SELF-HELP

I occasionally get palpitations. Now that I am approaching 50 are they going to get worse?

The first thing to do is not to panic. Your doctor will have already told you about not smoking and not drinking excess caffeine or alcohol. As you get older it is a good idea also to try and keep your weight down. Make sure that you:

• take regularly any tablets you have been prescribed;

• attend your doctor for regular checks;

• report any change in how you feel.

I have just had three attacks of palpitations in a week, which made me very worried. By the time I got to see my doctor, they had gone away. What should I do if I get another attack?

When you experience palpitations, take deep breaths and try to relax. If you feel faint, sit down or lie down with your feet up. Try doing a deep cough. If the palpitations are missed beats or rapid beats, and you feel unwell or know that you have a heart condition, let your doctor know. If you are otherwise well and just afraid, ask yourself whether any of these factors might have caused it:

• stress;

• caffeine;

• workload;

• alcohol;

• smoking;

• family anxiety or grief;

• problems at work;

• no recent holiday;

• being generally run-down and anxious.

Try to help yourself by learning to relax more and avoid stimulants to the heart.

After you have tried the first-line principles of not panicking, taking deep breaths etc., try the following procedures, designed to stimulate a nerve called the vagus nerve which can switch rapid palpitations off. These include:

• drinking ice-cold liquid or eating ice-cream, or putting your hand in a bucket of cold water;

• coughing deeply;

• blowing your nose with it pinched, as if trying to make your ears pop, for 20 seconds;

• pressing the right artery in the neck (this is known as carotid sinus massage (CSM) and needs medical instruction);

Do not press your eyes as this can be dangerous.

If rapid palpitations are a more frequent problem or cause distressing symptoms, then medication will be needed to suppress them (see the section Treatment below). Many types are available and more than one may be necessary. Just because you may need more than one medication does not mean that palpitations are dangerous, just awkward. Treatment is a bit hit and miss, so be patient and ask your doctor about any side effects.

I have heart disease and am finding that I occasionally get attacks of palpitations. Is this serious?

Missed beats in people with heart disease are not usually much to worry about but a check-up is a good idea. Those people on water pills (diuretics - see the question on diuretics in the section Risks of high blood pressure in Chapter 2), or blood pressure pills (see Chapter 2) may have a low potassium level. Although this is not a common cause of missed beats, the problem can easily be treated, so it should be considered if palpitations arise for no obvious reason when these medications are being taken. You should ask your doctor if your palpitations seem to arise for no apparent reason. Fresh fruit contains lots of potassium as does fruit juice, so the treatment is pleasant; however, it is best to avoid grapefruit juice as this affects the action of some medications.

There was something in the media about a problem with grapefruit juice interacting in some way with medications. Should I avoid the fruit or juice completely?

It is the concentrated juice that is a problem. The juice leaves the body via the liver where it shares the same breakdown system as some medications. It competes with the medications and stops them from being broken down (metabolised) so they may stay around much longer than normal and become more powerful.

I am in my sixties and have developed rapid heartbeats in the last few weeks. I like to drink with friends most evenings. Do you think I am drinking too much?

Rapid palpitations in older people may be caused by atrial fibrillation (see below). This is an irregular heartbeat caused by wear and tear but it is also more common in people with high blood pressure and those who drink a lot of alcohol. Sometimes it can be due to the coronary arteries becoming narrowed or to a thyroid problem (thyrotoxicosis).

If the rapid palpitations are other than normal speeding up (sinus tachycardia), your doctor may decide to treat you and base the treatment on how you feel. For instance, if your heart is sound and only one attack a month happens, then the main thing for you to do will be to cut down on your drinking which acts as a stimulant. Your doctor may treat you for high blood pressure.

I have tried all sorts of self-help methods but I keep getting palpitation attacks; when should I see the doctor?

Palpitations are common, mostly harmless but invariably worrying. Don't be afraid, try to understand the reasons - have a good look at how you are living and seek medical advice if there is not an obvious cause or the attacks just won't go away. If palpitations lead to symptoms of chest pain, light-headedness or blackouts, always get your doctor to check you over.

 
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