Why you should never dismiss a racing heartbeat as simply STRESS
As one woman’s cautionary tale starkly demonstrates . . .
A ngie Jones-Moore initially put her palpitations down to her father being seriously ill — clearly the pressure and worry was taking its toll and when she mentioned it to her Gp, they agreed.
in fact, Angie, then 41, a commercial copywriter, was suffering from an undiagnosed heart problem, which wasn’t spotted until nearly a year later.
As she knows now, far from being ‘just’ stress, there can be many underlying medical causes of a racing heart rate. As such, experts warn that while palpitations often prove to be harmless, they should never be dismissed.
‘obviously, Dad being ill was a very stressful time,’ she recalls. ‘i was also working and my children were only five and eight. so when i started getting these palpitations every few days — sometimes for nearly ten minutes at a time — i put it down to that; i felt my life was in overdrive and my body was simply reflecting that.’
in broad terms, palpitations are an abnormal awareness of the heartbeat, explains Dr glyn Thomas, a cardiologist and cardiac electrophysiologist, who runs a palpitations clinic at the Bristol Heart institute.
‘Heart palpitations are heartbeats that suddenly become more noticeable. Your heart may feel like it’s pounding, fluttering or beating irregularly, sometimes for a few seconds, sometimes for quite a few minutes. some of my patients describe it as feeling as if their heart has missed a beat.’
They are very common and most people may experience the occasional episode from time to time.
‘People often associate palpitations with middleaged women,’ says Dr Mark Vanderpump, a consultant endocrinologist at the Physicians’ Clinic in London.
‘in general, they are more common in women. And though some causes are specific to women — such as a deficiency in the hormone oestrogen, which can affect blood flow, especially in the run up to the menopause — i see men in my clinic who have palpitations because of a range of causes.’
THe mechanism for palpitations depends on the cause — for example, they can be down to a sudden surge of adrenaline, which increases blood flow — this is what tends to happen if you’re stressed, or there can be an underlying physical issue such as an overactive thyroid (hyperthyroidism) — where the thyroid gland produces too much of the thyroid hormones, which, in turn, affects heart rate, or anaemia where the number of red cells in the body is reduced, causing the heart to pump faster.
‘But, because palpitations are not out of the ordinary, Gps can fail to spot an underlying cause,’ says Professor Charles Knight, a consultant cardiologist at st Bartholomew’s Hospital, London.
Angie saw her doctor a couple of times in 2012 about her palpitations. They continued after the death of her father, and she was told that grief could be a factor.
‘The only advice i was given was to call an ambulance if i felt my palpitations seemed stronger than usual,’ she says. ‘i was worried because they were happening regularly. But i was the classic working mother — too busy and preoccupied to do much about it.’
Then, on new Year’s eve 2012, things took a turn for the worse. ‘i only had one glass of fizz to toast midnight and we went to bed at about 1am,’ Angie recalls.
‘But i woke up four hours later feeling really hot. i remember getting out of bed to go to the bathroom and then i collapsed.’
As her husband, gary, rushed to her aid, Angie tried to get up but blacked out — smashing her chin on the edge of the loo. she also broke a bone in her wrist.
gary called an ambulance, but at the hospital doctors couldn’t find any immediate cause for Angie’s blackout, so she was discharged. ‘But it was disturbing. i couldn’t understand why i had passed out like that,’ she says.
Again, she wondered if it could be down to stress. However, although she didn’t black out again, over the next few months she underwent a range of tests to determine the cause, including brain scans for possible epilepsy and an Ecg — a test to check the heart’s rhythm and electrical activity. This was because palpitations can be a sign of a group of issues known as arrhythmias, or heart rhythm problems.
These include atrial fibrillation, which can cause a fast, irregular heart rate, and an atrial flutter, where the top chambers beat much faster than the ones at the bottom.
Both can be caused by faulty electrical signals in the heart. This is the most common cardiacrelated cause in older people.
it’s hard to distinguish which sensations of palpitations are caused by which condition, which is why you should always consult your GP.
‘in the vast majority of cases, palpitations and a change in the awareness of heartbeats is nothing sinister — statistically most are caused by stress or anxiety,’ says Professor Knight.
‘it’s when they occur randomly — that is when, say, you’re not stressed or are just sitting in a chair watching TV — then it is likely to be something more.’ An ECG or ultrasound of the heart can rule out a heart rhythm problem, says Dr Thomas.
However, he says that if your gp does suspect a heart issue, it’s important the referral is made to a cardiac electrophysiologist rather than a cardiologist, as these doctors specialise in treating heart rhythm problems.
Treatment for arrhythmias often involves catheter ablation, a procedure used to destroy areas of the heart that are sending the faulty signals that are leading to abnormal heartbeats.
Thin, flexible wires called catheters are inserted into a vein, in the groin or neck and threaded up to the heart. An electrode at the tip of each wire sends out heat-creating radio waves that destroy the heart tissue causing the problem.
However, all of Angie’s tests came back normal. it took six months of tests for the cause to be identified — a heart murmur.
These are usually caused by a tight, narrow or leaking heart valve or a thickening or enlarging of the heart muscle — so the heart doesn’t pump blood properly.
‘Heart murmurs are the sound made by a defect in the heart, which could be a serious structural problem that could lead to heart failure and even sudden death,’ warns Dr Thomas.
‘For example, the murmur can be caused by a leaky heart valve — something many of us have without realising.’ in Angie’s case the cause was perplexing, since as well as being fit and healthy she didn’t have a family history of heart issues — and doctors had already ruled out a heart valve defect.
HoweVer, she had suffered with the blood infection sepsis after her son Daniel, who is now ten, was born. Her doctors concluded this historic infection may possibly have done some damage to her heart.
‘i was utterly shocked,’ says Angie. ‘How could i have a heart problem? i’d had a full Nhs medical the year before, when i turned 40, and all my results, such as cholesterol and blood pressure, had been normal.’ Following her diagnosis, Angie was told that there was no specific treatment — though she has to report back to her doctors if her palpitations get any worse and was advised to recalibrate her lifestyle since stress could exacerbate her situation.
‘i do have a busy life — there are simply not enough hours in the day. But i realised that something had to give as i didn’t want to risk causing any more damage, or having more blackouts.
‘i was advised that caffeine can speed up the heart, so i gave this up, which wasn’t hard as i’m not a big tea or coffee drinker. i also gave up alcohol and cut back my hours at work. i still get some palpitations, but i take care of myself now and they are nothing like what they used to be.’
Anyone who has palpitations should see a doctor — regardless of age or gender, advises Dr Vanderpump. it’s also vital to get medical help immediately if you also suffer from chest pain, dizziness or light-headedness, or blackouts.
‘Until i was diagnosed, i’d never thought that the palpitations could be a sign of anything really serious,’ says Angie. ‘And anyway, my Gps had dismissed them. But i’m glad i didn’t ignore it and would urge anyone who thinks they are “just stressed” to get themselves checked out, too.’