Dr. Christopher Quirk


Palipitations PDF Print E-mail
Wednesday, 11 November 2009 03:53

Palpitations are the awareness of one’s heart beating. You can be aware of a normal heart beat, one that is normal but beating more forcefully or when there is an abnormal heart beat or abnormal heart rhythm. It may be apparent from the nature of the palpitations what there likely cause is, but more often than not this will at best be an educated guess. Ultimately, to be sure of the nature of palpitations, we really do need to have an ECG recording of the heart during the palpitations. Of course, the more frequent the palpitations the easier this will be. Palpitations that occur every few months of less frequently are very challenging to identity. 

What might Palpitations be due to?

Palpitations may be due to an abnormal rhythm of the heart whereby the heart runs much faster than usual or they may be due to extra beats occurring in the presence of a normal heart rhythm. These may be intermittent, random or have some provoking factor that sets them off. The abnormal rhythm may not be serious, but some ventricular arrhythmias are life threatening and need to be documented and treated. The commonest cause for palpitations are extra beats in the heart, either from the top chamber of the heart (atrium) or the bottom chamber (ventricle). These are usually completely benign, although this is only the case if underlying heart disease is ruled out. In the presence of any type of heart disease, even extra heart beats can be serious, and it is for this reason that most cases of palpitations should be investigated. 

How do you investigate Palpitations?

There are two issues with patients presenting with palpitations, firstly trying to identify the nature of the palpitations and secondly ruling out any heart disease that may be associated.

How to capture the nature of the palpitations will largely depend on how frequent they occur. If they are daily, or almost daily, then a 24 Hr heart monitor has a high likelihood of being successful and would be the first test. Less frequent palpitations may require an event monitor to capture the symptoms. If the palpitations sound more serious but less frequent than every few months, and capturing them is important, your doctor may recommend an Implanted Loop Recorder.

The second issue is ruling out underlying heart disease. This is done by performing non-invasive tests including a cardiac ultrasound and likely an exercise test. If both of these are normal, such that there is no underlying heart disease or blocked arteries, and no abnormal heart rhythm on exercise, then it is highly likely that the palpitations are not serious, and even if monitoring has not captured them, they are unlikely to be life threatening. 

How do you treat Palpitations?

Clearly this will depend on the nature of the palpitations, the presence of heart disease as a cause of the palpitations and how much they are troubling the patient. In the absence of heart disease, most palpitations are not serious and treatment should be dictated by how bad the symptoms are, and usually do not require any treatment. Simply reassurance that the symptoms are not serious and avoiding precipitating factors often leads to resolution of the symptoms. Other benign arrhythmias of the heart, particularly atrial arrhythmias, are now curable with fairly simple and safe procedures and if suitable this is usually recommended rather than taking medications.        


Last Updated on Friday, 27 November 2009 01:08
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