Palpitations
Treatment
I have a very stressful job and find that I get really nervous. My heart seems to miss a beat when I am stressed or anxious. Is there anything that can help me?
Missed beats usually respond to self-help, perhaps with a doctor’s reassurance which might include taking an ECG at rest and recording the heartbeat for 24 hours. A lot of people, who get palpitations like this, are young and under stress, and are helped by beta-blockers which block the stimulation of adrenaline and caffeine to the heart. These can be used for a month while you try and change your lifestyle where possible, and then as required, for instance before a stressful meeting. Try not to drink too much coffee at meetings and change to decaffeinated-type drinks.
I am going for tests at the hospital next week for palpitations. Will I be offered any medication to treat irregular heartbeats?
It will depend on what type of palpitations that you are found to have. There are a large number of medications used to slow down fast heartbeats and to suppress extra beats.
• Digoxin is most often used to control atrial fibrillation. Doses vary according to how old you are and how good your kidneys are. Your body gets rid of digoxin through your kidneys so, if the kidney function is not as good as it should be,
digoxin will build up in the blood. Commonest side effects are loss of appetite, nausea and vomiting. Your doctor may check the level of digoxin in the blood 6 hours after you have taken it to make sure it is not too high or too low. If you get side effects, these will probably disappear if the dose is reduced.
• Beta-blockers are also used for controlling palpitations. They also help angina, heart failure and high blood pressure; they are especially useful if you have more than one of these conditions.
• The calcium antagonists, verapamil and diltiazem, are alternatives to beta-blockers for palpitations and, like beta-blockers, can be combined with digoxin.
Other more specific medications can be used to suppress extra beats and these include flecainide and amiodarone. These are powerful drugs, used if the simpler medications such as beta-blockers are not proving effective.
• Flecainide is effective in 30 minutes, so is often used as and when the attacks have to be stopped immediately. It is a very effective medication when taken on a regular daily basis by people whose lives are made a misery by troublesome palpitations, but it is unsafe to use it at all if you have heart failure or soon after a heart attack. It can cause nausea, dizziness, and unsteady feelings. It can be used just to stop an attack, known as ‘pill in the pocket’ so you carry it and use it when needed.
• Amiodarone is a life-saving medication for some but, because of its side effects, it is not normally used as a long-term treatment unless there is no alternative. It is very effective in the management of atrial fibrillation (see below), extra beats and dangerous palpitations, and it can be used when you have heart failure and after a heart attack. It takes some time to start working and can take a long time to leave the body.
Side effects include sensitivity to sunlight, skin reactions, lung problems and disturbances of the thyroid gland and liver. You will need regular supervision so that the doctor can check for side effects.
Amiodarone increases the action of warfarin so extra care is needed by your doctor to monitor the blood-thinning effects of warfarin, if you are taking this.
• Other drugs less frequently used and mainly alternatives to flecainide include disopyramide, propafenone and mexiletene.
All are effective drugs but side effects can be a problem. If you are prescribed any of these drugs, always read the package label and discuss the potential benefits and side effects with your doctor.
