FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SKIPPING A BEAT IS NOT A "DEAD AIM" ON HEART DISEASE

Question: I've noticed that my heart skips a beat now and again. Sometimes, I even feel a little faint or dizzy when this happens. My doctor doesn't seem very concerned. Should I see a cardiologist or just trust my family doctor's judgment?

Answer: The heart is a very strong muscle whose regular contractions shake the entire body. Most of the time we pay no attention to this rhythmic shaking, but at times the heart action becomes quite apparent. One of my hobbies is target shooting, and it makes me just like every other shooter acutely aware of the shaking generated by a normally beating heart. The cross-hairs swing back and forth past the bull's-eye because the heart shakes the shooter and the rifle.

Most people sense their heart beating what doctors call a palpation at times other than when they are trying to hit a dime-sized target 100 yards away. Such palpations can be due to an irregular heart beat caused by emotional tension, too much caffeine, or both. Also, a healthy heart takes a break from its series of regular contractions as often as six times each hour. This irregularity is often described as a "skipped beat" or an "extra beat." A sudden awareness of this normal process is the most common cause of a palpation.

This awareness often creates considerable anxiety about heart disease, which makes the person even more aware of his or her heartbeat and further increases the anxiety level. I suspect that a heightened anxiety level and worries about heart disease are what prompted you to write me. Fortunately, a palpation rarely indicates life-threatening heart disease.

However, there are some serious conditions that cause the heart to beat irregularly. While heart disease is among the most worrisome of these, there are other possible causes, including: An over-active thyroid gland, lung disease, anemia and lymphoma. To discover the cause of your problem, your doctor will start by taking a medical history, performing a physical examination and ordering blood tests. He or she will also order one or more of the following four tests.

An electrocardiogram (best known by its initials, ECG or the older German initials, EKG) only records a few seconds of heart activity. Nonetheless, it is an essential test to see how well the heart is working, even if your heart doesn't "skip a beat" while it is being taken.

A Holter monitor can record information much like an electrocardiogram, but it is small enough to be worn and can record for a longer period usually for 24 or 48 hours. During this longer recording time, it is much more likely that your heart will skip a beat.

An echocardiogram creates a picture of the heart walls and chambers by bouncing ultrahigh frequency sound waves through the chest and having a computer listen to the echoes as they bounce off the heart walls. The computer uses these echoes (hence the name echocardiogram) to draw a picture of the heart that is quite accurate at identifying certain types of heart problems.

An exercise electrocardiogram, also called a stress test, is an ECG that's done while the person exercises, usually by walking on a treadmill. This shows how the heart responds under increasing demands of physical work.

Through a careful history and physical examination as well as the use of one or more of these tests, your family doctor should be able to determine if your palpations are the result of a serious disorder or not. However, if you are still uncomfortable with your symptoms or with your doctor's evaluation of your symptoms, it would be quite appropriate to seek the consultation of a cardiologist. And, be sure to take copies of any tests done by your family doctor with you when you see the cardiologist. This will aid him or her in evaluating your heart condition, while helping to hold down the cost of health care by avoiding unnecessary duplication.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.