Heart palpitations, incl. atrial fibrillation can cause electrolyte disturbances, e.g. lack of potassium, and this happens with diarrhea, vomiting, but also after consuming more alcohol. We even distinguish such ailment called the Saturday night syndrome, one of the symptoms of which is heart palpitations due to electrolyte disturbances, dehydration and the toxic effect of alcohol and other stimulants. Atrial fibrillation can be caused by dehydration on hot days. If palpitations have occurred once and the cause is known, such as diarrhea, and what is more, it can be avoided – such as excessive alcohol consumption, then this is less disturbing than palpitations without a valid, removable cause. In addition, palpitations can be a symptom of many other arrhythmias and must therefore be diagnosed.

– Why is there so much talk about atrial fibrillation now? Ever since medicine began to notice a link between the regularity of the heartbeat and health?

‘Socrates must have known about this connection by now. Ancient Chinese medicine also relied on measuring the pulse for a large number of diagnoses. This is not unfounded, as many diseases are manifested by changes in the heart rate. Even fever changes them. Poles also play a part in heart rate research. During the Renaissance, Polish professor Józef Struś, teaching at the University of Padua, wrote the first dissertation on the pulse. He described its changeability during anger, sadness, fear and joy. However, it was not until the beginning of the XNUMXth century that the development of an electrocardiograph made it possible to precisely study the rhythm of the heart and its disturbances. Today, various methods of treating flicker and preventing its complications, sometimes very serious, such as a stroke, have appeared, so doctors are trying to publicize this problem.

– Why do we say the atria flicker?

“The idea came from the fact that during cardiac surgery, a glistening wet heart was noticed, when it started to flicker, it did not contract regularly, but it trembled and reflected the light of the surgical lamps, like the undulating surface of a lake. Reflected light sparkled and flashed.

– Why does the heart start flickering?

– Atrial fibrillation is a disturbance of the heart’s electrical system, which is the steady formation of electrical impulses causing the heart to contract and relax. This can be illustrated by a wave flowing on a lake. The work of a healthy heart can be compared to its steady hitting the shore of a lake. However, if it hits three or four islands, it collapses and produces many waves flowing in different directions. The more a patient has a damaged heart muscle, the more islands the wave encounters. Additionally, there are snipers lurking at the lake, shooting at the waves. Their arrows are the result of electrical discharges from the pulmonary veins. Such lightning can cause chaos, and therefore flicker.

– Until now, we have been threatened with a heart attack, now it is said that atrial fibrillation is also dangerous. Why?

– That’s true. More and more of us get this disease. Currently, about 400 suffer from it in Poland. people (the costs of treating this disease reach PLN 2 billion annually). It is almost as if all of Poznań fell ill. It is estimated that in 2050 there will be 1,5 million to 2 million patients. This increase is mainly due to the aging of the population, as well as the increasing number of people who are overweight, with high blood pressure, diabetes and lung disease.

– But you don’t die from flicker?

– The flicker itself is not fatal. But it is known that people suffering from this condition die twice as often. The most serious complication of flicker is stroke, which is a life-threatening condition. One-fourth of patients with blinking die shortly after a stroke, and half within a year of its occurrence. In addition, patients with fibrillation have a worse prognosis in the event of a heart attack or heart failure.

— How does flicker cause a stroke?

– When the atria are flickering, they don’t pump blood. Then it flows slower. This retention facilitates the formation of clots. Sometimes its fragment breaks off, which, along with the bloodstream, can flow to the cerebral arteriole and cause it to close, leading to a stroke, i.e. necrosis of a part of the brain.

– Does flicker only affect the elderly?

– Most often. The incidence doubles with each decade of life, reaching almost 10% in people aged 80-89. But young people can also suffer from them. It threatens people burdened with enormous effort in endurance sports – for example, runners in marathons. If, for example, we run 20 km several times a week without consulting a doctor, our heart may respond to this excessive effort with flickering. Of course, exercise is healthy, but dosed wisely.

– Is flicker diagnosis difficult?

– Is not easy. The medical history is definitely important. The only test that can show the occurrence of flicker is the ECG. The problem, however, is that it is not known when the flicker will occur. Therefore, it is best to do the test with a special device that measures the ECG around the clock. Unfortunately, it may also happen that arrhythmia occurs several times a month. The solution would be telemedicine, which is not very popular in Poland. It consists in examining the work of the heart, i.e. the ECG recording continuously for many days or weeks. The EKG machine, which is also a telephone apparatus, sends the results to the monitoring center all the time.

– A patient with flickering does not know if he is actually healthy and only sometimes he has something wrong, or if he is sick and only sometimes he is okay. So how should it be treated?

– Until recently, we did not know how to treat flicker. Patients are given antiarrhythmic drugs to balance their work. The effectiveness of these drugs reaches 30%. They also have many side effects. Recently, a procedure called ablation has been used, with an efficiency of up to 80%. To perform ablation, electrodes must be inserted through a femoral vein or artery into the heart. When an arrhythmia focus is successfully registered, the tip of the electrode is heated to approximately 60 ° C to permanently burn the arrhythmic site. Unfortunately, there are few specialists in Poland who perform this procedure, so even though we have 400. of patients, about 1000 ablations of atrial fibrillation are performed annually.

– It’s not much. Do the indications for surgery limit the number of patients?

– Not really. Given that flicker destroys the heart, which can be briefly described as follows: flicker causes flicker, the sooner the patient is ablated after being diagnosed with the condition, the better. However, the procedure takes up to XNUMX months.

– Is ablation a dangerous procedure?

– Complicated, but, contrary to appearances, not burdened with a high risk of complications. It can even be performed by pregnant women and young children. Atrial fibrillation ablation is done in patients without thrombus, but those who have not had irreversible damage to the atrial muscle have the best chance.

– So what treatment does the doctor start after diagnosing flicker?

– First of all, he must assess the risk of a stroke and, if there is such a risk, start anticoagulant treatment, i.e. to prevent the formation of blood clots. Patients treated with an anticoagulant have been shown to have a much lower risk of stroke.

— Are anti-clotting drugs safe?

– The benefits of taking these drugs are enormous – they prevent strokes in over 70%, and remember that about 30% of them die in the first month, and in another 70% – disability! Obviously, such treatment (decreased clotting) may predispose to bleeding. The most common ones – from the gums or from the nose, do not directly threaten the patient’s life, but there may also be those that are a serious threat. Therefore, taking medications that have been used so far (vitamin K antagonists) requires constant monitoring of blood clotting. Usually, the patient will have to do a blood test once a month to check the degree of clotting. However, this is not all, because clotting can be changed not only by other medications taken by the patient, but even by the food he was eating. However, new drugs have appeared (e.g. rivaroxaban or dabigatran), the taking of which does not require continuous coagulation control. These drugs are also safer in terms of bleeding. Unfortunately, they are still relatively expensive.

— However, they prevent clotting?

– Yes, and that is why patients taking these drugs are largely protected against the occurrence of a stroke, they can live normally, perform all household and work related tasks. They should be careful not to get a head injury, because it is difficult to stop the bleeding while the medicine is working. It is therefore recommended that they do not engage in extreme sports, ride a bike or use helmets on skis.

— Is it worth risking such bleeding to prevent a stroke that may not happen?

– Certainly so. The risk of having a stroke is much greater than that of a head injury. Atrial fibrillation almost fivefold increases the risk of stroke.

— How can we combat the epidemic of atrial fibrillation?

– Prevention of the disease is primarily the prevention of predisposing factors – hypertension, diabetes, ischemic heart disease by maintaining a healthy body weight, stopping smoking, practicing sports and a proper diet. It is also important to get diagnosed with atrial fibrillation. That is why it is worth consulting a doctor every palpitations and having an ECG once a year. If diagnosed flicker, it needs treatment and stroke prevention. Patients should have access to modern drugs to prevent stroke. The importance of this problem can be proved by the fact that the World Charter of Patients’ Rights with Atrial Fibrillation was created. A document created by a committee composed of several patient organizations from around the world and supported by several dozen such organizations around the world, including three Polish, incl. the Heart for Arrhythmia Foundation www.sercedlaarytmii.pl. The card promotes solutions that will improve the situation of patients with flicker and help prevent the dangerous consequences of this disease – such as a stroke. More about the card at www.signagainststroke.com (there is a Polish language version). Originators believe that with broad support, they will be able to convince policymakers to do something about the topic.

Medical consultation: dr Radosław Sierpiński, Heart for Arrhythmia Foundation