From the Doctor.
Heart flutters due to stress, vices
You talked about heart problems in
Friday's EMERALD and said you’d discuss
it further. Well — I wonder if you would
discuss “heart palpitations,’’ too.
I had a real heavy course load last year
and a demanding job on top of everything
else. I started getting "heart palpitations."
They lasted a few months. (I had an EKG
and they said I was O.K.). Then, I spent the
winter in a cabin in the woods and had
none at al — all winter. I was feeling great.
Now, I’m back in school, doing volunteer
work, and have a job too. Last week I
started getting the heart palpitations again.
Every now and then my heart will “flutter”
or seem to try to jump out of my chest!
(Average: about once or twice an hour).
I'm worried about it and a little scared
too. What should I do?
Thanks for your help
Dear Thanks:
Let’s start with the definition. “Palpita
tions” is a wonderful word, in fact an amaz
ing word, because it sounds like it says
something concrete and definite (“You've
got palpitations; take two aspirin and move
to Polynesia”), when it can actually mean a
whole range of things from innocent to sig
nificant to serious, depending on what the
heart is doing and who it is doing it in.
That's fine, what's so ambiguous about
that, you say. Wed, it covers everything
from a heart beating more strongly causing
the person to notice it and because of gen
eral nervousness, to become alarmed, to a
heart adding a few early beats (atrial and
ventricular premature beats), to a heart
skipping beats either due to normal re
flexes or to serious problems with the
pacemaker areas, which occurs in some
older folks, to sustained rapid beating
which can be normal with fear, fever, or
exertion, to intermittent very rapid regular
beating or paroxysmal atrial tachycardia,
which often occurs in young folks as well
as old and by itself is rarely serious, to
grossly irregular sustained rapid beating
(atrial fibillation) caused by significant
heart disease (usually rheumatic fever) in
young people and often occurring without
other serious heart disease in very old
folks. The list goes on for several more
pages.
So what’s happening to you and why?
Probably, you ai'i having premature beats,
since (1) they often occur in young adults
without heart disease, (2) the EKG will
often be normal, and the heart will be
negative, (3) the beat after the premature
beat is a lot stronger than normal and the
heart moved harder within the chest, giving
a sensation of the heart “trying to jump out
of my chest,” and (4) they went away when
you were relaxed and came back when
you were under stress.
The sinus node in the heart generates
brief electrical pulses that travel through
the heart to make it beat 60 to 100 times a
minute. Other places in the heart have the
ability to generate pulses, but normally
don’t because the sinus node generates
one first and keeps the other areas sup
pressed. However, when the heart is ex
posed to certain chemicals, to certain
nerve impulses, to certain toxins, or to a
lack of oxygen, other areas can be so
stimulated that they occasionally generate
a pulse before the sinus node does. This
pulse makes the heart beat prematurely,
and the premature beat is followed by a
pause until the sinus node picks up the
rhythm again. During that pause the heart
fills more fully with blood, and the muscle
fibers are rested and well supplied. Con
sequently, the next beat is a real strong
one, causing a thump within the chest that
can be easily felt.
Now let’s take a normal college student
in the mountains. Everything is relaxed,
cigarettes and coffee to get those papers
written are a thing of the past, adrenalin
levels are at a minimum. Most of the stimuli
to cause premature beats in the normal
heart are gone, and so is the anxiety level
that makes the student notice his or her
funny beats and get scared about them.
Now bring that same student to the Uni
versity Law School, give him or her a mock
trial to prepare for the next day and bar
exams in two months, deprive him or her
of sleep, add generous doses of nicotine,
caffeine, and occasionally alcohol, then
decongestants for his or her hay fever —
the wonder is not that the heart has a pre
mature beat once an hour, the wonder is
how it avoids racing at 400 beats a minute.
The body’s reaction to stress is to re
lease epinephrine (adrenalin), an extremely
potent cardiac beat accelerator and
stimulant, into the blood stream. In addi
tion, the heart has nerve endings on it
which can release epinephrine directly into
the heart tissue, under the control of cer
tain parts of the brain which in addition to
control of body functions, are related to
emotions. Thus stress and emotions can
cause premature beats and other kinds of
heart rhythm irregularities. Nicotine and
caffeine are also effective producers of
cardiac stimulation and premature beats.
Alcohol acts as a toxin and can cause the
same problem, and decongestants are re
lated to epinephrine.
Space and time don’t permit a full dis
cussion of aH of the other possibilities other
than premature beats. From what you tell
me, I think the most likely diagnosis is oc
casional premature beats and that this
does not indicate any real heart disease or
problem that will get any worse in the fu
ture. In essence, you should relax, elimi
nate cigarettes, caffeine, alcohol, cold pills,
and decongestants and stop worrying.
Most likely, this will eliminate the problem.
If it does not, come in for a further evalua
tion.
Terry Copperman, M.D.
Copyright 1977
tnerqv Plan could slow exoaus to suouros
City dwellers rewarded
for reduced consumption
NEW YORK (AP) — If logic
had anything to do with it, New
York City would benefit from
Pres. Carter's energy proposals.
The city's brownstone and
high-rise buildings are hard to
beat as potential energy savers. It
has enough buses, subways and
trains to move millions of people
to their jobs, enough for most to
avoid the higher gasoline prices
that are the centerpiece of
Carter’s energy strategy.
Most importantly, the feeling
among city officials is that
Carter s program should place
the overall costs of city living on a
more equal and attractive footing
with its surrounding suburbs. This
is mainly because suburbs would
bear the brunt of Carter’s deter
mination to make auto travel
more expensive.
And a study by a coalition of
Northeast legislative leaders says
that the proposed gas tax rebate
formula would heavily favor New
Yorkers and other Northeaster
ners, producing a possible net
federal revenue gain here of
about $140 million.
The reason is that the North
east has 23 per cent of the
nation's population and thus
would get back 23 per cent of the
proposed rebate. But the region
uses only 19.5 per cent of the
nation’s gasoline, resisting in a net
profit to taxpayers, especially
those in cities, who don’t drive
cars much.
All this has some New Yorkers
expressing hope that a new na
tional energy-saving lifestyle will
cause the young and affluent to
think a bit harder before leaving
for the suburbs.
But recent talks with energy
experts, economists, city home
owners, cab drivers and others
show there may be enough nega
tive impact in the Carter plan to
offset its touted pluses for cen
tralized cities like New York.
Negative items such as this:
The Carter energy package
leaves largely untouched the high
cost of foreign oil which, along
with high local utility taxes, are
the main culprits behind New
York’s high electricity and heating
costs.
And this: There are no new
proposals to reverse the ef
the city's energy-saving mass
transit system, which has suf
fered a steady decline in rider ship
for more than two decades
"The Carter approach is to beat
people over the head for driving
cars, without providing any alter
native,” says Dr. Barry Com
moner, an energy expert with
Brooklyn roots.
Studies show that the average
New Yorker uses slightly over
half tie amount of energy the av
erage American uses to travel,
run his utilities, and heat and cool
his home.
Yet the New Yorker’s saving
ways are rewarded with some of
the highest energy prices in the
nation, almost sure to rise under
Carter’s plan.
According to the Edison Elec
tric Institute, average New York
households use less than half the
electricity other Americans use.
But their average annual electric
bill is about $300, roughly the
same as the national average,
meaning the cost per kilowatt of
electricity in New York is more
than twice as high as the national
average.
Carter’s plans by themselves
won’t touch off vast lifestyle
changes in New York as might be
true in a sprawling city such as
Los Angeles which relies almost
entirely on cars.
But a number of existing trends
and behavior pattei is that have
affected New York for years could
either be hastened or slowed.
Among the possible effects are:
• The trend of people and jobs
moving from New York City to the
suburbs will likely continue, but
rising suburban energy costs re
sulting from the Carter program
may become a factor in slowing
the exodus.
• Carter’s program for the first
time offers some hope of ample
reserves of heating fuel for the
city. But according to Lou Verach,
a city researcher who is studying
the program's effects, Carter’s
plan to lift import ceilings on li
quefied natural gas (LNG) could
worsen the city's dependence on
Middle East fuel, and ultimately
higher prices.
• Perhaps the most striking
immediate impact of the Carter
program will be on New York’s
11,000 cabdrivers. Studies show
taxicabs are the most wasteful
mode of travel. Buses, trains,
subways, cars, and airplanes are
the most efficient, in that order.
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