What you need to know about heart palpitations
Stress and anxiety can cause heart palpitations. Here, Dr Fong Leong, consultant cardiologist/electrophysiologist at Spire Cardiff Hospital, looks at the common complaint and explains how it is treated
WHAT ARE PALPITATIONS?
Palpitations refer to the sensation of heartbeats that are out of the ordinary for the patient.
Since heartbeats are described in terms of their rhythm (regular or irregular) and rate (fast or slow), a complaint about “palpitations” can mean a perceived problem with the heart’s regularity (“there was a pause, then a strong beat”) or its pace (“it went crazy, like the spin cycle of a washing machine”), or both (“my heart was jumping like a box of frogs”).
Accordingly, it is useful to elaborate on what you mean by “palpitations” when you use that term.
Strictly, chest pain or chest discomfort is not synonymous with palpitations. If chest pain and palpitations co-exist, then the two should be reported as such (“I’ve got chest pain and palpitations”).
The same applies to breathlessness, which is often associated with palpitations, but which is not the same thing. Palpitations are subjective: you can have an ongoing arrhythmia and not get palpitations. It is also possible to feel “palpitations” when the cardiac rhythm and rate are perfectly fine.
IS IT NORMAL TO EXPERIENCE PALPITATIONS?
Palpitations are common and are often benign.
Although most people associate palpitations with cardiac arrhythmias, that issue actually only accounts for fewer than half of all cases.
Stress or anxiety, mental health problems, lifestyle factors (too much caffeine, alcohol, or energy drinks), hormonal imbalance, anaemia, illegal drugs (cocaine, etc), and some prescription medicines can also cause palpitations.
Whether an episode of palpitations is harmless or serious depends on its underlying cause, the circumstances in which it occurred, and whether it was well or poorly-tolerated.
A history of heart disease in that individual or their family may be relevant as well.
WHEN DO YOU NEED TO SEE YOUR GP ABOUT PALPITATIONS?
Palpitations that occur occasionally and are fleeting in nature (lasting seconds) are unlikely to be serious. You do not usually need to see your GP if this applies.
Palpitations that are prolonged or frequent, or associated with a personal or family history of heart disease or sudden death, or are causing concern, should be assessed by your GP.
Finally, palpitations that are accompanied by chest pain or chest tightness, severe breathlessness, dizziness, or blackouts are potentially life-threatening; these should be seen in A&E urgently.
CAN PALPITATIONS BE MANAGED CONSERVATIVELY?
This really depends on the cause of the palpitations and the how those palpitations affect the individual.
There are two aspects to the question of “management”.
The first is diagnostic: what is the cause of the palpitations? Clues to this may be drawn from the patient’s history, physical examination, and a heart tracing (the ECG). Blood tests may be required as well.
Depending on the initial findings, further tests may be done to clarify or refine the diagnosis.
This may involve an additional period of ECG monitoring and heart scans.
The second aspect of management concerns treatment, which is usually given after the cause of the palpitations has been established.
In general, palpitations that are benign, infrequent, brief, and well-tolerated can be managed conservatively, without aggressive testing or treatment, but with lifestyle adjustment perhaps (caffeine reduction, etc).
If the palpitations are troublesome, intrusive, or sinister, then tests and treatment are scaled up accordingly.
In the case of palpitations from cardiac arrhythmias, treatment often involves the use of medicines that help to control the rhythm or the rate of the heart.
THE TREATMENT
■ What other treatment options are available if drug therapy is ineffective, unsuitable, or undesirable?
For cardiac arrhythmias, a procedure to cauterise or to freeze (cryoablation) the source of that arrhythmia may be carried out to correct the problem.
Flexible wires are passed into the heart during this treatment (known as catheter ablation) via a vein or artery at the top of the thigh. Most arrhythmias can be treated in this way.
In many cases (not all) a permanent cure can be achieved; in others, repeat ablations may be required, with or without supplementary medication.
Although catheter ablation is generally safe and effective – and is actually the first-line treatment for some types of arrhythmias – you should discuss the likelihood of success and the risks involved with the cardiologist performing the procedure, as outcomes are both arrhythmia and patient-specific, and also operator-dependent.
Finally, pacemakers may be fitted to support a slow heart rate, and implantable cardiac defibrillators are given to deal with life-threatening arrhythmias that are not amenable to ablation.