To have heart at the poker table, you need a healthy one first

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I really enjoy playing in live multitable tournaments. I love the challenge of trying to navigate a large field, and if I can make a deep run, the financial and psychological rewards are superb.

I didn’t always feel this way. Years ago when I entered my first big tournament I was pretty nervous. I just knew I’d make novice mistakes that would advertise my lack of experience. As I waited for the tournament to begin, I studied the blind structure while I nursed an espresso in the food court.

My most awkward moment in the tournament came just after being moved to a new table. I was dealt a pair of kings under the gun. As I calculated a raise I thought, “This is a great opportunity. Don’t mess it up.” As I reached for my stack, I noticed my hand was trembling slightly. I dribbled out a few chips and then tried to hide my excitement by crossing my arms and leaning on them. I could feel my heart racing against my hand. Part of my skills set as an ER doctor is being able to estimate heart rate without looking at a watch. I’m sure mine was going at least 120.

So why does this happen? And why so fast? Is it something we can control? Is it dangerous?

First, a few definitions: An arrhythmia is secret doctor-talk for abnormal heart rhythm. The seriousness of an arrhythmia can range from “no big deal” to “call for help” to “Oh my God! You’re dead!” When you feel your heart beating abnormally, it’s a palpitation.
You can usually feel your pulse by pressing lightly on the underside of your wrist near the bone at the base of your thumb. You can also try to find it in your neck just underneath the angle of your jaw. Don’t press too hard. Count for 15 seconds and multiply by four. A solid regular rhythm between 60 and 100 is good.

My racing heart was caused by a number of factors. I was nervous and I had just picked up a big hand that I didn’t want to screw up. My stress produced surges of adrenalin that cranked up my heart rate. A shot of espresso-strength caffeine compounded the matter.
Heart rates in the 120 range are usually not a major problem, especially if you can identify and correct the cause of the extra adrenalin. Anger, stress, caffeine, lack of sleep, dehydration, smoking and some drugs (legal and illegal) can cause adrenalin surges.
Drink some Gatorade, put out the cigarette and take a deep cleansing breath to see if you can make your rate go down. Resolve to get more sleep and stop using those nasty stimulants. If these easy fixes don’t work, see your doctor. A host of more serious medical problems such as thyroid disease, blood clots in the lung, anemia and fever also can produce a persistently elevated heart rate.

Once you start hitting rates of 140 or more, it’s time to call for help. Commonly, rates that high aren’t caused by a simple gush of adrenalin, but by a short circuit in the heart’s electrical wiring. Your friendly paramedics carry a medication that usually works well to reset the circuit. Young, healthy hearts generally can sustain rapid rates without suffering long-term damage. But older, weaker tickers can quickly get overwhelmed by rates that high. Don’t hesitate to call 911.

Irregular rhythms are a different story. Usually a few “skipped beats” here and there are inconsequential. It would be wise to have them investigated, but don’t panic. The usual adrenalin-producing culprits are probably at fault. But a completely irregular rhythm with no pattern whatsoever is a cause for alarm. Atrial fibrillation (more secret doctor-talk) needs to be controlled and corrected as soon as possible. Visit your local ER doctor. This is not a problem you should put off until tomorrow.

So let’s summarize the “no big deal” and “call for help” groups. If it feels like your heart is thumping hard or fast, try to check your pulse. If your rate is mildly rapid or you feel a few skipped beats, think about the various things that could stimulate an adrenalin surge. If your rate is really high or completely irregular, call 911.

Next month I’ll cover “Oh my God! You’re dead!” and discuss how you can improve your chances if you get hit with “The Big One.”

In case you’re wondering, my kings ran into an ace on the flop, the button shoved and I ran away. I got blinded down by weak play and I eventually fizzled out. I don’t play like that anymore and I’m no longer nervous about big tournaments. I still, however, like my espresso.

— An avid poker player, Frank Toscano, M.D. is a board-certified emergency physician with more than 28 years of front-line experience. He’s medical
director for Red Bamboo Medi Spa in Clearwater, Fla. Email your poker-health
questions to ftoscano@redbamboomedispa.com