Top Doctors: 5 facts about a racing heart

When your pulse quickens, it's easy to fear that something's wrong.

There might be nothing wrong, but a racing heart, felt in your wrist, could be a sign that you need medical care -- maybe even right away.

Here's what you should know:

"Not every racing heart is an abnormality," said Dr. Louise Spadaro, a cardiologist at St. Francis Hospital in Roslyn. "It may simply reflect the body's normal response to a stimulus or stress. If you're excited, scared or nervous, that will naturally drive the heart rate up."

Still, if you feel your heart is racing, "the most important thing to do is to sit or lie down," said Dr. Rohan D. Bhansali, director of clinical cardiology at Long Island Jewish Medical Center in New Hyde Park. "Racing heartbeats can occasionally be a prelude to fainting, even if they are not due to a change in heart rhythm."

If you're driving, he said, pull over if you feel palpitations until the symptoms go away.

Seek emergency care immediately if your racing heartbeat comes with such symptoms as lightheadedness, fainting, chest pain, severe shortness of breath or an inability to breathe, Spadaro said. You should also go to the emergency room if you can't lie flat because you feel as if you're filling up with fluid, she said.

In some cases, though, it's OK to simply get in touch with your physician.

"If the palpitations are otherwise well tolerated and there are no other symptoms, you should notify your doctor so that an electrocardiogram can be done, especially if this is the first time it's happened," said Dr. Sei Iwai, a professor of clinical medicine and director of the Complex Arrhythmia Ablation Program at Stony Brook University Medical Center.

Bhansali noted that fever, infection, dehydration and low blood sugar are among the possible causes of a racing heartbeat. "Less commonly, it can be due to something that requires urgent medical attention, such as a blood clot in the lungs or an abnormal heart rhythm," he said.

An abnormal heart rhythm, also known as an arrhythmia, can have a variety of causes. A common one is an electrical glitch in the heart. This can cause atrial fibrillation, a condition that older people often have and that can cause the heartbeat to spike. Electrical glitches also can lead to several types of supraventricular tachycardia, a name for rapid heartbeats that are based in the upper part of the heart.

People with certain types of rapid heartbeats that are based in the upper chambers of the heart may have options to slow down their pulse, Spadaro said. They can throw cold water on their face, massage their neck to stimulate a crucial nerve, or bear down really hard, as if they're trying to have a bowel movement.

However, "always ask your doctor first," she cautioned. "These maneuvers only work for very specific types of upper chamber tachycardias it could be dangerous to not seek the type of medical help you may need right away." The techniques won't relieve all kinds of rapid heartbeats, including those caused by atrial fibrillation, Spadaro said.

"For the majority of types of rapid heartbeats, we can abolish them and make them go away," Spadaro said. "And for a good number of them, we don't necessarily make them go away, but we make them less pronounced, less symptomatic and maybe decrease the frequency with which they occur."

In many cases, doctors treat racing heartbeats by dealing with the underlying issue -- dehydration or low blood sugar, for instance -- or with medication, Bhansali said.

In some cases, doctors can fix electrical malfunctions in the heart through a procedure called radio-frequency ablation, which uses heat to destroy malfunctioning tissue. "The procedure is safe, highly effective and generally requires no long-term medication use," he said.

To be effectively treated, of course, you first need to be correctly diagnosed. And Iwai said that doesn't always happen.

For instance, he said, people may be diagnosed as simply having anxiety when they actually suffer from irregular heartbeats. "In young patients with no heart disease, this is often a supraventricular tachycardia, which is almost always curable," he said.

Cardiologists

This is the first installment of a 26-week series in which Newsday presents Castle Connolly's list of top LI doctors.

540 Union Blvd.

631-669-2555

8 Greenfield Rd.

516-496-7900

Oncology Building

27-05 76th Ave. 4th Fl.

718-470-7330

Stony Brook Cardiology

101 Nicolls Rd.

HSC Bldg. Fl. 16, Rm 080

631-444-1066

43 Crossways Park Dr.

516-938-3000

Stony Brook Univ. Med. Center

Div. Cardiology

Health Sci. Ctr. T16-080

Stony Brook

631-444-9970

South Nassau Comm. Hosp.

Electrophysiology Svcs.

1 Healthy Way

516-632-3418

129 Broadway

631-598-3434

325 W. Park Ave.

516-432-2004

225 Community Dr., Ste. 130

516-504-0474

1129 Northern Blvd., Ste. 408

516-627-2121

220 Belle Mead Rd., Ste. A

East Setauket

631-941-2273

225 Community Dr.

Ste. 130

516-504-0474

100 Port Washington Blvd.

516-570-6907

1279 E. Main St.

Riverhead

631-727-2100

120 Mineola Blvd., Ste. 500

516-663-4480

800 Community Dr.

516-627-6622

2 Ohio Dr.

516-622-6060

1010 Northern Blvd., Ste. 110

516-390-2430

1129 Northen Blvd., Ste. 408

516-627-2121

975 Stewart Ave.

516-222-8610

Dept. Cardiology

300 Community Dr.

516-562-4100

Arrhythmia Center

100 Port Washington Blvd.

516-562-6672

1 Hollow Lane, Ste. 103

516-869-5400

270-05 76 Ave., 4th floor

718-470-7330

875 Old Country Rd., Ste. 102

516-935-8877

Stony Brook Univ. Med. Ctr.

26 Research Way

631-444-1069

LI Jewish Med. Ctr.

Div. Cardiology

270-05 76th Ave.

718-470-7330

488 Great Neck Rd.

Great Neck

516-482-6747

3003 New Hyde Park Rd.

Ste. 406

New Hyde Park

516-358-5401

120 Mineola Blvd., Ste. 500

516-663-4481

540 Union Blvd.

631-669-2555

Three Village Cardiology

210 Belle Mead Rd.

East Setauket

631-689-1400

287 Northern Blvd., Ste. 211

Great Neck

516-482-3401

1615 Northern Blvd., Ste. 301

516-627-9355

155 Northern Blvd., Ste 330

Manhasset

516-726-7575

Stony Brook Health Sci. Ctr.

Level 4, Rm. 120

Stony Brook

631-444-5400

1401 Franklin Ave.

516-877-2626

2035 Lakeville Rd., Ste. 101

New Hyde Park

516-328-9797

70 Glen St.

516-484-7893

200 Old Country Rd., Ste. 278

516-877-0977

100 Port Washington Blvd.

Ste. 105

516-390-9640

Univ. Physicians at Stony Brook

3001 Expressway Dr. N.,

Ste. 200B

631-444-9600

Five Towns Heart Imaging

650 Central Ave., Ste. K

516-804-8590

St. Francis Hospital

VIZZA Bldg., Rm. 101

100 Port Washington Blvd.

516-562-6653

1155 Northern Blvd., Ste. 330

Manhasset

516-627-4330

158 Hempstead Ave.

516-593-3541

West Carver Med. Assocs.

200 W. Carver St., Ste. 8

Huntington

631-421-0020

200 Old Country Rd., Ste. 278

Mineola

516-877-0977

285 Sills Rd., Ste. 12-C

631-444-3575

300 Community Dr.

Manhasset

516-562-2300

100 Port Washington Blvd.

Roslyn

516-622-1011

Stony Brook Univ. Med. Ctr.

Cardiology

101 Nicolls Rd.

HSC Bldg. 16th Fl., Rm. 080

Stony Brook

631-444-3575

Interventional Cardiology

St. Francis Hospital

The Heart Center

100 Port Washington Blvd.

Ste. G-03

Roslyn

516-627-1155

100 Port Washington Blvd.

Roslyn

516-365-2211

100 Port Washington Blvd.

Ste. G-05

Roslyn

516-365-4888

North Shore Univ. Hosp.

Dept. Cardiology

300 Community Dr.

Manhasset

516-562-4100

1405 Old Northern Blvd. 1st fl.

Roslyn

516-484-6777

How they were picked

Castle Connolly Medical Ltd. is a health-care research and information company founded in 1991 by a former medical college, board chairman and president to help guide consumers to America's top doctors and top hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of top doctors and the medical leadership of leading hospitals.

Castle Connolly's physician-led team of researchers follows a rigorous screening process to select top doctors on both the national and regional levels. Its online nominations process -- located at castleconnolly.com/ nominations -- is open to all licensed physicians in America who are able to nominate physicians in any medical specialty and in any part of the country, as well as indicate whether the nominated physician is, in their opinion, among the best in their region in their medical specialty or among the best in the nation in their medical specialty.

Careful screening of doctors' educational and professional experience is essential before final selection is made among those physicians most highly regarded by their peers. The result -- Castle Connolly identifies the top doctors in America and provides the consumer with detailed information about their education, training and special expertise in their paperback guides, national and regional magazine "Top Doctors" features and online directories. Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors. (Newsday is not part of the selection process.)

Physicians selected for inclusion in this "Top Doctors" feature may also appear as Regional Top Doctors online at castleconnolly. com, or in one of Castle Connolly's Top Doctors guides, such as America's Top Doctors® or America's Top Doctors® for Cancer.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.