Palpitations

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

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 theperson, 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 presentin 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 strenuousphysical activity or obvious fright or anger. Medical attention should alsobe sought if palpitations are accompanied by chest pain, dizziness, shortnessof 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, theheart 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 toworry about unless it occurs frequently. Severe palpitations feel like a thudding or fluttering sensation in the chest. After chest pain, palpitations arethe most common reason that people are referred for cardiology evaluation.

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.

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 dangeror 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 theinformation about the palpitations for physician evaluation. Later the recording can be transmitted over the telephone line for analysis.

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 surgeryis rarely needed.

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

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.

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