Heart Dysrhythmias, Irregular Pulse, Missed beats and Palpitations

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A normal person's heart should beat somewhere between 60 and 80 beats per minute with the rate slightly speeding up as one breathes in and slightly slowing down as one breathes out. Fit athletes have a slower pulse because as a result of training the heart beats more powerfully at rest. A regular beat is achieved by the pacemaker, which is comprised of cells at the top of the heart, ie within the atria. The pacemaker generates an electrical pulse, which firstly flows down the top of the heart thereby making the atria contract, there is a small delay whilst the electrical wave flows into the bottom half of the heart, which makes the two ventricles contract. It is this alternate contraction of the atria which fires blood into the ventricles to fill them up, followed by a contraction of the ventricle, which fires blood out of the heart and sends it on its way round the body.

One can, therefore, get irregular heart rate or lack of co-ordination between the atria and the ventricles, or lack of co-ordination of the ventricles as a result of disturbances of the pacemaker and/or the tissues that conduct the wave of electricity away from the pacemaker to the rest of the heart.

Disturbances of the pacemaker and conducting tissue cause a whole variety of heart dysrhythmias from the heart going too slow or going too fast, to missed beats, irregular beats, or a complete disassociation of heart activity such as atrial fibrillation or even ventricular tachycardias or fibrillations. However, whatever the nature of the disturbance, the fundamental causes are pretty much the same. Many of these disturbances such as ventricular ectopics are fairly harmless and do not cause too much trouble. However, you should see them as a warning sign to change your lifestyle and address the underlying factors that are causing them in order that they do not progress onto anything more serious.

Should you have established dysrhythmias requiring prescription medication, then no changes should be made to medication without informed discussion with your GP and ideally a cardiologist.

All dysrhythmias need medical input from your GP and/or cardiologist but the following interventions may be additionally helpful.

Causes and Treatment

What I am interested in, of course, is why that person has heart irregularities and is it likely to be due to the damage to the pace maker and/or conducting tissues.

Firstly, apply The general approach to maintaining and restoring good health with respect to

Stone Age Diet,

Nutritional Supplements - what everybody should be taking all the time even if nothing is wrong,

Sleep is vital for good health - especially in CFS,

Exercise, good balance between work and play and

Detoxification - an overview.

The above will address many of the issues listed below. But to be more specific electrical disturbances of the heart are caused by:

1. Poor blood supply. All the risk factors pertaining to this should be explored. Please see Diabetes and High blood pressure and also Homocysteine - the biochemistry of - not essential reading but interesting!. Damage to the muscle of the heart as a result of an infarction also results in poor blood supply and possible dysrhythmias. See Ischaemic Heart Disease.

2. Micronutrient deficiencies. The pacemaker requires adequate levels of trace elements, in particular magnesium. Magnesium deficiency alone can trigger atrial fibrillation. All patients with atrial fibrillation should take my standard regime of Nutritional Supplements, and possibly extra magnesium up to 500mg daily.

3. Poor energy supply at the cellular level. We now know that poor blood supply to the heart does not explain all the cases of heart disease we see. We now know that a substantial part of heart disease is due to mitochondrial failure in the heart - that is to say the supply of oxygen and fuel to the heart is adequate, but the mitochondria cannot translate this into energy for the heart muscle to work properly. I see this same problem in patients with chronic fatigue syndrome who suffer with generalised mitochondrial failure. These patients with chronic fatigue syndrome often have very abnormal mitochondrial function tests. However, what I do not know is whether patients with heart disease have similar abnormalities with their mitochondrial function tests because I have not done sufficient number of tests in these patients to know the answer. However, the package of supplements needed to support the mitochondria has been tried and tested in all forms of heart disease with excellent results. Therefore anybody with atrial fibrillation should take the package of supplements to support mitochondria - see CFS - The Central Cause: Mitochondrial Failure

4. Thyroid disease. Both underactive thyroids and overactive thyroids can cause atrial fibrillation (AF). An underactive thyroid may cause AF because a thyroid being underactive is a major risk factor for arterial disease, which in itself can disturb the blood supply to the pace maker. See Hypothyroidism.

5. The heart is particularly susceptible to toxic stress. For example, some studies have demonstrated people with heart disease have high levels of mercury in the heart. Heavy metals can certainly interfere with normal electrical activity of the heart and are best tested for by measuring toxic metals in urine following a chelating agent such a DMSA. Detox sweating regimes have been shown in many studies to be extremely helpful in patients with heart disease although the reasons for this are uncertain. However, one could do no harm, and there is great potential to do good by undergoing. See Detoxing - Far Infrared Sauna (FIRS) and Detoxification - an overview. My experience is that FIR saunaing does not work reliably well for heavy metals. Chelation therapy is the most effective way of removing heavy metals. Much can be achieved simply by using oral chelation therapy with DMSA.

6. There is no doubt that tachycardias can be caused by allergies to foods. Indeed, this is the basis of the "Coco pulse test". Doctor Coco demonstrated that patients who are intolerant of food may change their pulse rate by 10 beats per minute or over. I certainly have had patients who have switched into atrial fibrillation as a result of eating foods to which they are allergic. Some stimulants such as caffeine can also cause dysrhythmias. See Stone Age Diet.

7. It is possible to use electric shocks across the heart to jump it back into sinus rhythm again. However, unless the underlying cause of the atrial fibrillation is addressed then that patient is simply going to jump back into atrial fibrillation again. So the best results are achieved by addressing as many of the above factors as possible, giving them time to work and then trying drugs (such as Amiodarone), or DC cardioversion to try to get back into a normal rhythm.

Symptoms of Heart Irregularities

If the heart is irregular (dysrhythmic), sometimes one becomes abnormally aware of the heartbeat and this is called a palpitation. If the dysrhythmia is more severe then the heart will cease to function effectively as a pump. If the cardiac output is impaired then the blood pressure will drop. In the early stages this means that the body can do less work, i.e. clinically you will have difficulty getting fit or maintaining your fitness. In more severe cases if the blood pressure drops then one can feel light headed and dizzy - the clue here is that if you feel much better lying down then that suggests poor cardiac output.

Diagnosis

Ideally all dysrhythmias need diagnosing with an ECG. If the dysrhythmia is only there for some of the time then you need a 24 hour ECG. By making an electrical recording of the heart at the time of dysrhythmia the type can be ascertained. However, it can be very helpful if you can describe your dysrhythmia. Feel your pulse at the time of the dysrhythmia and count how many beats there are per minute. Work out if the dysrhythmia is regular or irregular and how long it lasts for. Make a note of anything that may have triggered it because this helps diagnose the cause.

Your physician will want to know:

1. How fast the dysrhythmia is eg sinus tachycardia (normal pulse but fast), atrial tachycardia (normal pulse very fast)

2. If the pulse is regular or irregular

3. If irregular, what is the nature of the irregularity.

For example:

  • ventricular ectopics - basically a regular beat, then suddenly an early beat, then a pause before the next one comes along
  • atrial fibrillation - pulse all over the place, irregular in time and consistency - sometimes a strong beat, sometimes a beat that is obviously weak.

Common Problems

Ventricular ectopics - this occurs when another pacemaker throws in an extra beat. When you feel your pulse at the wrist, it is regular, then suddenly a beat is completely missed. If you feel the pulse over the heart (or listen to the heart) you feel a regular pulse, then an early, perhaps weak, beat then a pause before the next beat. Once felt, never forgotten! These are a very common problem often caused by excessive caffeine, thyroid disorders, allergies or possibly hypoglycaemia.

Atrial tachycardia - pacemaker going too fast

Bradycardia - pacemaker going too slow (betablockers are a common cause)

Atrial fibrillation - completely irregular pulse. This occurs when the top of the heart (the atria) do not beat at all - they just wobble about (fibrillate). The problem here is that the heart may become inefficient through going too fast or clots may form inside the heart on the wobbling surface - anticoagulants may be necessary. Clots are also a problem if you keep switching from regular to irregular rhythm.

Sick sinus syndrome - intermittent fault of the pacemaker

Bundle branch block - the passage of electricity from the pacemaker to the ventricles is slowed so the heart becomes slightly uncoordinated.

Atrial Fibrillation

Atrial fibrillation is an increasingly common problem. What happens in atrial fibrillation is that the pace maker of the heart ceases to function properly so that the two top chambers of the heart, namely the left and right atrium instead of contracting in an organised, rhythmical fashion simply wobble about in an uncoordinated way. I have to say, I am rather amazed that atrial fibrillation does not cause more immediate problems than it actually does! However, the heart becomes less efficient as a pump, it reduces cardiac output by about 20%, and so clinically this often manifests with poor exercise tolerance - that is to say one loses a certain level of fitness. The other complication of atrial fibrillation is that blood flow within the atria becomes rather turbulent and this can cause little clots to form on the lining of the atrium. The risk, of course, is that these little clots could break off and those going into lung could cause damage to the lung whilst those flicking off into the systemic circulation could cause small strokes or reduce blood supply to the limbs or whatever. Indeed, anybody with the diagnosis of atrial fibrillation needs a good opinion about whether or not they should be placed on anticoagulants. Obviously, anticoagulants have a risk of increasing one?s tendency to bleed so there is a fine judgement here. However, the younger one is, the more inclined cardiologists are to use anticoagulants.

It is actually not difficult to diagnose atrial fibrillation. Feel your pulse. It should be fairly regular running at between 65 and 80 beats per minute. Pulse is a little faster when you inhale and a little slower when you exhale. In atrial fibrillation the pulse is completely irregular in timing. It is also irregular in the size of the beats and with a little practice it is quite easy to distinguish between a good strong pulse and a thin thready one. In atrial fibrillation the two are mixed up as well as the rhythm being irregular. Sometimes the heart rate is very variable, but more often than not it is above 80 beats per minute.

I suspect that mercury and/or other heavy metal problems are a major couse of AF. Mercury bioconcentrates in the heart and Dr Paul Cheney states that levels of mercury may be 10,000 fold higher on the heart than the blood stream. One can test for mercury and other heavy metal toxicity by measuring heavy metals in urine following a chelating agent such as DMSA. See further information on mercury toxicity at Mercury - Toxicity of Dental Amalgam - Why you should have your dental amalgams removed.

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THE AFIB REPORT

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