palpitations


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Palpitations

 

Definition

A sensation in which a person is aware of an irregular, hard, or rapid heartbeat.

Description

Palpitations mean that the heart is not behaving normally. It can appear to skip beats, beat rapidly, beat irregularly, or thump in the chest. Although palpitations are very common and often harmless, they can be frightening to the person, who is usually unaware of his or her heartbeat.
Palpitations can also be a sign of serious heart trouble. Palpitations that are caused by certain types of abnormal heart rhythms (arrhythmias) can be serious, and even fatal if left untreated. Recognizable arrhythmias are present in a small number of patients who have palpitations. Immediate medical attention should be sought for palpitations that feel like a very fast series of heartbeats, last more than two or three minutes, and are unrelated to strenuous physical activity, obvious fright, or anger. Medical attention should also be sought if palpitations are accompanied by chest pain, dizziness, shortness of breath, or an overall feeling of weakness.
Most people have experienced a skipped or missed heartbeat, which is really an early beat and not a skipped beat at all. After a premature heartbeat, the heart rests for an instant then beats with extra force, making the person feel as if the heart has skipped a beat. This type of palpitation is nothing to worry about unless it occurs frequently. Severe palpitations feel like a thudding or fluttering sensation in the chest. After chest pain, palpitations are the most common reason that people are referred for cardiology evaluation.

Causes and symptoms

Palpitations can be caused by anxiety, arrhythmias, caffeine, certain medications, cocaine and other amphetamines, emotional stress, overeating, panic, somatization, and vigorous exercise. There may be no other symptoms. But, anxiety, dizziness, shortness of breath, and chest pain may be signs of more severe arrhythmias.

Diagnosis

Palpitations are diagnosed through a medical history, a physical examination, an electrocardiogram (ECG), and screening for psychiatric disorders. It is often difficult to distinguish palpitations from panic disorder, a common problem in which the person experiences frequent and unexplained "fight-or-flight" responses, which is the body's natural physical reaction to extreme danger or physical exertion, but without the obvious external stimulus.
To accurately diagnose palpitations, one of the irregular heartbeats must be "captured" on an EKG, which shows the heart's activity. Electrodes covered with a type of gel that conducts electrical impulses are placed on the patient's chest, arms, and legs. These electrodes send impulses of the heart's activity to a recorder, which traces them on paper. This electrocardiography test takes about 10 minutes and is performed in a physician's office or hospital. Because the palpitations are unlikely to occur during a standard EKG, Holter monitoring is often performed. In this procedure, the patient wears a small, portable tape recorder that is attached to a belt or shoulder strap and connected to electrode disks on his or her chest. The Holter monitor records the heart's rhythm during normal activities. Some medical centers are now using event recorders that the patient can carry for weeks or months. When the palpitations occur, the patient presses a button on the device, which captures the information about the palpitations for physician evaluation. Later the recording can be transmitted over the telephone line for analysis.

Treatment

Most palpitations require no treatment. Persistent palpitations can be treated with small doses of a beta blocker. Beta blockers are drugs that tend to lower blood pressure. They slow the heart rate and decrease the force with which the heart pumps. If the cause of the palpitations is determined to be an arrhythmia, medical or surgical treatment may be prescribed, although surgery is rarely needed.

Alternative treatment

Alternative treatments for palpitations should be used only as a complement to traditional medicine. Alternative treatments include: aromatherapy, Chinese herbs, herbal therapies, homeopathic medicine, exercise, mind/body medicine, and diet and nutrition. In aromatherapy, adding citrus oils to bath water may help with minor palpitations. Some Chinese herbs can also help, but others can worsen arrhythmias, so a qualified herbalist should be consulted. Herbal therapies such as hawthorn (Crataegus laevigata) and motherwort (Leonurus cardiaca) can help with palpitations. Homeopathic remedies such as Lachesis, Digitalis, and Aconite (Aconitum nnapellus) may be used to control palpitations but should be taken only when prescribed by a homeopathic physician. Mind/body medicine such as meditation and yoga can help the person relax, eliminating or reducing palpitations caused by anxiety or stress. Reducing or eliminating tea, cola, coffee, and chocolate, and consuming adequate amounts of the minerals calcium, magnesium, and potassium can help reduce or eliminate palpitations.

Prognosis

Most palpitations are harmless, but some can be a sign of heart trouble, which could be fatal if left untreated.

Prevention

Palpitations not caused by arrhythmias can be prevented by reducing or eliminating anxiety and emotional stress, and reducing or eliminating consumption of tea, cola, coffee, and chocolate. Exercise can also help, but a treadmill stress test performed by a physician should be considered first to make sure the exercise is safe.

Key terms

Arrhythmia — Any variation from the normal heartbeat. Some arrhythmias are harmless, while others, such as ventricular tachycardia, ventricular fibrillation, and ventricular standstill, can be fatal.
Somatization — Anxiety converted into physical symptoms. Somatization is a sign of panic disorder.

Resources

Periodicals

Mayou, Richard. "Chest Pain, Palpitations, and Panic." Journal of Psychosomatic Research 44 (1998): 53-70.

palpitations

A clinical sign characterised by patient awareness of rapid and/or irregular heartbeats. While palpitations are often cardiac in origin and accompanied by arrhythmias, they may be caused by non-cardiac conditions.

Palpitations, aetiology
Cardiac aetiology
Atrial—paroxysmal atrial tachycardia/flutter/fibrillation, premature atrial contractions, re-entry (Wolff-Parkinson-White syndrome), sick sinus syndrome (brady-tachy syndrome), sinus tachycardia, atrioventricular node dysfunction.

Ventricular—paroxysmal ventricular tachycardia/fibrillation, premature ventricular contractions.
References in classic literature ?
They were sombre blues, opaque like a delicately carved bowl in lapis lazuli, and yet with a quivering lustre that suggested the palpitation of mysterious life; there were purples, horrible like raw and putrid flesh, and yet with a glowing, sensual passion that called up vague memories of the Roman Empire of Heliogabalus; there were reds, shrill like the berries of holly -- one thought of Christmas in England, and the snow, the good cheer, and the pleasure of children -- and yet by some magic softened till they had the swooning tenderness of a dove's breast; there were deep yellows that died with an unnatural passion into a green as fragrant as the spring and as pure as the sparkling water of a mountain brook.
He read it with a sickening palpitation of his heart, but gave no outward sign of surprise.
Casaubon, who had risen early complaining of palpitation, was in the library giving audience to his curate Mr.
Cornelius put his hand on his heart, to repress as it were its violent palpitation, and listened.
He had taken thirty grains of quinine, and the drug was buzzing in his ears like a nest of hornets, making his hands and knees tremble, and causing a sickening palpitation of the stomach.
The hand that held the lump of quartz was trembling, and there was a tired, nervous palpitation apparently in the pit of his stomach.
As a result I awoke with mouth parched and dry, with a slight heaviness of head, and with a mild nervous palpitation in the stomach.
It happened that an old lord of great family, who was going to marry a young lady of no family in particular, came with the young lady, and the young lady's sister, to witness the ceremony of trying on two nuptial bonnets which had been ordered the day before, and Madame Mantalini announcing the fact, in a shrill treble, through the speaking-pipe, which communicated with the workroom, Miss Knag darted hastily upstairs with a bonnet in each hand, and presented herself in the show-room, in a charming state of palpitation, intended to demonstrate her enthusiasm in the cause.
A common and natural result of an undue respect for law is, that you may see a file of soldiers, colonel, captain, corporal, privates, powder-monkeys, and all, marching in admirable order over hill and dale to the wars, against their wills, ay, against their common sense and consciences, which makes it very steep marching indeed, and produces a palpitation of the heart.
See, in any house where virtue and self- respect abide, the palpitation which the approach of a stranger causes.
I fancied this morning, when I was lying here alone, that there was something almost like a palpitation - a quicker beat.
Fear and joy may both cause cardiac palpitation, but in one case we find high tonus of the skeletal muscles, in the other case relaxation and the general sense of weakness.