1. Palpitations are Very Common
It is very common for people to get palpitations. The term covers a myriad of conditions which can range from irregular or fast heartbeats to cardiac emergencies. As a practicing cardiologist, I hear patients from age 15-95 describe symptoms such as a pounding in the chest or throat, skipped beats, bursts of fast heartbeats, or dizziness and loss of consciousness. Some of these symptoms can be very serious and require urgent attention.
2. Irregular Heartbeat
A serious cause of irregular heartbeats is atrial fibrillation (Afib). Afib is the most common arrhythmia in elderly patients but can affect young healthy patients, also. Afib is a condition where the upper chambers of the heart do not beat in an orderly fashion. When any patient is found to have Afib for the first time it is essential to evaluate the function and structure of the heart with a cardiac ultrasound (Cardiac Echo). Abnormalities in the size function and structures of the heart determine the prognosis of restoring normal heart rhythm. The choice of medications that may be used is also determined by the Cardiac Echo. Many patients can live in Afib without ever knowing they are in it. Treatment with aspirin or Warfarin is necessary to reduce the chance of stroke that is associated with the disordered contractions of the upper chambers. Many patients require treatment with Beta-Blockers or Calcium Channel Blocker to keep their heart rate under good control with Afib.
3. Fast Heartbeats
Fast heartbeats can be seen in patients with Supraventricular tachycardia. These heartbeats are generated form the upper heart chambers at rates as high as 300 beats/min. The lower chamber will try to keep up and in younger patients often can reach levels as high as 200 beats per min. Atrial Fibrillation, Atrial Flutter and Atrial Tachycardia are common causes of fast heartbeats. Many types of SVT's respond to and stop with simple vagal maneuvers. These can be actions like coughing, bearing down/straining, immersion of the face in ice cold water or massage of the carotid artery (Do not attempt Carotid Massage without seeing a doctor first.). Lifestyle factors such as caffeine intake, drug and alcohol use, and thyroid disease can influence and worsen SVT. Heart rates in the 200 beat-per-minute range need evaluation from a physician immediately and may be associated with chest pains, loss of consciousness or extreme fatigue.
4. Slow Heartbeats
When the heart rate is slow patients may notice strong or extra beats. It is often considered a sign of good health to have a slow resting pulse and many world class athletes have a heart rate around 40-50 beats per minute. When the heart rate is in the 30 beat-per-minute range during the awake/conscious state, the intrinsic conduction system is likely malfunctioning. Beats from the lower chambers may be interspersed with the upper chamber and cause the feeling of a skipped or extra beat. These beats may be a response from the lower chamber when the heart rate is dangerously slow. Symptoms of dizziness and fatigue are common and are a sign that urgent medical attention is needed. If profound chest pains or pressure is associated with slow heart rate call 911 immediately. This may represent a heart attack involving the blood supply to the conduction system of the heart.
5. Diagnostic Approach to Palpitations
When a doctor sees a patient with palpitations it is common to get an electrocardiogram (ECG) to look at the electrical conduction and pattern of the heart beats. Often, patients get the symptoms and then seek medical attention after they have passed and the ECG is completely normal. Patients may benefit from longer term monitoring with a "Holter Monitor." This allows the patient to go about their usual activates while wearing a small ECG for 24 to 48 hours. A diary is often included to help the doctor determine if the palpitations started after you drank that triple nonfat no foam cappuccino or while you were running on the beach. The tracings can be analyzed and treatment recommendations can be made. If the tracings show simple extra beats from the upper or lower chambers (premature atrial or premature ventricular contractions) often no formal treatment is needed.
