Palpitations

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What are Palpitations?

Palpitations are an awareness of abnormal, fast, irregular, or forceful beating of the heart. In a majority of cases, they are harmless, while in a few they can be an indication of an underlying medical condition such as heart disease. They may be felt as “flip-flopping”, “fluttering”, or “pounding in the neck”.

Is Palpitations's condition a Medical emergency?

Palpitations are not a medical emergency in a majority of cases. They may however require further evaluation and management, especially when associated with other symptoms indicative of heart disease.

Causes

Palpitations can be caused by the following:

  • Increased stress
  • Fear or anxiety
  • Excessive physical activity
  • Thyroid disease
  • Low sugar
  • Low blood pressure
  • Fever
  • Dehydration
  • Consumption of excessive coffee or caffeinated drinks
  • Excessive smoking
  • Hormonal changes as seen during pregnancy or menopause
  • Recreational drugs like cocaine and methamphetamines
  • Electrolyte imbalances
  • Cardiac causes of Palpitations
    • Coronary artery disease
    • Heart arrhythmias
      • Supraventricular tachycardia
      • Sinus tachycardia
      • Atrial fibrillation
      • Ventricular tachycardia
      • Atrioventricular nodal reentry tachycardia
      • Bradycardia
      • Heart block
    • Heart valve disease
    • Heart enlargement or cardiomegaly
    • History of myocardial infarction

Risk factors

Factors that increase the risk of Palpitations include:

  • History of heart disease
  • Pregnancy
  • Thyroid disease
  • Anemia
  • Medications such as amphetamines, nasal decongestants, anti-allergy medications
  • Stressful lifestyle
  • Excessive consumption of alcohol, or caffeinated drinks
  • Excessive smoking
  • Use of recreational drugs

Symptoms & signs

Palpitations may present as an awareness of:

  • Skipping of heartbeats
  • Fluttering of the heart
  • Pounding of heartbeat in the neck
  • Rapid and irregular heartbeats
  • Flip-flopping of the heartbeat – As though the heart stops and starts again repeatedly

Investigations

Some investigations that are advised for the evaluation of Palpitations include:

  • Laboratory tests:
    • CBP &ESR
    • Electrolyte profile
    • Thyroid function tests
    • Tox screen
  • ECG:
    • Standard ECG
    • Continuous ECG:
      • Holter Monitoring
      • Event recording
    • Echocardiography

Diagnosis

A diagnosis of the underlying cause of Palpitations is established based on medical history, clinical evaluation, and results of the investigations done.

Treatment

The treatment of Palpitations depends on first identifying the underlying cause. Lifestyle modifications are the only advice given when Palpitations are not associated with heart disease. When an underlying heart condition is recognized, appropriate medical or surgical management may be done as required.

Medical management

Medical management of Palpitations due to heart rhythm disorders may include:

  • Antiarrhythmic Agents – they are used for suppressing abnormal heart rhythms

Interventional including surgery and indications for surgery

Interventional management of Palpitations due to heart rhythm disorders may include the following:

  • Electrical Intervention:
    • Pacing
    • Cardioversion
    • Defibrillation
  • Implantable Devices:
    • Pacemaker Implantation
    • Implantable Cardioverter- Defibrillator

Surgical Interventions for the management of heart rhythm disorders may include:

  • Maze procedure: It is done to create scar tissue that helps to bypass the additional signals
  • Coronary Bypass Surgery: It may be done if there is coronary artery disease in addition to heart rhythm disorders.

Role of diet/ Exercise/ Lifestyle changes/ Preventive measures

Some measures that may help in the management of and prevention of Palpitations may include:

  • Exercising and eating a healthy diet
  • Maintaining an ideal body weight
  • Keeping diabetes and hypertension under control
  • Cessation of smoking
  • Cessation of alcohol
  • Reducing emotional stress
  • Limiting the intake of coffee
  • Avoiding recreational drug use, and abuse of over the counter medications
  • Counselling and therapy for anxiety and panic disorders

Complications

Palpitations associated with heart rhythm disorders or heart disease may lead to:

  • Transient Ischemic Attack
  • Stroke
  • Heart Failure

Prognosis

The prognosis for Palpitations, in general, is very good, and a majority of them are harmless and managed with simple lifestyle modifications.

When to contact the doctor or hospital? / How to identify the emergency or complications?

It is advisable to seek immediate medical attention if Palpitations are associated with loss of consciousness, breathlessness, and/or chest pain, or if the individual is in the elderly age group.

Indications for hospitalization if required

Hospitalization is usually not required for the management of Palpitations; however, it may be required if there is a presence of an underlying heart condition that requires emergency management.

Suggested clinical specialist/ Department to consult for this condition

  • Cardiology
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