Palpitations

Heart palpitations are an unpleasant feeling of the beating of the heart. This can include the feeling of a rapid, fluttering or pounding heartbeat. Palpitations may be triggered by exercise, medication or stress.

Most people experience heart palpitations at some point in their life. On their own, palpitations are not life-threatening and usually only last a few seconds. In rare cases, palpitations may be a symptom of a more serious heart condition.

Signs and symptoms

Palpitations can be described as racing of the heart, skipping of heartbeats or fluttering. It can be temporary or persistent.

It can be associated with:

• Chest pain or discomfort;
• Sweating;
• Light-headedness or collapse;
• Nausea or vomiting, and;
• Difficulty breathing.

Heart palpitations may be felt as racing, fluttering or skipping of heartbeats. 

Associated symptoms

There are many symptoms that can occur with palpitations; however, dizziness and fainting may indicate an underlying cardiac cause.

Causes

The following medical conditions that alter the electrical rhythm of the heart (arrhythmia) can cause palpitations:

Atrial fibrillation

Atrial fibrillation is an irregularity in the heart's rhythm. During atrial fibrillation, the heart beats fast and abnormally.

Supraventricular tachycardia

Supraventricular tachycardia is a condition that causes a high heart rate, often above 150 beats per minute, usually due to a structural problem with the electrical system of the heart.

Premature beats

Premature beats occur when the heart is triggered to contract before the next heartbeat is due. Many people with premature beats do not need any specific treatment.

Non-sustained ventricular tachycardia

Non-sustained ventricular tachycardia is a very fast heart rhythm that originates in the lower chambers of the heart, known as the ventricles. If this type of irregular heartbeat persists, then it is called sustained ventricular tachycardia and this can be a potentially life-threatening rhythm.

Other causes

Numerous other conditions and medications can also cause palpitations. These include:

• Heart valve disease, heart defect at birth or heart attack;
• Anxiety or panic attacks;
• High levels of thyroid hormone (hyperthyroidism);
• Low blood glucose levels;
• Anemia, fever or pregnancy, and;
• Certain medications, such as pseudoephedrine (found in some cold and cough medicines) and salbutamol (used for asthma).

Triggers

Some factors that can trigger palpitations include:

• Stress, anxiety or another strong emotional response;
• Vigorous exercise;
• Recreational drugs, such as amphetamines or cocaine;
• Caffeine;
• Alcohol, and;
• Nicotine.

Methods for diagnosis

To help diagnose heart palpitations, your doctor may conduct a physical examination - including listening to your heart with a stethoscope - and ask you about your current lifestyle, diet and medications. You will also be asked how often and when the palpitations occur. Some other tests may be done to ensure you do not have a more serious condition. These tests include:

Electrocardiography

During electrocardiography (ECG), electrodes are attached to your chest while you lie on your back. These record your heart's electrical activity from different angles. This test is used to determine if there are any abnormalities in your heart's rhythm. To see how your heart responds to stress, an electrocardiogram can be performed while you jog on a treadmill.

An electrocardiography (ECG) procedure. 

Echocardiography

Echocardiography, also known as an 'echo', uses ultrasound waves to create an image of the heart. It allows your doctor to see the size of your heart and how well it is working. This may include information on how hard the heart is pumping blood, whether the heart valves are leaking and any areas of damage caused by events such as a heart attack. To determine how the heart is working under stress, rather than resting conditions, echocardiography can be performed after exercise.

Holter monitor

A Holter monitor is a portable version of electrocardiography that records the electrical activity and heart rate over time (e.g., 24 hours). It is worn under your clothing without causing you discomfort.

Event recorder

An event recorder is similar to a Holter monitor, with the exception that it only transmits signals when you are experiencing symptoms. An event recorder may be worn for up to a month and is useful when trying to diagnose rhythm disturbances that occur at unpredictable times.

Chest X-ray

A chest X-ray will give an indication of the condition of your heart and lungs. It may also help to identify issues other than palpitations to explain your signs and symptoms.

Blood tests

Your doctor may also want to do blood tests to examine the level of glucose, amount of hormones secreted by the thyroid or, a blood cell count to diagnose a condition such as anemia.

Types of treatment

Heart palpitations often do not require any treatment, unless your palpitations are caused by a more serious heart condition. When no treatment is required, your doctor may simply recommend that you avoid the activities that cause your palpitations. In the rarer cases when palpitations are caused by a more serious condition, such as an irregular heartbeat, the treatment will focus on improving this condition.

Prognosis

Almost everyone experiences palpitations at some time in their life. For most people it is a normal occurrence and will go away on its own. There is a low risk that you may have a more serious medical condition.

Prevention

To help prevent palpitations, you may try to avoid activities or stresses that might cause you to have them. Some common causes include anxiety or panic attacks and having too much caffeine or alcohol.