Dear Dr. Roach: I am a 70-year-old man who is generally in good health. I take medication for high blood pressure, but nothing else. I have periodic episodes of heart palpitations where my heart will beat noticeably and rapidly for about four or five beats, after which there is a longer pause and a final hard beat, then the beats become regular again. These occur about once a month or so. My doctor ordered a 24-hour heart monitor test, which showed no problems (but I didn鈥檛 have one of these episodes during monitoring). My at-home blood pressure monitor often shows results with a sign of irregular heartbeats as well. Is this something I should be worried about?
A.S.
My experience with patients who have complaints similar to yours is that most of the time, it turns out to be nothing to worry about. On average, we have hundreds of abnormal beats per day, sometimes with runs of several fast beats. When the heart resumes normal rhythm, there often is a pause, and the following heartbeat will be noticeably more powerful, as the heart will have had more time to fill with blood. Occasional symptoms like yours are very common.
However, it sometimes can be a symptom of a more serious heart problem, such as atrial fibrillation. That鈥檚 why your doctor ordered the heart monitor (often called a Holter monitor), which takes a continuous EKG reading of the heart, usually for 24-48 hours. With your symptoms happening only once a month, though, the monitor is unlikely to catch the episode.
When the Holter monitor doesn鈥檛 catch the event, the next option would be a longer-lasting device. Event monitors are similar to Holter monitors, but they can capture data for two to four weeks. A Zio device is a small adhesive patch that captures data from a single EKG lead for up to two weeks. Finally, an implantable (into the chest, under local anesthetic) loop recorder can get data for months to even years.
Based on the way you are describing the symptoms, I suspect this will turn out to be nothing to worry about. However, only capturing the event allows your doctor to evaluate your heart with the highest level of confidence.
Dear Dr. Roach: I nearly died from a urinary tract infection; I was in the hospital for eight days. I was told to drink three ounces of cranberry juice in the morning and take a cranberry extract capsule every night. Since then, I have had no more UTIs. I pray this will help others.
L.A.
I am always glad when people write in with their stories, because it gives me an opportunity to discuss the science behind them.
Cranberries contain substances (proanthocyanidins) that prevent bacteria from sticking to the lining of the bladder, so there is a plausible reason why they might prevent UTIs.
However, the studies to support this hypothesis have had mixed results.
Previous studies showed as much as a 38 per cent risk reduction in UTI, and 47 per cent reduction in recurrent UTIs; however, the most recent review of all studies did not show a benefit in taking either cranberry capsules or cranberry juice in preventing infection.
I don鈥檛 think the science is settled, however. Larger and more robust studies still might prove a benefit in UTI prevention. Until then, there is little downside to drinking cranberry juice (I recommend getting 100 per cent cranberry juice and diluting it with plain or soda water to avoid excess sugar).
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
