What does a person feel and why is it so scary?
The mechanism of sensation explains almost everything. An extraordinary contraction comes too early, the ventricle does not have time to fill with blood, and the release is weak - a person often does not feel this blow at all, and there is a feeling of pause. This is followed by a compensatory pause, during which the heart fills more than usual, and the next contraction is strong and powerful. It is this that a person perceives as a blow, push or revolution in the chest. Thus, the frightening sensation of “stopping and then hitting” is not a sign of a malfunction of the heart, but a natural consequence of the normal physiology of filling.
- Feeling of freezing, failure, “missing a beat”
- A strong push or blow to the chest after a pause
- Feeling of the heart turning or somersaulting
- Brief dizziness or slight weakness during a pause
- Throbbing or pulsating sensation in the neck
- The urge to cough or the need to take a deep breath during interruptions
- Anxiety, fear, feeling of shortness of breath occurring immediately after the episode
A very characteristic feature is that the interruptions intensify at rest, especially in the evening in bed, in silence, when lying on the left side, and decrease or disappear with physical activity. This is explained in two ways: on the one hand, by the influence of the autonomic nervous system, on the other, by the fact that at rest a person simply hears his own heart better. The practical conclusion is important: if the interruptions bother you in the evening in bed and completely disappear when walking or working, this is a rather encouraging picture. The inverse relationship—the appearance or intensification of interruptions precisely under load—requires examination.
Why is this a normal option in healthy people?
The heart has its own electrical system, and cells capable of generating an impulse are not only in the main pacemaker. Sometimes some part of the atria or ventricles is excited ahead of time - this is how an extrasystole occurs. When recording an ECG on a daily basis, single extraordinary contractions are detected in the vast majority of those examined, including young, healthy, trained people. This is background electrical activity, not a disease.
- Single extrasystoles are recorded in almost everyone during daily monitoring
- Their number increases with age, and this is a natural phenomenon.
- In people with a structurally healthy heart, even frequent extrasystoles usually do not worsen the prognosis
- Supraventricular extrasystoles originating from the atria are generally safer than ventricular extrasystoles
- The absence of complaints does not mean the absence of extrasystoles, and pronounced sensations do not mean a large number of them
- Different people with the same number of extrasystoles feel completely different: perception depends on sensitivity, not on arrhythmia
The key concept here is a structurally healthy heart. This is the name given to a heart in which there are no scars after a heart attack, no thickening or stretching of the walls, no significant valve defects, and contractility is preserved. This can be determined by echocardiography together with an ECG and examination. If the heart is structurally healthy, extrasystole in the vast majority of patients is considered a benign condition, and the main task of the doctor in such a situation is not to prescribe treatment, but to convincingly explain this to the patient.
When Outages Really Need Attention
The danger is not associated with the extrasystole itself, but with the soil on which it occurs. The same changes on the cardiogram in a young man with a healthy heart and in a patient who has suffered a heart attack mean completely different things. Therefore, there is a fairly clear set of signs for which an examination is mandatory and should not be postponed.
- Обморок или предобморочное состояние на фоне перебоев — самый значимый признак, требующий обследования в ближайшее время.
- Появление или усиление перебоев именно во время физической нагрузки, а не в покое.
- Известное заболевание сердца: перенесённый инфаркт, кардиомиопатия, порок клапана, сниженная фракция выброса.
- Сочетание перебоев с одышкой, отёками, болью в груди или снижением переносимости нагрузок.
- Случаи внезапной смерти в молодом возрасте у близких родственников.
- Переход единичных перебоев в приступы частого сердцебиения, длящиеся минуты и часы.
- Очень большое количество экстрасистол по данным суточного мониторирования, особенно при появлении жалоб на утомляемость и одышку.
Separately, it is worth highlighting attacks in which the heart begins to beat quickly and rhythmically, “as if an engine is starting,” with a clear beginning and an equally clear ending, sometimes with darkening in the eyes and the urge to urinate after the attack. This is no longer an extrasystole, but a different type of arrhythmia, and it requires a separate examination. The same is the case with a completely uneven, chaotic pulse that persists for a long time - this is a possible sign of atrial fibrillation, and it requires not only treatment of the rhythm, but also an assessment of the risk of stroke.
What causes interruptions: coffee, alcohol, lack of sleep, stress
For most patients with a healthy heart, the interruptions are related to lifestyle, and this is good news, because a lot depends on the person himself. The influence of provoking factors is easy to check: it is enough to consistently eliminate them for two to three weeks and evaluate the result, rather than trying to remove everything at once.
- Caffeine: coffee, strong tea, energy drinks, and pre-workout supplements containing stimulants
- Alcohol is one of the most reliable provocateurs; interruptions and rapid heartbeat occur especially often the day after a feast
- Lack of sleep and disrupted sleep patterns, night shift work
- Psycho-emotional stress and anxiety conditions
- Smoking and nicotine-containing mixtures
- Dehydration and loss of electrolytes due to heat, intense exercise, diarrhea
- Potassium and magnesium deficiency, including when taking diuretics
- Diseases of the thyroid gland, especially increasing its function
- Anemia, as well as overeating and a large dinner before bed - a full stomach often provokes interruptions through the diaphragm
- Certain medications, including some cold remedies, bronchodilators, and weight loss medications
Sleep apnea syndrome is worth mentioning separately because it is almost never thought about. Stopping breathing during sleep causes episodes of oxygen starvation and sudden surges of adrenaline, which provoke rhythm disturbances specifically at night and in the morning. If a person snores, wakes up groggy, experiences daytime sleepiness and is overweight, and interruptions occur mainly at night, testing for apnea can solve the problem more effectively than any antiarrhythmic drugs.
Examination: why do you need a holter?
A standard ECG is recorded for about ten seconds, and the likelihood that an extrasystole will occur during this time is low. Therefore, a normal cardiogram with complaints of interruptions does not mean that they do not exist - it simply did not have time to record anything. Circadian monitoring records the rhythm continuously for a day or more, covering sleep, work, stress and rest, and answers several questions at once that are important for tactics.
- Сколько экстрасистол происходит за сутки и какую долю они составляют от общего числа сокращений.
- Откуда они исходят — of предсердий или желудочков, of одного очага или of нескольких.
- Как они распределены во времени: преобладают ночью и в покое или при нагрузке.
- Есть ли более серьёзные нарушения ритма, которые пациент не ощущает: пробежки тахикардии, паузы, эпизоды мерцательной аритмии.
- Совпадают ли ощущения пациента с реальными эпизодами — для этого во время мониторирования ведут дневник, отмечая время жалоб.
- ЭхоКГ параллельно оценивает структуру сердца — именно она определяет, доброкачественная это экстрасистолия или нет.
- Анализы: калий, магний, гормоны щитовидной железы, общий анализ крови, при показаниях — ферритин.
Comparing the diary with the recording is one of the most useful results of the study. It often turns out that the moments that a person described as “interruptions” occur during a completely normal rhythm, and real extrasystoles occurred when he did not feel anything. This result in itself has therapeutic significance: it shows that the sensations are not associated with arrhythmia, but with increased sensitivity to the work of one’s own heart, often against a background of anxiety, and this changes both the understanding of the problem and the approach to solving it.
Treatment: from coffee abstinence to intervention
The approach to treatment differs from intuitive expectations. The goal is not to achieve zero extrasystoles on the cardiogram, but to eliminate symptoms and prevent rare complications. If the heart is structurally healthy and well tolerated, treatment is often not required at all, and the most useful intervention is a detailed explanation of the nature of the phenomenon.
- Первый шаг — устранение провокаторов: кофеина, алкоголя, никотина, недосыпания, обезвоживания; коррекция дефицита калия, магния и железа при его подтверждении.
- Treatment сопутствующих состояний: нарушений функции щитовидной железы, анемии, апноэ сна, тревожного расстройства.
- Наблюдение без препаратов при бессимптомном течении и здоровом сердце — это полноценная тактика, а не отказ от помощи.
- При выраженных симптомах — препараты, урежающие ритм; они не столько убирают экстрасистолы, сколько уменьшают силу восприятия и связанную с ней тревогу.
- Антиаритмические препараты применяют ограниченно и только по назначению кардиолога: часть of них при определённых состояниях способна сама провоцировать опасные нарушения ритма.
- Катетерная абляция — прижигание очага, of которого исходят экстрасистолы; обсуждается при очень большом их количестве, при снижении функции сердца или при плохой переносимости симптомов, несмотря на лечение.
- Регулярное наблюдение с повторной ЭхоКГ при большом количестве желудочковых экстрасистол — чтобы вовремя заметить влияние на сократимость.
Separately, about self-medication, which is common with this problem. Potassium and magnesium supplements are often taken “for the heart” without testing, although with normal levels of electrolytes no effect can be expected from them, and in case of kidney disease, excessive potassium intake is unsafe. It is even more risky to take antiarrhythmic drugs on your own, left over from relatives or prescribed to someone else: the selection of such therapy requires an assessment of the structure of the heart and ECG data, and in the wrong situation these drugs worsen the situation rather than improve it.