Arrhythmia/Palipations Solutions

So finally after waiting since June I’ve received the results of my 24 hour ECG and they’ve shown episodes of Bigeminy. The GP did mention beta blockers but advised it would be better all round if I can just learn to live with the sensation. I can go back if it becomes more sinister or concerning but it isn’t hurting my heart. It’s flipping annoying! I’m back in a flare up of it and have had 4 repetitions of it already today that I’ve felt and the last couple of days it’s happened as soon as I’ve been consciously aware in the morning and it then wakes me up because it’s like a swallow is trapped in my rib cage.

I’m wondering what others have found helps to reduce arrhythmia or palpitations? I don’t drink or smoke and I work from home somewhere pretty great so no stress. The only other thing is to reduce caffeine but I have a maximum number of 4 cups of tea a day and I really enjoy a decent cup of tea. Is caffeine free tea any good? or I may as well drink dish water?

How’s your sleep?

Is caffeine free tea any good? or I may as well drink dish water?

Variable. I tried cutting out caffeine as part of my sleep apnea journey, it made no difference, so i’m back on full fat tea now.
Twinings, Yorkshire and Pukka were the least bad.

Sounds a little frightening, but glad to read it’s just a sensation more than something harmful.

Caffeine-free tea like Rooibos are pretty nice as are a few herbal teas, but they don’t really taste as nice as regular builders. I’ve not tried decaff “normal” tea before so no recommendations there! You could always have a couple normal teas before lunch and then change to decaf options afterwards to start with. Or get into nice hot chocolate.

I like to have some Teapigs tea with valerian in it before bed, which usually sees me through all night and reduces stress, however I am sure I have read that Valerian is not good in combination with certain cardio medicines – for example, if you do end up taking the beta blockers. Just something to keep an eye on in future if you go down that route.

Well pretty rubbish currently because I’m also having a bout of vertigo which means every time I roll over I feel like someone is using my head as a magic 8 ball. But generally speaking I get a solid 8 hours of sleep because I’m in bed for 10pm, it did pick up a low heart rate overnight of 36 but he said because it’s not waking me up that it’s also ok. I prioritise my sleep because my IBD tends to mean I’m always exhausted, well that and the 7 miles I walk every day.

Trouble with hot chocolate is, you have to make it with milk which is pretty callorific! So my heart will feel better but I’ll be big as a house!

Caveat – I am a nurse, but this is not clinical advice.

I get periods of arrythmia’s, usually when got an infection, run down or not sleeping enough – I take a few days of double dose magnesium supplements and it usually resolves it. I’ve got these ever since had case of suspect post-viral myocarditis 15 years ago.

Caffeine doesn’t seem affect mine, though I did switch to caffeine free tea a few years ago for other reasons. Drink 2-3 cups caffeinated coffee/ day without issue.

I’m stuck in permanent/persistant Atrial Fibrillation and went caffeine free about 8 months ago.

Its made no difference whatsoever to the AF but I did sleep better. I say did because my sleep for weeks has been terrible, but at least I know it’s not caffeine causing it.

Yorkshire Tea decaffeinated is by far the best I’ve found and is almost identical to the normal stuff.

I have suffered with debilitating ectopic beats and other fun stuff for some years.

Had all the cardiac tests to show my pipes are clean etc . Beta blockers and statins (made me feel horrendous), sprays  etc did no good,  and in the end tried decaf tea and coffee (like you mainly a tea drinker) and it’s made a massive difference.  I didn’t think my 3/4 cups of tea a day would make a difference, but they did, and the odd time I have a proper coffee when out if I forget to ask for decaf I feel it.

I also have to moderate my exercise, too much duration and/or intensity brings it on, as does lack of sleep (OSAS and PLMD) and general fatigue.

Basically decaf everything was a game changer for me (though it doesn’t taste as good). BTW (hot) chocolate has a fair amount of caffeine in it too.

I started getting ectopic beats really bad in my mid 30’s. (I’m 62 now) It was deeply uncomfortable, unpredictable and at times; frightening. I had a 24 hour recording which recorded several thousand ectopics, a stress test & ultrasound check on my heart. These didn’t tend to be noticeable during exercise but I’d stopped cycling until the doc gave me the all clear. I’ve never smoked, enjoy a drink & always did sport of some description. I was reasonably fit at the time, had a stringent medical every year & no family history.

Nothing I tried or omitted from my diet made any difference. I think the single thing that helped the most was the strong reassurance from the cardiac specialist. Despite the alarming nature of these ectopic beats I was in fact fine. It took about five years for them to subside & I only now experience the odd missed beat.

Hopefully yours subside with time as mine did.

Hmmm seems like mixed reports about caffeine reduction helping at all. I’ve also wondered whether my general lack of fluid intake won’t be helping, I’ve never drank much but maybe my age means it’s affecting me more. I might try a slight reduction and see if it helps at all, if not I guess just live with it and hope it eventually disappears.

Hmmm seems like mixed reports about caffeine reduction helping at all

Only one way to find out if it works for you…

I was sceptical when it was suggested as I didn’t think had much with just drinking tea really, but it’s made a massive difference.

Worth trying for a couple of weeks?

I’ve had this too.

I’d not heard it called Bigeminy before – I know it as premature ventricular contractions/ PVCs / Ectopic beats, but I think it is all the same thing.

I found ignoring them to be *a lot* easier said than done. When I was getting particularly strong ones it was bloody terrifying to be honest and had a massive affect on my mental health.

Anyway, I had loads of different tests and scans and tried various things. Magnesium supplements helped to suppress them for me when they got bad, as did Coenzyme CQ10. Keeping hydrated and well slept also helped.

I tried cutting out caffeine, which made no difference to me.

Weirdly, exercise could both bring them on, or also suppress them!

Being generally run down, or drinking too much alcohol, definitely increased the risk of them happening, but didn’t necessarily reliably trigger them

I went private (through Bupa policy paid for by work) and has an ablation which mostly solved it, although I did still get a few milder PVCs, but it was much reduced to a level I was comfortable with.

Then one day, after about 2 years, they just stopped. This is quite common.

I do still get a few but very very rarely. I only think I notice because I am hyper-aware of it.

I found the book ‘the haywire heart’ very helpful for understanding what was going on, and it made me able to understand the various things cardiologists were discussing with me and that I agreed with the direction they were taking my care/treatment.

Hope you get it sorted.

Edit to add… I did go on beta blockers for a bit. Initial side effects weren’t fun but after the initial adjustment phase I found them OK. It definitely stopped them, however I found it diminished my top end cycling performance – basically it’s like a rev limiter.
One other good/interesting (!?) side effect of the beta blockers though was that I definitely stopped giving as much of a flying **** about trivial little things 🙂

I used to get lots of ectopic beats during exercise. They tended to happen on the first few climbs (or just after) and then settle down, but if it was a big ride it would happen for 8 hours or so afterwards.

I googled it for years and then eventually found a case study with the same symptoms that had been pinned down to potassium deficiency in someone who drank tons of coffee and peed out all their potassium intake. I drink one or two strong cups a day but realising that I bike a fair bit and I sweat a lot during that, I started taking electrolyte powder in my bottle all the time rather than just on hot days, and hey presto – gone.

I do still get heart flutters at rest sometimes if I’m feeling a bit rubbish – I think this is related to low grade viruses or inflammation (I hope the causal link is not the other way round). I also found that artificial sweetners make it worse, perhaps because they promote inflammation.

Only advice I can offer, which my Doc provided, is cut out alchohol, entirely. Alchohol is surprisingly bad for the heart and just 1 drink a week can increase risk of arythmias.

https://www.sciencedirect.com/science/article/pii/S2405500X22009379#:~:text=These%20data%20suggest%20that%20even,or%20binge%20consumption%20is%20required.

I have exercise-induced paroxymal AF and luckily so far, only one serious episode, so YMMV.

Alchohol is surprisingly bad for the heart and just 1 drink a week can increase risk of arythmias.

Exactly. My brother has AF, he knows that alcohol triggers it (sometimes) and that it can be as little as a small bottle, and yet he still drinks. And then regrets it.

If you drink alcohol I would cut that out before the caffeine. No point being caffeine-free if you are drinking alcohol imo.

And keep very well hydrated, thin blood is a lot easier on the heart!

The GP did mention beta blockers but advised it would be better all round if I can just learn to live with the sensation. 

Not challenging your GP’s expertise as a GP but isn’t this an issue for a cardiologist? Shouldn’t you be asking for a referral?

Just for the record I don’t drink alcohol at all, just the tea, but the long distance and high intensity riding definitely brought them on and they were bad in the exercise stress tests I did and 24 hour monitors where I deliberately exercised a good bit so they could see.

Initial cardiologist had me down as having cardiovascular disease before tests rules it out, then microvascular disease as an absence of blockages in the usual investigations of heart and arteries (he was obviously stuck on that track).

It was only when I moved and moved health boards and had to see a different cardiologist after a series of bad events, one where i truly thought I’m **** and actually asked my wife to take me to hospital, did i get a second opinion that made sense.  He ruled out all the variations on CVD the other consultant was saying, and said they were electrical issues, but didn’t feel they warranted an ablation and that invasive investigation would likely do more harm than good.

The advice he gave…. cut out caffeine and moderate/pace my exercise to avoid bringing them on.

Both of which worked for me.  I still get them and ‘heart ache’  if I get over tired from doing too much in general and if I’m run down, but not to the same extent. If I do accidentally have full power coffee I feel some effects fairly soon but they then ease off.

On the ablation note… An old  work colleague had this done after suffering with massive bouts of super ventricular tachycardia, and last I knew he was still symptom free, exercising and back at his P/T firefighting role.

Thanks All, it’s nice to hear that it’s fairly common place. Also for the record I dont drink alcohol at all, it’s vile!

As you say sometimes it’s easy enough to ignore them because they’re subtle but other times it takes my breath away and almost makes me want to cough. I also find when it’s a particularly bad flare that it’s uncomfortable when cycling like I almost hit a lower wall than usual and find I don’t want to push through it. I can almost guarantee after exercise that I feel a small bout of it almost while my heart tries to settle back into it’s own pattern. I went cycling on purpose during the 24 hour ecg for that very reason, if I’d sat and done nothing it probably wouldn’t have tweaked it because by the time the test got sorted it had been over a month and it comes and goes and I knew it was dying off again. I’ve had a few weeks free of it before it returns for the last three weeks or so now. The annoying thing is there’s no particular trigger for it, so I drink the same amount of tea, the same amount of fluids in general, sleep them same and for some reason boom it’s back again.

Only thing you can do is try not to worry about it, which is easier said than done. The moment I notice it, I become aware of every ectopic beat or short run of bigeminy or trigeminy, until I forget that it’s happening and it goes unnoticed for a while again. It started after a bout of Covid-19 last year, but I’ve had a history of occasional PVCs showing on ECGs for years.

As you say, it’s like a whack in the chest followed by a cough when it happens. Did exactly the same as you when I had the portable ECG on and decided to see how far I could push things. There’s a whole series of unpleasant wobbles as my heart accelerates but once it’s gone through about 140 bpm it behaves itself.

Fatigue (lack of sleep as opposed to just a lot of exercise) and stress affects mine in roughly equal measure. Not impacted by alcohol or caffeine in my case.

If you need to do an exercise ECG in the hospital and are a half-decent runner, you’ll need to make it clear in advance that the Bruce Protocol is not suitable and that they’ll need to pick something else or hold the last stage.

AF and palpitations are very different things.  AF can be v dangerous depending on the type, whereas palpitations aren’t, generally….I assume your doctor has told you it’s palpitations?

I’ve had AF, stopped after an ablation.  I still get palpitations on occasion. It’s well worth looking at these videos (recommended by my GP not some random) York Cardiology

I’ve reduced caffeine but it hasn’t made any difference (btw I think 4 cups of tea gives you quite a lot of caffeine in a day).  Alcohol definitely makes it worse, as does dehydration.  Not tried magnesium but may do at some point (tho I believe standard magnesium supplements aren’t the right type..they are normally magnesium citrate or oxide or glycinate and it should be magnesium pitolate but it can cause GI issues).

Potassium is probably more important for heart function. Low potassium and high potassium can both cause problems, although low potassium is much more common as it’s a dietary deficiency, whereas high potassium is usually found in people with other health conditions like kidney disease. Potato soup could be the answer…

Potassium is probably more important for heart function

The cardiologist above says magnesium Heart palpitations: Proof that magnesium works for ectopic heart beats

Mine come and go, but I was getting week long episodes of 20 PVCs/min resulting in numerous hospital visits as it crashed my BP. I have taken a beta blocker for about 4 years now (was a bit trial and error to the find the right one for me) and like the comment above, it is a bit of a rev limiter but I don’t race so don’t mind and got used to it. It has also helped my anxiety and migraines, so in discussion with the doctors have decided to stay on them long term.

However, if I’m very tired, have over exercised in the heat (ie my salt is out), run down (with a virus), or very stressed then they can comeback.

I don’t drink caffeine in the afternoon/evening which does seem to make it easier to sleep without them disturbing me so much. I do use hydration salts for most cardio above 1 hour, which definitely helps – my cardiology friend suggested for me salt imbalance seems to be an issue.

Try hitting the rda of potassium which is about 3500mg/day or about 10 bananas

I started getting palpitations after a bout of long covid. They came on quite suddenly and I was having them all day long. I cut out all the fun stuff: caffeine, alcohol, sugar even tried gluten free. Eventually they went – im not sure there was a direct correlation between the foods I cut out or not. I still get the odd very minor bout. Tiredness, stress and diet are all a factor I think.

It’s not a silver bullet, but CBT type approaches might be worth trying for reducing the impact of annoying persistent symptoms. They helped greatly with my post-Covid tinnitus, and helped in reducing my fatigue triggered fatigue cycles too. I used MindEar for tinnitus and found Curable good for chronic fatigue (substituting my chronic fatigue for its main focus, chronic pain).