Palpitation is an awareness of a strong, fast, irregular, abnormal or “galloping” heartbeat. Palpitations tend to be unpleasant and may even be quite violent. They are caused by a change in the heart's rhythm or rate or an increase in the force of its contractions. Fortunately, palpitations are usually brief, and the majority of them are benign.
More serious palpitations may be caused by an underlying heart-related condition (e.g., coronary artery disease or mitral valve prolapse), or they may be due to other situations (e.g., stress or overuse of caffeine). Palpitations are also frequently caused by psychological disorders, such as panic attacks or depression. Some palpitations have no known cause. Anyone who has experienced palpitations is strongly encouraged to see a physician to diagnose and, if necessary, treat the condition.
About palpitations
Palpitation is an awareness of a strong, fast, irregular, abnormal or “galloping” heartbeat that tends to be unpleasant. While typically lasting only a few seconds, they may be forceful or even violent. Palpitations are frequently described by patients as “flip-flopping” or rapid fluttering in the chest, or pounding in the neck.
Palpitations associated with coronary artery disease have the highest risk of fatal arrhythmias, or abnormal heartbeats. These palpitations are more likely to be accompanied by other symptoms, such as:
Sweating
Chest pain
Dizziness
Shortness of breath
Nausea
Lightheadedness
Some patients with palpitations feel as if they are having a heart attack. While this sensation is uncomfortable and even jolting at times, it is only occasionally a sign of a serious problem. Nevertheless, a patient experiencing palpitations, especially when accompanied by one or more of the above symptoms, should seek medical attention.
Potential causes for palpitations
Palpitations may or may not be related to heart-related conditions such as:
High blood pressure (hypertension).
Arrhythmia. An abnormal heartbeat resulting from any change, deviation or malfunction in the heart's normal and natural electrical impulse system. The condition can lead to a skipped, early, rapid or slow beat. This may include atrial fibrillation or any number of tachycardias (abnormally rapid heartbeats), premature atrial contractions and premature ventricular contractions.
Mitral valve prolapse. An abnormality of the mitral valve (the heart valve between the left ventricular chamber and the left atrial chamber) in which the valve doesn't close properly.
Hyperthyroidism (an overactive thyroid gland).
Anemia (a reduced red blood cell count).
Coronary artery disease (a chronic disease that involves a “hardening” or atherosclerosis of the coronary arteries).
Palpitations can also be triggered by any of the following:
Depression
Stress
Anxiety
Panic attacks
Stimulants such as caffeine or nicotine, cocaine or amphetamines
Alcohol
Cigarette smoking
Certain over-the-counter and prescription medications, including some for high blood pressure (hypertension), colds (e.g., decongestants), weight loss and thyroid hormone replacement
Heavy activity or strenuous exercise
High consumption of nutmeg
Other palpitations are random events with no known cause, disappearing as quickly as they began.
Diagnosis methods for palpitations
Upon examination, a physician will review the patient's complete medical history. The physician will want to know about the frequency, strength and type of irregular heartbeat. Patients may be asked to tap out the rhythm of the palpitation on a table. The physician will likely listen to the patient's heart through a stethoscope and ask for a complete description of the palpitations and any accompanying symptoms.
Other tests that may be ordered include:
Holter monitor or event recorder. A portable EKG that is connected to a freely-moving (ambulatory) patient, usually for 24 hours, to measure the heart's electrical activity. Because the palpitations may occur only rarely during those 24 hours, a portable EKG is more likely to detect the palpitations and their source by recording the heart's activity continuously, rather than one random measurement at a physician's office or hospital visit.
Other types of event recorders include continuous loop event recorders and relatively newer implantable recorders. A continuous loop event recorder constantly records data but only saves data for the preceding and subsequent two minutes after the patient manually activates the monitor after an episode of palpitation. This kind of recorder can be worn longer than a Holter monitor in the event of palpitations that occur less than daily. Implanted recorders can record the EKG for one year. As the name implies, they are implanted in the patient and activated by an abnormal heart rhythm. Implanted recorders have not yet been extensively tested.
Echocardiogram. This test uses sound waves to visualize the structures and functions of the heart. A moving image of the patient's beating heart is played on a video screen, where a physician can study the heart's thickness, size and function. The image also shows the motion pattern and structure of the four heart valves, revealing any potential leakage (regurgitation) or narrowing (stenosis). During this test, a Doppler ultrasound may be done to evaluate blood flow.
Electrophysiology study. A test in which a catheter is inserted into a blood vessel and guided to the heart. There, it can measure the heart’s electrical activity and pathways. This test is performed only on certain patients by an electrophysiologist.
Treatment options for palpitations
To relieve the discomfort of palpitations, the patient may be instructed to perform certain simple actions to alleviate some of the discomfort or the symptoms altogether. These include deep breathing, relaxing, splashing cold water on one's face or drinking cold water. Medical treatment may also be recommended if the palpitations are extremely bothersome. Beta blockers are often successful in alleviating the symptoms of palpitations.
If palpitations are occurring because of a substance that the patient is using (e.g., caffeine, nicotine or certain medications), these should be limited or eliminated from the diet. If the palpitations are the symptom of an underlying condition, such as depression or arrhythmia, then treatment will focus on the condition itself. Most patients with palpitations, however, are not suffering from major arrhythmias or psychological disorders.
People may also be referred to a specialist who deals with the diagnosis and management of patients with palpitations (e.g., an electrophysiologist).
Questions for your doctor on palpitations
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about palpitations:
Does the pattern of my palpitations tell you anything about what might be causing them?
What tests do you recommend to determine if there is an underlying cause of my palpitations?
If we can't find an underlying cause, does that mean nothing is wrong?
What conditions might be associated with my kind of palpitations?
Am I candidate for medical treatment even if we cannot find a cause?
Will treating the underlying condition always resolve my palpitations?
Do I need to eliminate all caffeine or can I simply reduce my intake?
In addition to caffeinated beverages, are there any other high-caffeine products I should avoid?
Can my palpitations lead to a more serious condition?
