Palpitation medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Medical Therapy
Treating heart palpitations depends greatly on the nature of the problem. In many patients, excessive caffeine intake triggers heart palpitations. In this case, treatment simply requires caffeine intake reduction. If it's been determined that caffeine is not the cause, another dietary consideration is too little magnesium, particularly in pre-menopausal women. A supplement of equal dosages of magnesium and calcium may be helpful in eliminating palpitations. For severe cases, medication is often prescribed.
A variety of medications manipulate heart rhythm, which can be used to prevent palpitations. If severe palpitations occur, a beta-blocking drug is commonly prescribed. These block the effect of adrenaline on the heart, and are also used for the treatment of angina and high blood pressure. However, they can cause drowsiness, sleep disturbance, depression, impotence, and can aggravate asthma. Other anti-arrhythmic drugs can be employed if beta blockers are not appropriate.
If heart palpitations become severe, anti arrhythmic medication can be injected intravenously. If this treatment fails, cardioversion may be required. Cardioversion is usually performed under a short general anesthesia, and involves delivering an electric shock to the chest, which stops the abnormal rhythm and allows the normal rhythm to continue.
For some patients, often those with specific underlying problems found in ECG tests, an electrophysiological study may be advised. This procedure involves inserting a series of wires into a vein in the groin, or the side of the neck, and positioning them inside the heart. Once in position, the wires can be used to record the ECG from different sites within the heart, and can also start and stop abnormal rhythms to further accurate diagnosis. If appropriate, i.e. if an electrical "short responds circuit" is shown to have an abnormal rhythm, then a special wire can be used to cut the "short circuit" by placing a small burn at the site. This is known as "radiofrequency ablation" and is curative in the majority of patients with this condition.
Atrial fibrillation has been discussed in a separate article. Differential Diagnosis of Palpitation
Treatment may include medication to control heart rate, or cardioversion to support normal heart rhythm. Patients may require medication after a cardioversion to maintain a normal rhythm. In some patients, if attacks of atrial fibrillation occur frequently despite medication, ablation of the connection between the atria and the ventricles (with implantation of a pacemaker) may be advised. A very important risk of atrial fibrillation is the increased risk of stroke.
Also, palpitations are associated with an increased risk of blackouts and even premature death. Generally speaking, serious arrhythmias occur in patients who are known to have heart disease, or carry a genetic predisposition for heart disease or related abnormalities and complications.
Palpitations, in the setting of the above problems, or occurrences such as blackouts or near blackouts, should be taken seriously. Even if ultimately nothing is found, a doctor should be contacted immediately to arrange the appropriate investigations, especially if palpitations occur with blackouts or if any of the above conditions are noticed.
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