“Can I calm my heart palpitations with medications?”

Yes. Palpitations are usually due to ectopic beats, either atrial or ventricular. They are usually early after a regular sinus beat, followed by a compensatory pause, as the sinus rhythm resumes before the next sinus node depolarization. Patients can often feel the ectopic beat ( especially premature ventricular contractions, which are more pronounced) or the pause, which feels like a skipped beat. The other possibilities for new palpitations are short runs of sinus tachycardia and/or supraventricular tachycardia (SVT). Tachycardia is abnormally fast heart rates above 100 beats per minute. These heart rate increase are normal in everyone, but not every patient feels the rate changes. The heart rate increases with activity and exercise to elevate cardiac output ( 5-6 liters per minute at rest) to allow the heart to pump extra blood to lower body muscles above resting levels. Most patients feel palpitations at rest, when its quiet. Many patients have underlying stress or anxiety. Ectopic beats, sinus tachycardia and SVT are benign. Only true, sustained and recurring SVT require cardiac consultation to determine the type and treatment options. However, we generally recommend at least a 24 hr holter or Event Monitors to diagnose the exact etiology, to be certain its not runs of atrial fibrillation or atrial flutter. These arrhythmias require more aggressive diagnostic testing and treatment to determine etiology and prevent thromboembolic events ( strokes) from blood clots formed in the left atrium. Rarely, a patient will have a congenital anomaly in the cardiac conduction system resulting in ventricular arrhythmias which are much more serious and occasionally life threatening. However, ventricular arrhythmias are usually confined to patients with underlying damage to the cardiac muscle from heart attacks or other cardiomyopathies (abnormal heart muscle function) from various causes. In a healthy patient with no underlying cardiac diseases, the diagnosis and treatment are routine. the vast majority of patients do fine with low dose beta-blockers, such as long acting metoprolol ( toprol xl), which treat ectopic beats, sinus tachycardia, SVT and symptoms of MVP. Occasionally a a low dose of a safe anti-arrhythmic can be given to otherwise healthy heart patients, like flecainide or propafenone. Generally the causes of ectopic beats ST, SVT can be helped by lifestyle changes ( less caffeine, energy drinks, otc Sudafed containing product, diet pills, and other stimulants ). Treatment of stress, anxiety and dysautonomia may also be necessary.