Heart palpitations, the uncomfortable awareness of heartbeats, are a common complaint. For no apparent reason, one may feel a short burst of rapid heartbeats. At times one may feel that the heart skipped a beat or two, or there may be awareness of having a very slow heartbeat.
People vary a lot in their ability to feel their heartbeat. Some people are entirely unaware of it, even if it's very irregular. Others notice, and dread, one unusual beat in a 24-hour period. Your child's doctor must determine when palpitations are a threat to your child's health and when to treat a problem.
Infrequent palpitations or skipped heart beats that start in the lower chambers of the heart are called premature ventricular contractions. In the upper chambers, they are called premature atrial contractions. Both may be findings in normal people. If they are frequent, they may be associated with underlying heart disease such as muscle disease of the heart (called cardiomyopathy), tumors, or inflammation of the heart (myocarditis). There may be an underlying in the chemical imbalance or drug use, which in turn is the cause of the rhythm abnormalities.
Some palpitations are normal after exercise, emotional upsets or stress. Some may be caused by nicotine, coffee or other drugs.
Doctors can help determine if the palpitations are dangerous. They can also help determine if the unusual heartbeats are starting in the upper or lower chambers of the heart. If the palpitations occur while visiting the doctor, an immediate electrocardiogram can make the diagnosis.
Unfortunately, most palpitations occur when a doctor is not around. However, there is a test that can record your child's heart's electrocardiogram for 24 to 48 hours or even longer. This test is called ambulatory electrocardiographic monitoring (AEM), or Holter monitoring. AEM continuously records the activity of your/your child's heart on a tape cassette. Your child will place marking signals on a tape by pushing a button on the recorder when you/your child feel palpitations. Later, your child's doctor can review the tape and identify the type of palpitation and where it came from in your child's heart.
Other types of tests called event recorders are worn for several weeks and only record the rhythm for a short period after a button is pressed. This recording is then sent over the phone to the cardiologist's office for interpretation. This allows the detection of abnormal heart rhythms that do not occur very often or do not last long.
Some patients have frequent or prolonged runs of palpitations. Most palpitations are just nuisances and interfere with comfortable living, but some are potentially dangerous. Runs of palpitations are sometimes called supraventricular tachycardia (SVT) if they come from the upper chambers of the heart or ventricular tachycardia (VT) if they come from the lower chamber of the heart. The latter may sometimes be more concerning in adults as they can rapidly change into a more life-threatening rhythm abnormality such as ventricular fibrillation which may cause loss of consciousness and sudden death.
In children, however, the long-term effect may be similar to SVT. Although they may not be life-threatening, when they are too frequent or lengthy, these rhythm abnormalities need treatment to allow normal lifestyles and to prevent heart muscle damage.
Reducing or eliminating the caffeine in your child's diet and reducing stress can help to lessen or stop palpitations. Many people feel so relieved after they hear palpitations are nothing to worry about that they no longer feel frightened when the palpitations occur.
If your child's palpitations are not serious, your child's doctor may decide not to treat them. If your child does need or want treatment, the decision of how to treat the palpitations is based on several factors. The type of palpitations, the potential seriousness, the side effects of drug treatments, and your concerns will be taken into account.
Most palpitations are treated with drugs. Sometimes several drugs must be tried before both you and your child's doctor are satisfied.
Some types of palpitations, certain types of tachycardia, may not respond well to long-term drug treatment. If drug treatment fails, a treatment called ablation may be used. Radiofrequency ablation uses heat in the form of radiofrequency waves to destroy a tiny portion of your heart muscle. This usually permanently stops the palpitations. If drug and ablation treatment fails, devices implanted in the heart may be placed to pace the heart out of the abnormal heart rhythm.
Unwanted side effects from the drugs are the most common problem. Some of the drugs may actually make the palpitations worse. Other symptoms may include fatigue, cold hands and feet, skin rashes and blood-clotting abnormalities. Sometimes side effects prevent the use of a drug. Ablation treatment is not always successful and may need to be repeated.