The Trumpet Medical Advisor

Patricia Naeder, RN, BS.

pat@billbaur.com/public

April, 2011 Edition ew3

~ ~ Understanding Heart Rhythms and your Lifestyle ~ ~

1 -   What keeps your heart in a normal sinus rhythm? What can cause it to go too fast, have palpitations, or go too slow or have irregular beats or rhythms?

 2 -   There are many factors that influence your heart rate and rhythm.

a.    The underlying health of your heart.

b.    Whether or not you’ve had a heart attack (myocardial infarction).

c.     Do you have a valve condition?

d.    And the one you can control the most - Your Lifestyle choices. What you eat, drink, whether you smoke or use alcohol daily, and your level of activity, which should be moderate and even throughout a 5 day week. Take two days off to allow your body to repair.

3 -   Everything you put into or do to your body makes a microbiological change in the cells of your heart and blood vessel walls. Be judicious about what goes into your body and how much stress you place on your body and mind. Things are not as harmless as you might think.

4 -   Energy drinks, smoking, food and daily alcohol use all have an effect on your body, including your heart and its rhythm. Any of the above can give you palpitations and the possibility of them galloping out of control without notice. Balance is the answer.

5 -   The causes of irregular heart rhythms can range from potassium electrolyte imbalance, alcoholism, stress, and disorders of the heart valves and vessels, to drinking too much coffee, alcohol, or energy drinks, to smoking.

6 -   What makes the heart beat? Electrical impulses arise from the sino-atrial (S/A) node in the upper right atrium and conduct to the atrio-ventricular (A/V) node which disperses the electrical messages throughout your heart to create a strong efficient pumping of blood out of the left ventricle to perfuse your body with oxygen and nutrients to keep you and your organs, including your brain healthy.

7 -   The four chambers of the heart each have a function. The upper right chamber is the electrical rhythm dictator. There the sino-atrial (S/A) node originates the electrical beat which then conducts the impulse and travels down to the atrio-ventricular (A/V) node  in the center of the heart to be dispersed over the purkinje fibers which spread out over the heart and will make the left ventricular chamber squeeze the blood out and pump it out to the rest of the body, carrying oxygenated blood, with nutrients  to nourish your organs and entire body.

8 -   The blood is then returned to the lungs, via the veins in your limbs and torso, to be re-oxygenated through your lungs, and the beat goes on. That is the electrical conductions part of the system.

9 -   Then there is the actual health of the parts of the cardiovascular system which also influence the heart rhythm. The heart muscle itself, it’s valves and the 3 main coronary arteries can be efficient or there can be plaque in the vessels, or there can be a blockage of one of the three main coronary arteries that feed the heart. That would be a myocardial infarction or heart attack.

10 - Another issue is that there can be valve problems which are discovered by hearing a murmur when your doctor listens with the stethoscope. The leaflet flap in the valves may have damaged uneven vegetative ends that have either been stretched or been damaged by streptococcus infection from gum disease which travels directly down to the delicate heart valves, or by septicemia. The valve can also go backwards, called a prolapse, usually a mitral valve prolapse. This causes palpitations.

11 - When the valve has been infected and damaged, this causes mitral valve dysfunction because there is not a tight seal in the one way blood flow direction. There is backflow of the blood and subsequent congestion in the area. It impedes forward blood flow. These conditions are some of the many causes of palpitations and irregular heartbeats, but there are more such as lifestyle. Obesity, smoking, daily alcohol intake and too many drugs can all cause heart palpitations and arrhythmias.

What kinds of rhythms are there?

·       Well, your heart can go too fast, Tachycardia

·       Or too slow, Bradycardia

·       Or be irregular: PACs, PVCs, Atrial Tachycardia, Paroxysismal Atrial Tachycardia (PAT,) Atrial flutter, Ventricular Tachycardia, Ventricular Fibrillation, Ventricular or Cardiac Standstill

12 -Tachycardia- When your heart rhythm is going more than 100 beats per minute it is called tachycardia.

13 - When it is going less than 60 bpm it is called bradycardia. This will automatically cause extra compensatory beats.

14 -When you have an extra beat it is called either a premature atrial contraction, PAC, or a premature ventricular contraction, PVC.

15 - PAC’s or atrial beats are not usually dangerous. The biggest concern here is that blood is sporatically static and clots can form.

16 - PVCs or premature ventricular beats are more dangerous and can lead to a cascading deterioration into Ventricular Tachycardia, then Ventricular Fibrillation which can be fatal if not treated by electric shock, stat, to stop the cascade. The electrical shock can force the heart back into a Regular Sinus Rhythm.

17 -  The ventricles perform the pumping action for the body therefore life is not possible without the Left Ventricle pumping blood throughout your body. Ventricular Fibrillation is the ineffective quivering of your ventricles. It does not allow pumping of blood out to feed your body. It causes death if not converted back to Regular Sinus Rhythm by cardio-version electrical shock.

18 -This is why it is important to control what you can control in your daily lifestyle to keep your heart functioning in a healthy calm and strong manner. Excess is never good. You are not invincible yet young people and athletes think that they are. Know when to stop the over-demand on your body. Moderation in all things.

19 -  Do NOT drink an overdose of stimulating drinks such as energy drinks. They over stimulate your heart too suddenly and can quickly cause these chaotic rhythms which can be dangerous. Excess alcohol intake can do the same. Smoking does direct damage to oxygen feed too.

20 - This is why having regular visits to your Physician for all symptoms is so important.

They will do blood panels and can see your blood substances! There is no guess work.  We can see all of your electrolytes, your rbc’s, wbc’s, heart enzymes, and dozens of blood and heart indicators. Also the history tells a Physician a lot. Just listening to your heart sounds and lung sounds reveals a lot.

21 - Tachycardia: Blood carries oxygen around your body through hemoglobin. If you are not getting enough oxygen to your brain, your heart will automatically speed up to compensate for that problem.

Other causes of tachycardia are alcohol, stress, overactive thyroid, smoking and not walking and allowing your heart to pump regularly on a regular basis. Being sedentary is as dangerous as being overactive or exercising too much.

Clots can form in any vessel at any time and then they can travel. Then they are called an embolism and they can lodge anywhere- the brain, the heart, or the lungs, resulting in heart attack (M.I) or stroke (Cerebral Vascular Accident) or pulmonary embolism.

Moderate movement daily is optimal for heart efficiency. If you and your Physician feel that you need to thin your blood a little you may be told to take Vitamin E or aspirin or eat vegetables with Vit E in them, or be prescribed one of many anti-coagulants.

22 -  Stress causes the release of adrenaline/epinephrine which increases your heart rate. Avoid all sources of stress. Get away from vexatious people, situations and even your worries and bills. Take a break and relax throughout the day. Build in your breaks. Also take time away. Even a drive to a peaceful place for a long lunch will help. Make sure your lunch is low fat. Flat clogs your blood vessels and puts strain on your heart.

Another way to handle stress is to take control of it by making a list of problem solving strategies and you accomplish them your stress will diminish because you are in control of your problems, instead of the reverse.

23 -  Excess alcohol consumption changes your body’s chemistry and can cause arrhythmias. Not to mention destroying your brain, liver and causing pancreatitis, one of the most difficult to treat diagnosis with a poor prognosis.

First recognize if you are putting too much ethyl alcohol in your body. If you cannot go one or two daywith without alcohol, you are addicted. Get a 3 day detoxification in the hospital and then resolves to protect your brain, heart, liver and pancreas.

24 -  Smoking changes the oxygen level in your body and the O2 level in your blood. Smoking has also been found to cause inflammation in the walls of your blood vessels throughout your entire body including the vessels that feed oxygen to your organs. This narrowing of your blood vessel walls also raises your blood pressure and makes your heart have to work harder pushing against this increased resistance.

25 - Bradycardia, a slow rhythm can be caused by abnormalities in the S/A  and A/V nodes.

It can also be caused by interruption in the integrity of the heart muscle due to a myocardial infarction (M.I) which is a heart attack. This can change the conduction of the electrical circuitry throughout the purkinje fiber conduction system. If the electrical circuit is interrupted, the messaging needs to take a detour and this causes slower beats per minute.

When the heart rate gets too slow you can feel dizzy, weak and can faint. Also bradycardia may call for the heart to produce some compensatory extra beats. If they are pac’s they are generally harmless, but if they are pvc’s they can trigger runs of ventricular tachycardia which could be fatal. So see your physician for bradycardias. They should be treated with medication.

26 -Electrolytes influence body and heart chemistry. Potassium, Magnesium, Calcium, Sodium and Chloride all influence your body’s chemistry. So excessive running and exercising depletes electrolytes. Conversely, loading your body with highly concentrated electrolyte drinks can be toxic and overdoing it too, causing PVCs which can be dangerous. Be moderate. See your physician if you have any palpitations. Get an EKG done.

27 - Irregular rhythms of the heart fall into two anatomical categories; atrial which is the top chamber of the heart, and ventricular which is the bottom chamber.

28 - An extra beat or palpitations in the atrium is called atrial premature beat and is harmless. If the artrium has bursts of fast beats, it is called Paroxysmal Atrial Tachycardia. This needs to be treated by your physician.

This can be chronic and can cause clots because the blood can stand around too long and at irregular intervals.

29 - Another Atrial Dysrhythmia is Atrial Fibrillation. This also can allow blood clots to form because of the stasis of blood in the area. See your physician. This can be treated with medication to control the rhythm, plus aspirin or other mild blood thinners.

There are surgical interventions that can be done also, if the cause in a re-entry phenomenon causing a loop pattern of electrical conduction. This can be interrupted surgically in certain cases. See your physician.

30 - If there are atrial premature beats you may feel it in your neck, fleetingly, like a flutter. This is usually harmless. If it recurs regularly, then see your physician for a routine work-up, an EKG and some blood work.

31 - If there are PVCs in the ventricle you may feel it lower down in your chest. Singly they are no problem, but if they turn into runs, and especially if you get dizzy, they must be evaluated and treated immediately. It’s all about frequency and accompanying symptoms.

32 -When runs of ventricular tachycardia are left untreated they can deteriorate into ventricular fibrillation which is a continuous high rate of useless fluttering of the ventricles that doesn’t pump blood and its vital oxygen at all.  This is life threatening requiring emergency intervention to prevent cardiac standstill.

33 -Cardiac arrhythmias can be treated by first diagnosing the cause. If an overactive thyroid or electrical imbalance is found, or if you are overloading your body and stressing your heart with too many energy drinks then treating that can return your heart function to normal.

34 - If you are over exercising and placing excessive demand on your heart, you can modify that. If a sport is demanding excessive exercise practices, see the Coach or Principal and state that the practices appear to be excessive.

We all know that young athletes drop dead during over activity. Usually this is because they have an underlying cardiac abnormality, BUT, it can also be that the electrical circuitry cannot keep up with the abnormally high demand of over-exercising.  Common sense must be the guiding protocol regarding exercise.

The best way to become a highly effective as an athlete is exercise in moderation on a regular basis. This builds stamina. Other short bursts of excessive exercise are dangerous and unnecessary.

For older people, moderate walking to stores or parks or to run errands is excellent.

35 - In summary your heart does not want excess in either activity or in toxins put into your body. Live a clean life.  Your heart wants moderate exercise, a balanced diet with low fat, low sugar and high vegetables and some fruit, nuts, seeds and yogurt, or whatever goes with your particular health profile. Personally I don’t like overdoing the water intake. To me it strains the heart. Hydration is good, but over- loading and over-burdening your body with fluid is just not healthy.

36 - Medications can slow, speed up and regulate your heart rate. DO NOT ignore palpitations. Most of them are harmless, but some need to be fixed with a pill or two. See your cardiologist. Get your EKG, maybe an Echo Cardiogram, and your blood work and a history and physical and you will have optimum cardiac health.

Good Health to You!

Patricia Naeder, RN, BS

Medical Advisor