Have you ever had the sensation of your heart skipping a beat ? Well that may have been a palpitation you felt. There are many causes for palpitations that we will discuss. These causes include: hyperthyroidism, hypocalcemia (low calcium levels in the blood), hypoglycemia (low blood sugar), anemia, hypertension, infection, anxiety attacks, causative agents (caffeine, alcohol, nicotine, recreational drugs, stimulants, stress, exercise, over the counter weight control medications), and mitral valve prolapse.
When a patient comes in complaining of palpitations as a healthcare provider we must run all of these differential diagnoses through our mind. We must complete a detailed history and physical to find the causative agent or refer to cardiology if all signs point to cardiac origin. If the patient is complaining of palpitations along with chest pain, we must defer them to the emergency room immediately to rule out life threatening cardiac issues.
Of course if the identified cause can easily be solved by lifestyle changes such as reducing caffeine intake, we must educate our patients on lifestyle changes. Palpitations is a condition we as healthcare providers should not take lightly and must adequately work-up each patient for. If you are experiencing palpitations, contact your healthcare provider immediately to be evaluated.
Hypertension is known as the “silent killer”. A person rarely has any symptoms of hypertension and can live with it for years without knowing. The effects of long term high blood pressure can be life-threatening. The outcomes from hypertension can be stroke, myocardial infarction (heart attack), and it can damage organs such as the kidneys leading to renal failure. It is highly important to be routinely screened for hypertension and to manage it appropriately to prevent these outcomes.
The Eighth Joint National Committee guidelines on hypertension express that adults over the age of 60 must strive for a blood pressure goal of less than 150/90 mm Hg. For adults aged 30 – 59 and those with diabetes and chronic kidney disease, the panel recommends a goal of less than 140/90 mm Hg.
The first line of treatment for hypertension would be lifestyle modifications. This includes: exercise, healthy diet, and restricting sodium intake. High levels of sodium causes fluid to be retained in the body which increases blood volume thus increasing blood pressure. If lifestyle modifications do not work then it is time to move to medications.
The healthcare provider has various medication options for the hypertensive patient.
- ACE inhibitors – Ex: Lisinopril, Benzapril,
- ARBs – Ex: Losartan, Valsartan
- Calcium Channel Blocker – Ex: Amlodipine, Verapamil, Diltiazem
- Thiazide-type Diuretics – Ex: Hydrochlorothiazide, Metolazone
In the black population it is recommended to initiate hypertensive medication therapy with a calcium channel blocker and a thiazide-type diuretic.
If blood pressure is not controlled with one medication, a second class can be added. It is not recommended for an ACE inhibitor and an ARB to be used in conjunction. If two medications cannot control the blood pressure then a third class can be added. If blood pressure goal is still not being attained then referral to a hypertensive specialist is recommended.