Heart Palpitations
What are Heart Palpitations?
Heart palpitations are the awareness of your heart beating, usually in an irregular or quick manner. Palpitations symptoms are sometimes harmless, though can be an indicator of an abnormal heart beat (arrhythmia). The typical description of palpitations includes “fluttering”, skipped, or heavy beats, sometimes associated with other sensations, such as lightheadedness, chest/neck discomfort or the need to pass urine afterwards.
How Common are Palpitations?
Palpitations are one of the most common reasons for individuals to seek appointments with a heart specialist. They are particularly common at times of emotional stress, after consuming caffeinated drinks and in individuals with menopausal symptoms. However, should your palpitations be more sustained, associated with other symptoms or if they are causing you anxiety, it would be advisable to seek the help of a medical professional.
How Long Do They Last?
Palpitations can be fleeting (lasting just 1–2 seconds) or sustained (defined as lasting 30 seconds). In general, longer-lasting palpitations are more indicative of a sustained arrhythmia, though fleeting palpitations can also cause intrusive symptoms.
Causes
Ectopics beats are the most common cause of heart palpitations seen in Dr Jordan’s clinic. These typically result in a feeling of a skipped or missed beat, followed by a heavy beat. Some individuals describe these occurring in brief flurries or in clusters and most often whilst resting.
It is important to determine if palpitations are being caused by ectopic beats or a sustained rhythm problem, as the latter frequently requires specific treatment.
The key causes of a sustained arrhythmia can be divided into those arising from the top chambers of the heart (atrial arrhythmia), a short circuit involving the middle of the heart (re-entry tachycardia) or an issue with the bottom chambers of the heart (ventricular arrhythmia). Further testing is indicated if a sustained rhythm issue is suspected.
The most common cause of a sustained heart rhythm issue is atrial fibrillation – this is an essential diagnosis to make as it is a major cause of stroke; the Cleveland clinic cites that 1 in 3 cases of atrial fibrillation goes undiagnosed. As such, it is essential that you seek medical advice if you feel your heart palpitations may be in-keeping with this form of heart disease.
Symptoms
Palpitations are the awareness of your heart beating, usually in an irregular or quick manner. Individuals can also report other symptoms occurring at the same time or separately, most commonly anxiety, chest/neck discomfort, lightheadedness (or collapse), a need to pass urine afterwards, breathlessness and/or exercise intolerance. If you are suffering from any of these additional symptoms, it would be advisable to seek the help of a medical professional.
Diagnosis
The key to investigating individuals with heart palpitations is to obtain an ECG (heart tracing) at the same time as their typical symptoms. When obtained, it means that your medical professional can be sure of your diagnosis. However, it is often reported that, by the time an individual is able to attend the site of a GP surgery or hospital to obtain an ECG, their palpitations have resolved, and their ECG is normal.
There are therefore several means of obtaining an ECG using portable technology, to capture a reading at the time of an individual’s heart palpitations without needing to attend the hospital site. Traditionally, continuous ECG monitors (Holter monitors) are used and these provide excellent diagnostic quality ECGs. However, if your heart palpitations occur infrequently, an event recorder can be provided, for you to record your own ECG at the time of your typical palpitations.
In recent times, wearable technology, including Apple, Garmin and Fitbit devices, have become more prevalent. The latest versions of these devices are typically able to record an ECG to aid with your diagnosis.
If your heart palpitations occur very infrequently and there is a high suspicion of a concerning heart rhythm disorder, particularly if there are other associated symptoms such as blackouts, a small monitor (implantable loop recorder) can be injected under the skin of your chest. This can then be connected to your smartphone via Bluetooth and any significant arrhythmia sent directly to a monitoring station on the hospital site. These monitors typically stay in place for up to 3 years, or until a heart rhythm diagnosis is achieved.
In addition to ECG monitoring, additional tests can often provide a fuller picture of your heart’s health and exclude underlying conditions as the reason for developing a heart rhythm problem. In particular, an echocardiogram scan is frequently employed to ensure that your palpitations are not being caused by an issue with your heart valves or your heart’s function as a pump. This may be supplemented by other scans, particularly CT or MRI scans, or blood tests, if needed.
Treatment
Treatment of heart palpitations depends on the underlying cause, underscoring the need to obtain the correct diagnosis with appropriate tests.
Isolated ectopy is often treatment with reassurance, sometimes with the addition of mindfulness techniques. However, palpitations due to ectopy and resistant to these measures usually respond to medication and, in rare cases, invasive treatment with an ablation.
Heart palpitations caused by sustained rhythm disorders usually require medication or an invasive heart treatment to regulate the rhythm. If there is an increased risk of stroke, mitigation of this risk with medication needs to be considered. In addition, if the rhythm disorder is found to be due to underlying heart disease, this will also need to be identified and treated appropriately.
Prevention
Keeping your heart in good health can help prevent disorders from leading to heart palpitations. In particular, it is helpful to moderate your alcohol and caffeinated drink intake, alleviate stress and anxiety (if possible), identify medications which may be contributing to your palpitations and ensure that any underlying heart disease is promptly diagnosed and treated.
Are Heart Palpitations Dangerous?
You should seek emergency medical attention and attend the hospital site if your palpitations are persistent and in particular if you feel generally unwell, are suffering from chest pain or have lost consciousness in association with your heart palpitations.
When Should I Worry About My Heart Health?
You should seek the advice of a medical professional if your palpitations are concerning you. Although the majority of people suffering from palpitations do not have underlying heart disease, it is particularly important to seek help if your palpitations are sustained, rather than fleeting, or if they are associated with other symptoms.
Conclusion
Heart palpitations are a common reason to seek the advice of a heart specialist. Although the majority of individuals with palpitations have symptomatic extra beats (isolated ectopy), securing a clear rhythm diagnosis provides reassurance where this is the case and allows for prompt treatment of a sustained rhythm disorder, should this be detected.
You may be interested in reading other heart condition: Atrial Flutter