Introduction
Heart palpitations are commonly experienced. Often they can be transient, and the cause can be explained. On the other hand, if the palpitations are persistent, the underlying cause should be be determined and the necessary interventions instituted.
A general definition
Mariam-Webster dictionary defines palpitation as “an abnormally rapid or irregular beating of the heart (such as that caused by panic, arrhythmia, or strenuous physical exercise)” [1] (Mariam-Webster, 2022)
In such instances, where the underlying cause can be easily explained e.g., panic, or tiredness, there will be no worries. To this list of easily identified causes, we may add other common causes like excessive indulgence of stimulants like coffee, or alcohol, as well as smoking. Yes, smoking can cause palpitations. [2] (Anon. Cleveland Clinic. Heart Palpitations, 2 Dec. 2021)
When then should we be worried?
Whilst most of the time, heart palpitations are harmless, as can be deduced from the above examples, sometimes they need to be attended to, namely, when the palpitations are accompanied by one of the following:
- Chest pain
- Dizziness
- Nausea, or
- Shortness of breath.
Palpitations may also be felt as abnormal rhythms like:
- Irregular heart beats – every beat feels different in intensity from the previous beat
- Fast beats accompanied by dizziness, and/or shortness of breath
- Fast beats with history of weight loss – these may be due to thyroid overactivity namely, thyrotoxicosis
- Fast beats with exertion and tiredness – these may be due to anemia.
Finally, palpitations may be a symptom of heart failure. We will deal with heart failure in the next post on heart matters.
What to do next when you experience heart palpitations?
- Don’t panic but don’t ignore the palpitations either.
- Most heart palpitations are harmless if you are healthy and only experience the palpitations once a while. Just watch.
- Persistent palpitations alone or accompanied by abnormal rhythms or symptoms listed above, need you to have a consultation with your family doctor. If you are feeling very unwell, a visit to the Emergency Department will be the next thing to do.
What would your family doctor do?
He is likely to
- take a history of your palpitations paying particular attention to the frequency, and associated factors, and the outcome of each episode; a history of presence of heart problems will be relevant; and other clinical features like fatigue, weight loss will be relevant too.
- conduct a clinical examination of the pulse, the neck veins, the apex beat, and hearing the heart sounds in the different areas of the chest will be done.
- order an electrocardiogram which will tell him if your rhythm is regular, and if abnormal, the tracing will help him have an idea what is the problem, and
- decide if he needs to refer you to a cardiologist for further work-up.
Finally, what can you do to prevent heart palpitations?
Depending on what has caused your heart palpitations, the following tips can help you have them less frequently. [2] You can:
1-Avoid or reduce the amount of alcohol you drink.
2-Avoid or reduce the amount of coffee in a day.
3-Avoid or reduce foods and activities that trigger heart palpitations.
4-Stop smoking.
5-Exercise regularly five days a week. Walking regularly is the easiest to organise.
6-Control your blood pressure and cholesterol levels, if these are above normal.
Take home messages
1-Mariam-Webster dictionary defines palpitation as “an abnormally rapid or irregular beating of the heart (such as that caused by panic, arrhythmia, or strenuous physical exercise)” [1] (Mariam-Webster, 2022).
2-The underlying cause can be easily explained in the majority of the episodes e.g., panic, or tiredness, excessive consumption of stimulants like coffee, or alcohol, as well as smoking. [2] (Anon. Cleveland Clinic. Heart Palpitations, 2 Dec. 2021)
3-Whilst most of the time, heart palpitations are harmless, sometimes they need to be attended to, if the palpitations are accompanied by symptoms, or are persistent. See your family doctor, or go to Emergency department if you have chest pain, dizziness, nausea, or shortness of breath.
Acknowledgements
Grateful thanks are due to:
1-Mr Nick Fewings for feature picture from Unsplash.
2-Healio.com for the normal sinus rhythm electrocardiogram tracing (Figure 1).
3-Dreamstimes.com for the ECG tracing showing supraventricular extrasystoles, and short paroxysm of atrial fibrillation (Figure 2).
References for further reading
1-Palpitations – Merriam-Webster dictionary URL: https://www.merriam-webster.com/dictionary/palpitation. Accessed: 22 Aug 2022.
2-Anon. Cleveland Clinic. Heart Palpitations, 2 Dec 2021. https://my.clevelandclinic.org/health/diseases/17084-heart-palpitations. Accessed: 22 Aug 2022.
3- Govender I, Nashed KK, Rangiah S, Okeke S, Maphasha OM. Palpitations: Evaluation and management by primary care practitioners. S Afr Fam Pract. ((2004). 2022 Feb 24;64(1):e1-e8. PMID: 35261258. Accessed 22 Aug 2022. https://safpj.co.za/index.php/safpj/article/view/5449/7238
Dr LG Goh
Dr GOH Lee Gan is a retired Associate Professor in the Department of Family Medicine, National University Health System. He has an interest in learning and teaching how we can age well everyday (AWE).
