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Medical Edge Newspaper Column from Mayo Clinic
MISSED HEARTBEATS AS LITTLE RED FLAGS
DEAR MAYO CLINIC: I have a cardiac problem. My heart often misses a beat, causing me to be lightheaded and short of breath. What treatments are available for this condition? — Morristown, N.J.
ANSWER: A missed heartbeat is usually an extra beat between two normal beats. Given the pause that follows this premature beat, it just seems as if one were missed; and because the heart’s lower chambers fill with a greater-than-usual amount of blood during the pause, the next regular heartbeat can feel like a bit of a jolt. But a perceived missed beat can also be an actual missed beat. Either way, the sensation is the result of a fleeting irregularity in the heart’s electrical system, which provides heartbeat-initiating impulses.
Such missed beats are generally harmless. Remember that a person’s heart beats about 100,000 times a day, or more than 2.5 billion times during an average lifespan. Because it is not driven by an atomic clock, the intervals between all these beats will not be identical. In this case, no treatment is required, although your doctor may suggest some lifestyle changes: reducing or eliminating caffeine, alcohol and tobacco; limiting high-stress situations or overly vigorous exercise; and stopping the use of certain drugs. These practices are known to induce heartbeat irregularities.
Persistent missed beats could signal a more serious underlying condition that warrants immediate medical attention. This possibility is heightened when the irregular beats are accompanied by symptoms such as the lightheadedness and shortness of breath that you mention. These may be related to diminished blood output from the heart.
I do not mean to alarm you. Whatever is causing your symptoms could be totally benign. But from the modest amount of information presented, we have no way of knowing.
It’s best to regard missed heartbeats as little red flags, warning us that something is not quite right and that the situation should be investigated. A thorough medical history and physical exam — including an electrocardiogram (which records the electrical signals that trigger heartbeats) and echocardiogram (which images the heart and its motions through the use of sound waves) — should be done.
Your doctor may also ask you to carry a loop recorder — a small device activated by the patient to gather data on the missed beats, and accompanying heart activity when the event occurs. These tests can be invaluable in revealing the structure and function of the heart, thus allowing us to better distinguish the dangerous from the benign.
If the results of such an evaluation are negative, they provide peace of mind: You can be reasonably confident that your heart is normal. If the testing reveals abnormalities, your physician can recommend the best treatment for managing or eliminating the problem.
— Gregory T. Altemose, M.D., Cardiology, Mayo Clinic, Scottsdale, Ariz.
Additional Resources:
Cardiovascular Disease
Appointment Information
More Information from the Heart Center
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© 2006 TRIBUNE MEDIA SERVICES, INC.
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