By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

TESTS NEEDED TO DETERMINE CAUSE OF READER’S IRREGULAR HEARTBEAT

Question: I went to the doctor after noticing my heartbeat seemed to be skipping beats. She checked it and said that is a little irregular. Now she wants me to have more tests. I have had a heart bypass in the past, and I don’t want another one. I really don’t want tests done. Can’t we just watch this?

Answer: An irregular heartbeat can range from very mild to very serious. Doctors call these cardiac arrhythmias. They are a group of conditions in which the heart beats faster or slower than it should or beats irregularly. Some arrhythmias are life threatening and others are no cause for concern.

Frequently you can’t differentiate between arrhythmias that pose a serious risk and those that do not without additional tests. Most people are afraid of “what the doctor will find,” but deep down inside they know the testing needs to be done.

Let me give you some information on tests for irregular heartbeat and some possible outcomes. The first test your doctor might do is an electrocardiogram (ECG). The irregularity may or may not show up on this test. The ECG can give your physician some information, but usually more tests are needed.

Your doctor will also want to do blood tests to rule out thyroid problems and infection. She will take a medical history with attention to caffeine intake, smoking, alcohol intake and over-the-counter medication use.

A serious type of arrhythmia is called fibrillation. This can be generated from the top chambers of the heart, the atria, or from the bottom part of the heart, the ventricles. Both atrial and ventricular fibrillation are serious conditions. Fibrillation causes the muscles of the affected chamber of the heart to quiver instead of contracting, or beating.

If this happens in the atria, it’s most often due to an underlying medical condition and is not usually a medical emergency. Treatment of the underlying condition, though, may be needed to avoid long-term consequences such as a stroke. Ventricular fibrillation, on the other hand, is a medical emergency. It requires immediate defibrillation or it can lead to death.

More commonly when people are told they have an irregular heart beat, it is caused by “extra” beats from the upper or lower chambers. An extra beat from an upper chamber is usually called a PAC -- premature atrial contraction. An extra beat from a lower chamber is called a PVC -- premature ventricular contraction. The treatment, if any, is determined by the frequency of the “extra” or early beat and its origination. In many cases, these extra beats are just watched by the physician to make sure that other heart problems don’t develop over time.

Work with your physician to get to the bottom of your irregular heartbeat problem. Not knowing what is going on can hurt you much more than knowing.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.