By Dr. Ngô Chí Hiếu*

What are heart palpitations?

Dr. Ngô Chí Hiếu. — Photo courtesy of Hanoi French Hospital

When you get the feeling that your heart is beating too fast, pounding, fluttering or seems to be “skipping a beat”, you probably have what is commonly referred to as palpitations. Many things can cause palpitations: excitement, stress, pregnancy, strong coffee and some medications. They are also associated with some medical conditions, such as gastritis and dehydration. They are usually more uncomfortable than dangerous.

In a few cases, though, they can be a symptom of a more serious heart condition: heart valve disease, coronary heart disease, heart failure or other underlying problems, which might require treatment.

What are the symptoms?

Typically, you may experience the feeling that your heart:

• Is beating too fast
• Is pounding in your chest as if it wants to jump out
• Is fluttering
• Is skipping a beat
• Has extra beats in between your normal heart beats

Palpitations can happen during exercise but are equally likely to come when you are quietly watching TV. They can even wake you up at night. You may feel them only in your chest or they may radiate to your throat and neck. That is where the expression ‘to feel your heart in your throat’ comes from.

When should you see a doctor?

Many people get palpitations and if they come only occasionally and last for a few seconds or so, they don’t need to be checked. If, on the other hand they occur frequently, last longer, or become worse over time, you should talk to your doctor. The same applies if you have a history of heart disease. Your doctor may suggest simple non-invasive tests to rule out any serious condition.

You must seek immediate medical attention though if your palpitations are accompanied by:

• Chest discomfort or chest pain
• Dizziness
• Fainting
• Severe shortness of breath

What causes palpitations?

On many occasions palpitations are called ‘idiopathic’, which means that the actual cause cannot be identified. Other common causes include:

• Stress, anxiety or depression
• Vigorous exercise
• Some substances such as alcohol, caffeine, nicotine, amphetamines and decongestants containing pseudoephedrine, asthma inhalers or thyroid hormones
• Fever
• Hormone changes associated with menstruation or menopause
• Pregnancy
• Overactive thyroid gland, low blood pressure and low blood sugar levels
• Some herbal and nutritional supplements
• Abnormal electrolyte levels
• Some people get heart palpitations after eating certain foods

They can also be related to heart disease. When they are, they are more likely to represent arrhythmia, which is a very fast or very slow heart rate or irregular heartbeat. Heart conditions tied to palpitations include:

• Prior heart attack
• Coronary artery disease
• Heart failure
• Heart valve problems
• Heart muscle problems

Diagnosis

Your doctor will do a physical examination, which includes listening to your heart with a stethoscope and taking your medical history. He may order some blood tests to examine thyroid hormone levels, blood sugar or other factors to find the cause. If he finds one, the right treatment can reduce or get rid of the palpitations.

If you doctor suspects a heart-related cause, tests may include:

• Electrocardiogram (ECG) - a noninvasive test that records the electrical impulses which make your heart beat. It can help to detect irregularities in heart rhythm and structure. An ECG can be taken while you lie down (resting ECG) or during exercise (stress ECG).
• Holter monitoring – Is a small portable device you wear for 24-72 hours which records your ECG continuously. You will be asked to keep a diary to indicate when you feel palpitations. It can detect palpitations that cannot be seen during one ECG recording only.
• Event recorder – similar to Holter monitoring only you will carry the device on-and-off for up to several weeks. You press the record button when you feel the palpitations which allows your doctor to assess your exact heart rhythm while you have symptoms.
• Echocardiogram - an ultrasound of your heart showing detailed images of your heart’s structure and function.

Treatment

This depends on their cause. Often, palpitations are harmless and go away on their own. In that case, no treatment is needed. Your doctor may advise you to avoid the things that may trigger them. Strategies may include:

• Relaxation exercises such as yoga and tai chi to ease anxiety and stress
• Avoiding certain foods, beverages and other substances
• Avoiding medications listed above

If these home remedies do not help, you may be prescribed medications such as beta-blockers or calcium channel blockers.

If your doctor finds a reason for your palpitations, he will focus on treating that reason. — Hanoi French Hospital

* Dr. Ngô Chí Hiếu is a clinical and interventional cardiologist with years of international training and experience. Together with his colleague Dr. George Cloatre, a French clinical cardiologist, they bring state of the art knowledge and treatment for cardiovascular conditions, diseases and interventions to our customers.

If you have any questions or want to book an appointment with our doctors, please contact us at our phone number 84 – 24.3577.1100, access www.hfh.com.vn, or email us at contact@hfh.com.vn, Address: 1 Phương Mai, Đống Đa, Hà Nội.