Palpitations, harmless or cause for concern?

Palpitations are the unpleasant and sometimes alarming sensations of rapid, irregular or forceful beating of the heart.  The term "palpitations" is fairly non-specific since it can refer to a number of different types of disturbances of the heart's normal "rhythm". Depending on the nature of the rhythm disturbance, palpitations may be described as "skipped beats", "fluttering" or "racing".  In most instances, palpitations are harmless, and in fact, in certain instances, may even be considered normal.
   
Normally, the heart beats between 60-100 times per minute.  When the heart beats faster than this, it is called "tachycardia".  Under certain circumstances, tachycardia can be considered to be normal. For example, when you are exercising vigorously or frightened, your heart normally beats faster and more forcefully.  This allows the heart to pump more blood to the muscles and lungs.  If, on the other hand, heart "racing" occurs while you are at rest, this may indicate an abnormal heart rhythm (dysrhythmia), such as atrial fibrillation.

One common dysrhythmia is known as premature contractions or ectopic beats.  These are usually described as "skipped beats" or as the heart briefly "stopping".  In this type of dysrhythmia, the heart contracts earlier than the next normal beat, followed by a pause.  When the heart resumes beating, a more forceful beat or "thump" may be felt.  When these occur infrequently, they may be entirely benign.  Premature contractions occurring frequently, on the other hand, can be an indication of a heart condition.

What causes palpitations?   Some of the most common causes for palpitations are:

• Diseases of the heart valves (mitral valve prolapse, aortic stenosis, etc.)
• Excess thyroid hormone (hyperthyroidism)
• Stress, fear, anxiety
• Fever
• Caffeine, nicotine, cocaine, diet pills 
• Anemia
• Low blood oxygen level (hypoxia)
• Medications such as thyroid replacement, diet pills and asthma drugs

Palpitation "red flags"   Anyone with known heart disease should consider palpitations to be a cause for concern.  Actual blackouts or near blackouts associated with palpitations should be taken very seriously because they are often due to underlying heart disease.  Chest pain or shortness of breath occurring during episodes of palpitations suggests that the heart is not pumping adequately and should also prompt medical evaluation.

How are palpitations evaluated?   Should palpitations occur frequently, cause alarm, or if any of the "red flags" mentioned previously are present, medical attention should be sought. The object of the evaluation is to determine if the palpitations are "physiologic" or whether they are caused by an underlying medical condition.  The evaluation starts with a medical history to consider the circumstances under which the palpitations occurred (drinking too much coffee, drinking alcohol, stressful work situation, etc.).  A review of medications that one is taking as well as other symptoms that could suggest a medical problem such as hyperthyroidism or anemia is also done. Following this, a physical examination and often a resting electrocardiogram is performed. For suspected heart-related problems, other diagnostic tests include a 24-hour recording of the heart rhythm (Holter scan), an exercise stress test, and tests to study the electrical system of the heart (electrophysiologic study).

How are palpitations treated?   Palpitations can be relieved in many patients by stress reduction, stopping cigarettes, and reduction of caffeine and alcohol.  In the case of underlying heart disease, taking a medication to suppress the dysrhythmia or specialized surgical procedures may be necessary. If a condition such as hyperthyroidism is found to be responsible, measures to reduce the level of thyroid hormone will address the problem.

Sources for article:
Heart palpitations from Mayo Foundation for Medical Education and Research
Skipping a beat — the surprise of heart palpitations from Harvard Health Publications
Heart palpitations from Medline Plus

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Why Does My Eyelid Twitch?

Eye twitching, or blepharospasm, is a condition that generates a number of questions among our clients. "Blepharo" means eyelid and "spasm" refers to an uncontrolled muscle contraction. There are benign as well as serious causes of blepharospasm. Today's Health Tip will look at the two most common types.
   
Simple Eyelid Twitch
Typically, with a simple eyelid twitch, the upper lid blinks and you can't make it stop. Usually, this affects only one eye with the lid twitching every few seconds.  This is the most common and least serious type of blepharospasm. Although there is no definite cause, its occurrence seems to be associated with fatigue, stress, lack of sleep and use of alcohol, tobacco or caffeine. Once these spasms begin, they may continue off and on for a few days and then disappear as quickly as they began. People who experience this find it very annoying and in some cases frightening. This type of eyelid twitching requires no treatment although getting plenty of rest, and reducing stress and caffeine consumption seems to help.

Benign Essential Blepharospasm (BEB)
A second, much less common type of eyelid twitching is called Benign Essential Blepharospasm (BEB). "Benign" indicates the condition is not life threatening and "essential" is a medical term meaning "of unknown cause." It is estimated that there are at least 50,000 cases of blepharospasm in the United States, with up to 2000 new cases diagnosed annually. This type of blepharospasm usually involves both eyes, causing the eyelids to close involuntarily. In BEB, abnormal nerve impulses develop in a vicious cycle, producing the spasms. BEB may also be seen in those with conditions that result in irritation of the surface of the eye (cornea) or the membranes lining the eyelids (conjunctiva). This type of blepharospasm may become a chronic, progressively worsening process, and can even become incapacitating.

In most cases, doctors are able to diagnose BEB from the clinical appearance of the patient. There are no laboratory or imaging studies that are specific to the condition. Since light sensitivity is a common trigger for BEB, one of the treatment measures involves the use of tinted glasses to block ultraviolet rays.  For mild cases, medications may be tried initially.  Drugs with the highest percentages of favorable patient responses include the tranquilizer lorazepam and Artane, a medication used in the treatment of Parkinson's disease.

Botulinum (BOTOX®) injections have now become the most commonly recommended treatment for BEB with up to 95% of patients reporting significant improvement. Injection in very small quantities into the muscles around the eyes will relax the spasm. The injection works for several months, but will slowly wear off and usually needs to be repeated. In patients who do receive adequate relief of their spasms with BOTOX® injections, surgical intervention may be considered. Surgical treatment for BEB involves severing the involved muscles around the eye.

When Should I See a Doctor?  As mentioned, most cases of eyelid twitching are benign and related to lifestyle issues such as fatigue and caffeine consumption.  Reasons to consult a physician include: 1) twitching lasting longer than a week, 2) spasm involving other facial muscles, 3) drooping of the eyelid, and 4) redness, swelling or discharge from the eye.

Sources for article:

Eyelid Spasms from Kellogg Eye Center, University of Michigan
Eye twitching from Mayo Foundation for Medical Education and Research
Eyelid twitch from Medline Plus

What works for cellulite (and what does not)?

First of all, let's be clear: cellulite is fat.  Cellulite is not a medical term, but a term that was coined in European salons and spas to describe deposits of dimpled fat found on the thighs and buttocks of up to 90% of women.  Cellulite occurs primarily in women, rather than in men, because of the configuration of fibrous bands that separates fat cells into compartments.  In women, this connective tissue has a honeycomb configuration, rather than the crisscross pattern in men, which allows fat to protrude, creating the characteristic "cottage-cheese" pattern. Cellulite development also appears to be under the influence of hormonal factors, with most cellulite developing in the post-adolescent period.

A recent internet search for "cellulite treatment" revealed thousands of entries.  Special washcloths, loofah sponges, creams and gels to "dissolve" cellulite, vitamin and herbal supplements,  massagers,  rollers,  body wraps,  toning lotions,  electrical muscle stimulation, vibrating machines, "enzyme" injections, liposuction, and massage are just a few of the treatments that are touted at these sites.  Despite a prolific number of treatments, there has been scant research performed to evaluate most of these and only a tiny number have received approval from the U.S. Food and Drug Administration (FDA). Let's look at some of the treatments that work and some that don't.

Weight Loss.  Reduction in body fat can have a beneficial effect on the appearance of cellulite. This makes sense when you consider that having less surplus fat makes it less likely to protrude through the connective tissue.  Of course, this is best done through healthy means such as a sensible c
alorie restricted diet and exercise.  Weight loss is not always successful, however, as genetics also has a major bearing on whether or not cellulite develops.  Even women of ideal weight can have cellulite.

Cardiovascular exercise and weight training.  There is some evidence that along with weight loss, a program that includes cardiovascular exercise (walking, jogging, cycling, etc.) and strength training can help improve the appearance of cellulite.  The cardio portion is best done for 30-40 minutes, 3-4 times per week. The strength training program should include calisthenics-type exercises involving the use of small dumbbells, ankle weights or resistance bands.

Liposuction is falling out of favor as a treatment for cellulite. While this surgical treatment does remove fat, it does not remove cellulite specifically.  In fact liposuction can worsen the appearance of cellulite in cases in which large amounts of fat are removed.

Endermologie is a FDA-approved treatment for cellulite which allows for deep   tissue mobilization with the use of a hand-held machine to knead the skin between rollers.  Up to 14 sessions, at significant expense, may be required to see results.  Unfortunately, these results are usually short-lived and follow-up treatments are usually required.

What's new?  Two of the more recently FDA-approved treatments for cellulite involve a "miminally invasive" technique to sever the fibrous bands beneath the skin that cause the characteristic appearance of cellulite.  The first, marketed under the name, Cellulaze, involves the use of a small laser that is inserted under the patient's skin. Laser energy is used to "melt" fat under the skin and release the fibrous bands that pull down on the skin.  A second system called Cellfina uses a needle-like instrument to "cut" the fibrous bands.  Both procedures require the use of a local anesthetic since small incisions have to be made to introduce instruments beneath the skin.  These procedure can be performed on an outpatient basis and generally only require a single treatment. The results are reported to last a year or more.  Both of these forms of treatment are expensive and are most appropriately used after trying less invasive measures, such as weight loss and exercise.

Buyer Beware.   Body wraps, electric muscle stimulators, bowel cleansers, herbal extracts, mesotherapy (a technique in which substances are injected into layers of fat and connective tissue under the skin), creams or gels to "dissolve" cellulite, most massaging devices, and any "anti-cellulite pills" are ineffective and a huge waste of money.

Genetics and statistics indicate that most women will develop cellulite.  Its appearance, however, can be improved by avoiding excess weight and exercising regularly.  If more than this is needed, by all means stick with a method that has proven results.
   
Sources for article:
Cellulite, Causes and Treatment from WebMD
Cellulite from Mayo Foundation for Medical Education and Research