Arrhythmias: Off the Beaten Path
Arrhythmias: Off the Beaten Path
© 2012 Dr. Dale Peterson & drdalepeterson.com
An arrhythmia is an abnormal heart rhythm. It may be as innocuous as a single beat coming earlier than it should that causes no symptoms or as dangerous as the lower chambers of the heart racing out of control and causing lightheadedness, loss of consciousness, and possibly death. The arrhythmia may be easy to control or it may persist despite all efforts made to correct it.
When the heart is functioning normally it follows its pacemaker, the sinus node, which is located at the top of the right atrium (upper chamber). The right atrium contracts, and is followed closely by the left atrium. The pacing signal next arrives at the atrioventricular (AV) node, which sends signals through fibers called the Bundle of His to the ventricles (lower chambers), causing them to contract. This results in an efficient system in which blood is first pumped from the atria to fill the ventricles, which then contract to pump blood throughout the body.
The simplest arrhythmia is an early beat. The beat may originate in one of the upper chambers of the heart, in which case it is referred to as a premature atrial contraction (PAC) or a premature supraventricular contraction (PSC). If the early beat originates in one of the lower chambers of the heart it is called a premature ventricular contraction (PVC). Premature beats are inefficient, because the heart chambers have not had enough time to fill with blood before contracting. There is a pause after a premature beat until the next regularly scheduled beat occurs.
Premature beats occur in most people from time to time and are generally harmless and not indicative of a heart defect. A number of factors can cause them to become more frequent. When this occurs, symptoms are more likely to appear. The most common symptom of frequent premature beats is a fluttering in the chest. This may be mild, as though a hiccup occurred, or it may feel as though a fish is flopping around beneath the breastbone. Other symptoms that may occur include shortness of breath, lightheadedness, dizziness, chest pain, and fainting.
Premature beats can be triggered by lack of sleep, stimulants such as caffeine, nicotine, or decongestant medications, mineral deficiencies, anxiety, and stress. These triggers are additive. One of the most dramatic instances of premature beats I have seen occurred in a policeman who had been assigned a stakeout. He had been awake for an extended period of time and had been chain smoking and drinking large amounts of coffee to counter his sleepiness and fatigue.
I experienced a prolonged episode of frequent premature beats many years ago following a school board retreat. The event had been somewhat stressful, I had not slept well, and I purchased and drank a large caffeinated beverage to help me stay awake on the drive home. The symptoms I experienced were alarming and taught me to avoid the use of stimulants to combat fatigue in the future.
When I see someone who is experiencing frequent premature beats I advise them to get adequate rest as indicated by the ability to awake without the use of an alarm. I caution against using tobacco products or consuming caffeinated beverages. I warn them to avoid decongestant medications or combination products that say “decongestant” or contain the letter “D” such as Claritin D or Mucinex D. I recommend a magnesium supplement, starting with 200 – 400 mg. of a chelated form such as magnesium citrate or magnesium aspartate twice daily. I also explain that premature beats are almost always annoying, but not dangerous. This is because, if one becomes alarmed, the anxiety will aggravate the situation and tend to make the premature beats more frequent or prolong the arrhythmia.
When premature beats continue to cause symptoms I recommend that a combination of magnesium, potassium, and bromelain, which is available as CM Formula be added or used in place of magnesium alone. This is almost always effective in controlling the premature beats.
At times the heart will beat regularly, but the heart rate will either be too fast or too slow to effectively pump blood throughout the body. An excessively rapid rate is called a tachycardia and an abnormally slow rate is called a bradycardia. Heart rates above 100 beats per minute are considered tachycardias and those below 60 are considered bradycardias, but there are times when rates above or below the standard range can be normal.
The heart rate rises with physical activity and will almost always exceed 100 beats per minute during exercise. It will also rise along with the body temperature when an infection is present. Physical training will lower the resting heart rate. Well-conditioned athletes will often have a resting pulse rate in the fifties or even the upper forties. This is particularly true of distance runners. This type of bradycardia is perfectly normal.
Some people are prone to sudden and unexpected tachycardia episodes, a condition called paroxysmal supraventricular tachycardia (PSVT). The cause of PSVT is often unknown, but it is more likely to occur with the use of alcohol, caffeine, or nicotine and when total body magnesium levels are low. Since the level of magnesium in the bloodstream doesn’t correlate directly with the level of magnesium in the tissues of the body, magnesium supplementation may be needed even though the blood magnesium level is in the normal range.
PSVT usually stops as suddenly as it starts. A number of techniques are helpful in stopping an episode of PSVT. One, called a Valsalva maneuver, is to hold the breath and strain, as though attempting to have a bowel movement. Another is to cough while bending forward. A third is to splash the face with cold water. If the rapid heart rate persists and symptoms of shortness of breath or lightheadedness are present, emergency medical intervention may be required.
Thyroid disease can affect the heart rate. Tachycardia is generally present when the thyroid is overactive. An underactive thyroid will commonly result in bradycardia. Mineral imbalances can also cause tachycardia or bradycardia. Medications are often responsible for an abnormal heart rate.
When no underlying cause can be found for an abnormal heart rate an artificial pacemaker may be required. I know a farmer who, because of his years of regular physical activity had a resting heart rate in the low fifties. As he grew older he began feeling excessively tired as the day progressed. He developed severe shortness of breath when he went to Colorado, and he experienced episodes during which he felt fuzzy and lightheaded. I found that his heart rate had fallen into the forties and referred him to a cardiologist.
The cardiologist chose not to insert a pacemaker because he felt that the low rate was protecting the man’s heart from damage. By the time the rate fell to forty the man was feeling too tired to help out around the farm. His son finally went with him to the cardiologist and insisted that his father’s condition had deteriorated to the point that he could no longer perform normal activities. A pacemaker was finally inserted. The man’s energy returned immediately and he was able to resume activities on the farm and once again enjoy vacationing in Colorado.
One of the most common arrhythmias encountered today is called atrial fibrillation. It is a condition in which the heart is no longer being paced in a normal manner. To fibrillate means that individual muscle fibers are twitching in an uncoordinated manner and that there is little or no movement of the muscle as a whole. Therefore, in atrial fibrillation the upper chambers stop beating and simply quiver. Lacking a pacing signal, the ventricles contract irregularly. Since the atria are no longer pumping, the only blood that reaches the ventricles is that that seeps in between beats.
In recent years, atrial fibrillation has become more common. When I entered medicine in 1970s atrial fibrillation was relatively rare and seen only in people with a history of heart disease. It was typically due to enlargement of an atrium due to a defective valve or related to damage from high blood pressure or a previous heart attack. It is now known that esophageal reflux and sleep apnea can also cause atrial fibrillation.
Atrial fibrillation is now frequently seen in people who appear to have normal hearts. When this happens it is referred to as “lone” atrial fibrillation, meaning that the arrhythmia is the only abnormality that is present. People with lone atrial fibrillation will typically experience episodes in which the arrhythmia is present and then revert to a normal rhythm for a period of time. Lone atrial fibrillation episodes may be triggered by bending over, lying down, drinking a cold beverage or eating cold food, jumping into cold water or being hit by a cold wind, gassiness in the stomach, eating a large meal, drinking alcohol, or straining to have a bowel movement. The episodes tend to occur more frequently over time and the arrhythmia eventually becomes permanent in most individuals.
Amazingly, I have seen several people who were symptom-free and totally unaware that they had developed atrial fibrillation. My detection of an irregular heart rhythm was the first indication that the condition was present. Most people will have symptoms such as pounding or fluttering in their chest, lightheadedness, weakness, and shortness of breath with exertion. If the ventricular rate is rapid very little blood will be circulated and the individual may develop heart failure with shortness of breath that worsens upon lying down and swelling due to fluid retention.
Medications are available for the prevention of atrial fibrillation, but most have significant adverse effects. Some of the most effective medications carry the risk of triggering a more serious arrhythmia like ventricular fibrillation, which is almost always fatal. They must therefore be used with caution.
One of the most widely recommended treatments for atrial fibrillation is a procedure called an ablation. An effort is made to identify the region of the heart that is triggering the arrhythmia and then the area is destroyed by using a catheter to heat or freeze the tissue. The success rate from a single ablation is only 40 - 50 %, unless drugs are added in which case the success rate climbs to 70 %. Unfortunately, studies have shown that the percentage of patients still free of atrial fibrillation five years after an ablation is less than 30 percent.
A number of strategies may be employed before turning to drugs or surgery for fibrillation control. Begin by following basic wellness principles including drinking enough pure water to keep the urine pale, eating a diet rich in fruits and vegetables and low in refined foods, getting the body moving for thirty minutes daily, and obtaining enough sleep to be able to awaken without the use of an alarm. Avoid any actions that have triggered atrial fibrillation episodes in the past. Follow the measures recommended for preventing premature beats, including mineral supplementation.
It is believed that diminished mitochondrial function is one of the factors responsible for atrial fibrillation. Mitochondria are the energy factories of the body. Mitochondrial function should be supported by the supplementation of coenzyme Q10 and L-carnitine or with XTra Mile, which is a comprehensive mitochondrial support product. Start with 100 mg. of coenzyme Q10 and 500 mg. of L-carnitine twice daily or 2 capsules of XTra Mile three times daily.
Another mitochondrial support is D-ribose, a sugar that has been shown to significantly enhance energy in heart muscle cells. Adenosine triphosphate (ATP) is the main molecule the body uses to store energy. It is believed that levels of ATP are low in many types of heart disease. Ribose is a key component of ATP. It is derived from glucose in the body, but the body is unable to produce adequate amounts of ribose to meet the demand for ATP in certain conditions, including heart disease. Supplementation of D-ribose augments the amount produced naturally and helps the body to restore ATP to normal levels. The amount required is generally between 5 and 15 grams daily. Because it is absorbed and utilized very quickly it is best to split the amount into two or three different servings.
Muscle contraction is regulated by the passage of minerals in and out of cells. The movement of sodium, potassium, calcium, and magnesium is facilitated by L-taurine, an amino acid. Taurine also moderates the activity of the sympathetic nervous system and thus acts to prevent rapid heart rates. Supplementation of L-taurine has been shown to protect the heart and help maintain a normal heart rhythm.
L-arginine is an amino acid that increases the production of nitrous oxide (NO), a substance that causes blood vessels to dilate. NO reduces resistance to blood flow and helps to normalize blood pressure. NO is also believed to have a stabilizing effect on the heart’s pacemaker. L-arginine has been shown to restore a normal heart rhythm and to increase exercise capacity in people with heart disease.
One of the dangers of atrial fibrillation is the potential for a blood clot to form in the atria while they are quivering rather than pumping. A portion of the clot can then break off and be carried to the brain where it blocks an artery and causes a stroke. Warfarin (Coumadin) or other potent blood thinners are generally prescribed to lessen stroke risk. L-arginine lessens the risk of clot formation and may decrease the amount of warfarin required.
Supplementation of L-taurine and L-arginine was studied in three people with disabling arrhythmias. One of the individuals was found to be having 25,000 PACs daily and another was having 21,000 PVCs daily. The premature beats were accompanied by episodes of tachycardia or atrial fibrillation. L-taurine supplementation reduced the number of premature beats by half. When L-arginine was added the number of PACs in one individual dropped from 25,000 to 100 per day. PVCs were completely eliminated and the episodes of tachycardia and atrial fibrillation ceased. The amount of L-taurine used ranged from 10 to 20 grams daily and the amount of L-arginine ranged from 3 to 6 grams daily. The total amount was divided into three or four servings and taken with meals and at bedtime.
Because therapeutic amounts of D-ribose, L-taurine, and L-arginine are difficult to find I worked with Gary Paulsen of Vitality Corporation to develop a palatable combination of the nutrients that is now available as Rhythmatrol. 1 ˝ scoops (approximately 9.6 grams) of Rhythmatrol contain 5 grams of D-Ribose, 3 grams of L-taurine, and 1.4 grams of L-arginine. Three or four servings daily provide optimum amounts of the three supports.
Arrhythmias are common. They can lower quality of life and are some are potentially fatal. Taking lifestyle measures and providing nutritional support can significantly decrease the frequency and severity of arrhythmias and thus improve quality of life and increase longevity.
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