Heart Palpitations

• Introduction to heart palpitations
• What are heart palpitations?
• What does a heart palpitation involve?
• What causes heart palpitations?
• When to see a doctor
• Tests and examinations
• How to prevent heart palpitations

Introduction to heart palpitations

A person is said to be having heart palpitations when they have a sudden awareness of their heart beating in their chest. The feeling is sometimes described as ‘pounding’ of ‘fluttering’ and there are many different things that can cause them. Some of these causes can be very minor, but there are also very serious and dangerous reasons for experiencing heart palpitations. This page will summarise some of the causes of palpitations, what a doctor may like to test for and will also deal briefly with the prevention of palpitations.

What are heart palpitations?

A heart palpitation (often just called a palpitation) is the sudden sensation that you can feel your heart beating in your chest. There are lots of different types of palpitations and people have lots of different descriptions for how it feels. Some common descriptions include that their heart is ‘pounding’, ‘fluttering’, ‘flopping’, ‘skipping’, ‘jumping’ or ‘thumping’.

What does a heart palpitation involve?

The reason that people suddenly notice their heart is usually because of a sudden change in how fast or how hard it is beating. Sometimes a palpitation can be caused by a change in the rhythm of a heart beat, going from the regular thump to a different, less predictable pattern. People can also notice their heart beat just because there is very little else in the room to hear, such as at night when they are going to sleep.

What causes heart palpitation?

Causes outside the heart
There are lots of different causes for heart palpitations. While some of these are due to the heart itself, there are lots of reasons outside the heart that can also lead to heart palpitations. These include:

• An overactive thyroid
• Electrolyte disturbances
• Fever
• Pregnancy
• Anaemia
• Menopause
• Phaeochromocytoma (very rare)

There are also many different drugs that can cause heart palpitations. These include:

• Alcohol
• Some anti-depressants
• Tobacco
• Coffee/tea/other caffeinated drinks
• Decongestants
• Salbutamol (Ventolin)

Some illicit drugs such as cocaine and ecstasy can also cause heart palpitations. Emotional factors can also cause palpitations. If someone is particularly anxious or worried about something then they can occasionally feel their heart beating as it begins to increase in rate. Sometimes, someone can get so worried about their heart that they can begin to get stressed and make their palpitations worse. Some psychiatric conditions are also associated with heart palpitations, the most common are panic disorder and depression.

Causes of palpitations from within the heart
Some of the causes within the heart that can lead to palpitations include:

• A normal but fast heart rate, due to:
  • Stress
  • Fever
  • Exercise
• A condition known as paroxysmal supraventricular tachycardia (PSVT)
• Atrial fibrillation (AF)

Less commonly, it is possible that a heart attack or unstable angina can alter the rhythm of the heart and cause palpitations. This is almost always associated with severe pain in the chest. It is also possible that heart palpitations are due to an enlargement of one of the heart’s chambers, or problems with one of the heart’s valves.

When to see a doctor

In general, it is always wise to go and see your local general practitioner if the heart palpitations are worrying you. Even the conditions that are not related to the heart can often be investigated by your GP. If you know the reason for the palpitations however, such as having done some exercise, drunk a lot of coffee or just hearing your normal heart as you go to sleep then medical advice is usually not necessary. Some things that should encourage you to go and see your doctor more quickly include:

• A feeling of an irregular rhythm during the palpitation
• Symptoms accompanying the palpitation including:
  • Loss of consciousness
  • Light-headedness
  • Dizziness
  • Shortness of breath
• Pain in the chest during an attack

 

Tests and examinations

Your doctor may want to examine your heart, lungs and thyroid as part of their check up for palpitations. They will want to take your pulse as well as blood pressure, but it should be noted that unless you are having the palpitations while you are in seeing them then they may not find anything. After this, there are several investigations that they may want to run including:

• Blood tests to check the thyroid, electrolytes and many other things
• A chest x-ray to look at the heart
• An ECG (electrocardiogram)
• An ambulatory 24-hour ECG: a portable machine is worn around the waist with numerous electrodes that record your heart’s activity for a day and records it, hopefully picking up any abnormalities
• An exercise stress test that can assess how your heart copes with the stress of exercise
• Echocardiography to get a clear picture of your heart

How to prevent heart palpitations

Preventing palpitations will depend on what has been causing them in the first place. It may involve simply cutting down the amount of coffee that you drink, smoking less, or altering a medication that you are on. It could also involve treating an over-active thyroid or anaemia. If the palpitations are brought about by anxiety then your doctor might recommend starting an anti-anxiety medication or some counselling such as cognitive behavioural therapy. There are many different ways that palpitations can be dealt with, but because there are so many possible causes it is important that you speak to your doctor and discuss any possible causes and/or treatments.

References

1. Lee TH. Chest Discomfort and Palpitations. Harrison’s Internal Medicine [online]. Access Medicine. [cited 20 August 2006]. Available from URL: http://www.accessmedicine.com
2. Longmore M, Wilkinson I, Rajagopalan S. Oxford Handbook of Clinical Medicine (sixth edition). New York: Oxford University Press; 2004.
3. Murtagh J. General Practice (third edition). North Ryde: McGraw-Hill Australia; 2003.