A heightened awareness of one’s heartbeat whether too fast or too slow is referred to as palpitations. Patients may additionally describe the sensation as a rapid fluttering or a flip-flopping in the chest, or a pounding sensation in the chest or neck. Palpitations are a very common reason for patients to present to their primary care providers. Although usually harmless, palpitations can present as potentially life threatening arrhythmia hence a proper evaluation is necessary.
A variety of conditions can cause heart palpitations. These include;
- strenuous exercise
- lack of sleep
- stress and anxiety
- medicines (check the leaflet that comes with the medicine)
- alcohol, caffeine, nicotine and recreational drugs
- medical conditions such as anaemia and an overactive thyroid gland.
- Hormone changes associated with menstruation, pregnancy, or menopause
Cardiac disease can also be a cause of palpitations. These includes diseases of the heart muscle and heart valves. Heart rhythm problems known as arrythmias are also a common causes of palpitations. The commonest arrythmia is atrial fibrillation which can result in erratic fast heartbeat and affects blood flow that can eventually lead to blood clots. Other arrythmias are named depending where they originate. Ventricular arrythmias originate within the ventricles whereas supraventricular arrythmias originate above the ventricles.
Evaluation of a patient with palpitations involves a comprehensive history and physical examination. Laboratory investigations are done to exclude medical causes. An ECG ( electrocardiogram) which is a test that assess the heart rhythm is done.
An ECG is important for diagnosis as it can pick up arrythmias. occasionally a patient may have to have a Holter, which is a small pocket sized machine that is connected to the chest to detect abnormal rhythms over a period of 24 to 48 hours.
The management of palpitations often is simple and involves lifestyle modification. These includes cutting down on caffeine, alcohol, recreational drugs and smoking. In certain instances, they resolve when one manages the underlying condition.
Occasionally one needs to prescribe antiarrhythmic drugs such as beta blockers and calcium channel blockers to effectively manage palpitations. Complicated cases of palpitations need referral to a cardiologist; and sometimes require a procedure called an ablation which removes the pathways in the heart that cause abnormal rhythms. In some instances, a cardioversion is done to help normalise the heart rhythm.
The take home message is that palpitations are quite common and often harmless. One need to get them evaluated immediately if they are associated with chest pains, shortness of breath and fainting. In most cases palpitations can be managed by treating the underlying condition or using antiarrhythmic drugs.