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Does Your Heart Race?

Dr. Westby G. Fisher February 25, 2010 11:00 AM This chat has ended. Thank you for participating.
Moderator (Moderator) - 10:57 AM:
Welcome! Today’s chat: Does Your Heart Race? Please start submitting your questions and Dr. Wes Fisher will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit our Cardiovascular Care Pages to obtain more information.

Dr. Westby G. Fisher (NorthShore) - 11:01 AM:
Welcome to the world famous online chat session with “Dr. Wes,” your personal electrophysiologist for the next hour. A few words about “SVT” or “supraventricular tachycardia”. The term “tachycardia” is derived from “tachy-“, meaning fast, and “-cardia” meaning “heart”. “Supraventricular” refers to heart rhythm abnormalities coming from any cardiac structure above the lower chambers (ventricles) of the heart. Specifically, it includes heart rhythm abnormalities of the (1) the two upper chambers of the heart (atria), (2) from the conduction system that connects the upper chambers to the lower chambers (ventricles) called the atrioventricular node, or “AV node” for short, and (3) abnormal congenital muscle fibers (accessory pathways) that might “short-circuit” the normally insulating fibrous valve rings that separate the upper from lower heart chambers. So go ahead and submit those questions. I'm standing by....

Caroline (Winnetka IL) - 11:02 AM:
I am a 57 year old woman and one of 5 siblings. My brothers and I recently learned we have each been diagnosed with some type of cardiac arrhythmia, but no other underlying cardiac disease. Do electrophysiologic problems typically run in families?

Dr. Westby G. Fisher (NorthShore):
Caroline- Heart rhythm abnormalities are very common, so multiple family members can have their own individual heart rhythm problem OR some heart rhythm problems can occur in families, although these are rare.

Eileen Watson (Elmwood Park,Il) - 11:04 AM:
Good day doctor, question what are the chances of heart problems, all in general as far as family history goes? Both my parents had heart issues, as well as my older siblings. What are my chances?

Dr. Westby G. Fisher (NorthShore):
Eileen - There are many heart problems that can be transmitted genetically: from coronary artery disease, to primary muscle disease of the heart. Each of these can cause later rhythm problems related to these other disorders. Without knowing the specific problem(s) of your siblings, its pretty hard to say what YOUR chances are. If there are concerns, I'd suggest you consult your doctor about the specifics.

Nicolas Vilt - 11:07 AM:
I haven't been diagnosed with SVT in 5 years since the surgery. But my heart races out of the blue but it seems to happen more often! What should I do?

Dr. Westby G. Fisher (NorthShore):
The simplest test to diagnose and SVT is an electrocardiogram, also known as an “ECG” or “EKG,” but this requires you to have the rhythm at the time of this 12-second test. If your symptoms occur very sporatically, then a 30-day event recorder (a small device about the size of a pager with two electrodes) can be worn to capture the rhythm. For VERY infrequent episodes, there are even implantable devices that might be able to capture an event that last up to three years. You should be able to get your answer from one of these tests in conjunction with your doctor.

CJ (La Grange, IL) - 11:09 AM:
My 22 year old daugher has complained of a racing heart since she was young. Should she have a more thorough cardiac exam? We have been told it's panic attacks (she has high anxiety). Could it be something more?

Dr. Westby G. Fisher (NorthShore):
I can't tell you how many people I have seen that have had their problem ignored this way, only to find that a real issue existed. There are plenty of non-invasive monitoring tests that can correlate your daughter's symptoms to her heart rhythm at the time that can determine if there is a problem (see the "event recorder" - also known as "loop recorder" - above).

NIki (Highland Park, IL) - 11:11 AM:
What is the first thing to look for in determining an abnormal heart beat?

Dr. Westby G. Fisher (NorthShore):
Niki- A “palpitation” is an abnormality of heartbeat that causes a conscious awareness of its beating, whether it is too slow, too fast, irregular, or at its normal frequency. People who perceive their heart is suddenly beating rapidly (whether the beating is regular or irregular) in a continuous fashion may have a form of SVT. If the rhythm occurs intermittently, doctors will sometimes use the term “paroxysmal SVT” or “PSVT” for short. Doctors rely on history, physical examination and simple, non-invasive tests (mentioned earlier in this chat) to determine if there is aheart rhythm problem and what might be causing it.

Marion Sagan (Evanston IL) - 11:13 AM:
I'm trying to learn more about my newly diagnosed heart condition- a type A fibrillation. What should I know?

Dr. Westby G. Fisher (NorthShore):
Marion - I think you might mean the heart condition called "atrial fibrillation." We have a pretty good video online on our NorthShore website (found at http://www.northshore.org/afib) that reviews the cause and treatment issues associated with that form of "SVT." I'd direct you there for starters...

David (Northbrook IL) - 11:16 AM:
After a pacemaker is installed, will you still have the fast heart rate. What is the function of the pacemaker?

Dr. Westby G. Fisher (NorthShore):
David - Pacemakers only prevent the heart rate from going too slowly and keep the heart beating at a minimum heart rate. Some people have heart rhythms that go fast at times and very slow at times. For these people, sometimes a pacemaker is installed to support the slow rhythms so the doctor can add medications safely to treat the fast rhythms. If these same people cannot tolerate the medications to slow the heart rhythm after the pacemaker is in place, a cardiac electrophysiologist (a "heart electrician," if you will) will sometimes burn (ablate) the connection point between the upper and lower chambers of the heart so the fast upper chamber rhythms cannot drive the lower chambers too fast, thereby rendering the person pacemaker-dependent so their heart rhythm will be driven only by the pacemaker. This makes the heart rhythm perfectly regular and it should never race again.

Nancy (Las Vegas, NV) - 11:23 AM:
I was diagnosed with SVT at age of 22. All of my EKG's have subsequently come up abnormal since then. In the last year, my heart will now be at a constant rate of over 100. I've seen 3 cardiologists who have all told me it's nothing. I have occasional PAC's but nothing bad. Is this something to worry about? Should I find another doctor?

Dr. Westby G. Fisher (NorthShore):
Nancy - It never hurts to get a second opinion, but it looks like you've done that and it's hard to know exactly what's been done. It is rare to have the heart rate "constantly" over 100 - particularly during sleep. I have seen this occur in women who might be anemic, or on other medications that can drive the heart rhythm up. In other words, the heart is a pretty adaptive organ and makes sure your body gets the blood flow it needs if other things outside the heart are occurring. Also, while very rare, there are some disorders that involve the neurologic system that can affect the heart rate. Hope that helps a bit.

NIki (Highland Park, IL) - 11:28 AM:
How do you know when your heart racing is important enough to see a doctor?

Dr. Westby G. Fisher (NorthShore):
Niki- If it bothers you, get it checked with your doctor. It might be nothing or (yeah, I know, this sounds obvious) it might be something. Either way, you'll sleep better.

Kris (Chicago) - 11:33 AM:
How does the physician evaluate palpitations?

Dr. Westby G. Fisher (NorthShore):
Kris- It depends how often they occur. If they're happening all the time, then an EKG with a "rhythm strip" printed out as they're occuring might suffice. If they occur every day but not at the time of the office visit, then sometimes we order a 24-hour EKG recording called a "Holter monitor." A Holter records every heart beat for 24 hours. If the palpitations occur every several days or weeks, then we'll obtain an "event recorder" (also called a "loop recorder") described earlier in this chat. This device is usually issued for 30-days and is worn all of the time and has a button that, when pushed, will send the heart rhythm that occurred one minute before and one minute after the button was pushed (since it is continuously recoding the heart rhythm in its memory). This recording is then transmitted via an 800-number to a 24-hour central recording center that prints the strips and sends them to us for evaluation.

Lisa (Northbrook, IL) - 11:39 AM:
I have a friend who has a pacemaker as of about 4 years. He has instances of a rapid heart rhythm that zaps his strength for the day. The attacks are coming more frequently. What can be done if anything?

Dr. Westby G. Fisher (NorthShore):
Lisa- Often there are rate-control or antiarrhythmic medications than can be added to your friend's medicines to can help prevent those bothersome episodes. On rare occassions, minor pacemaker programming changes can help improve symptoms as well.

Niki (Highland Park, IL) - 11:41 AM:
I sometimes have panic attacks, and my heart will race-is it logical to assume that I am experiencing palpitations?

Dr. Westby G. Fisher (NorthShore):
Yes. But not all palpitations imply there is a problem with the heart. Palpitations can be perceived in normal instances (like feeling the heart pounding before public speaking engagements or on-line chats) :)

Dr. Westby G. Fisher (NorthShore) - 11:43 AM:
15 minutes more! Boy does time fly when you're having fun....

Dr. Westby G. Fisher (NorthShore) - 11:45 AM:
I should mention one more thing as I wait for another question: Almost always, single skipped heart beats, irrespective of cause, are benign. Typically, the shorter the episode of fast heart beats, the less concerning they are to doctors. But brief “flutters” that are long enough might require treatment, particularly if they make you lightheaded or cause you to pass out. Any palpitations that cause lightheadedness or loss of consciousness should always be brought to the attention of your doctor and should be evaluated.

Marion Sagan (Evanston IL) - 11:46 AM:
How common is PSVT? Is there a video on it at the AFib site you previously mentioned?

Dr. Westby G. Fisher (NorthShore):
Marion- SVT is very common in all of its various forms. The most common "SVT" is atrial fibrillation that is more common in seniors, occuring in over 2 million Americans. The Heart Rhythm Society (our professional organization) has some great additional information on the various forms of SVT that are credible and good resources. in general other forms of SVT are commonly quoted to occur as often as 1 in 1000 people. Unfortunately, we do not have a video for PSVT yet.

Moderator (Moderator) - 11:51 AM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

NIki (Highland Park, IL) - 11:54 AM:
Why does alcohol cause racing of the heart?

Dr. Westby G. Fisher (NorthShore):
Alcohol is a diuretic. As such, it causes people to lose intravascular volume. In response to this drop in volume, the heart increases its flow by first increasing the force of contraction with each heart beat, then later by increasing the heart rate to make sure blood pressure is maintained to the head.

Dr. Westby G. Fisher (NorthShore) - 12:02 PM:
Alright folks, looks like things are coming to an end. Thank you so much for submitting your thoughtful questions. Have a great day!

Moderator (Moderator) - 12:02 PM:
Thank you again for participating in our chat today. For more information please visit our Cardiovascular Care Pages

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