printer friendly

PALPITATIONS

Definition

Heartbeat sensations involve a regular or irregular pounding of the heart. It is a conscious, unpleasant awareness of one's own heartbeat, or a sensation of skipped or stopped beats. Palpitations can be felt in the chest, throat, or neck.

Considerations

Normally the heart beats between 60 and 100 times per minute. In people who are physically very fit (those who exercise routinely) and in people who take medications that slow the heart, the rate may drop below 55 beats per minute.

Palpitations may be felt accompanying emotions such as excitment or fright, and also accompanying a fever, an overactive thyroid gland, anemia, or other illnesses. They may or may not be associated with a fast heart rate (tachycardia), with the heart beating faster than 100 times per minute, or with an extra heart beat (called extrasystole).

Pregnant women often feel palpitations in the late-second and third trimesters. This is often due to stress, worry and fatigue experienced by moms-to-be. This is typically not an indication that your baby is in danger. Prenatal nutrition needs accelerate around week 30, causing increased blood flow throughout the mother's body.

Everyone experiences palpitations at some time in life. Pounding of the heart, brought on by strenuous exercise or strong emotions, is rarely associated with serious disease.

Often, people who complain about palpitations do not have heart disease, but are concerned about the possibility of heart disease, and become overly sensitive to normal heart actions. Extra heart beats are commonly noticed just before going to sleep, when resting quietly, or when changing positions.

The significance of palpitations usually depends on the presence of an abnormal heart rhythm or other symptoms of heart disease that accompany it.

Common causes

• Anxiety and fever are the most frequent causes of heart pounding (other than exercise)
• Being frightened
• Pregnancy
• Medication such as thyroid pills, caffeine, appetite suppressants, anti-asthmatics (such as Theo-Dur), the nicotine in tobacco, anti-arrhythmics, beta blockers, cocaine, psychotropics, and sympathomimetics
• Mitral valve prolapse (more common in women)
• Metabolic and respiratory disorders (respiratory acidosis, metabolic acidosis, hyperventilation, hypoxemia)
• Congenital heart disease
• Overactive thyroid
• Diagnostic procedures on the heart

Home care

Heart pounding/palpitations may be normal or may accompany stress and anxiety. If these are present, they may need to be reduced.

Palpitations may also indicate a cardiac rhythm disorders. However, not all cardiac rhythm disorders are treated with medications. Every anti-arrhythmic medication currently available can produce side effects, some of which are potentially more dangerous and troublesome than the arrhythmia itself.

Except for those who need to monitor their heart rate for specific reasons (such as taking digitalis or a beta blocker, or to monitor for aerobic exercise), monitoring the pulse on a regular basis is not necessary.

Call your health care provider if

• A rapid heartbeat continues for more than an hour, or if there is shortness of breath, chest pain, unusual sweating, dizziness, or fainting.
• There are very frequent extra beats (more than 6 per minute or coming in runs of 3 or more).
• The pulse is more than 100 beats per minute (without exercise, anxiety, or fever).

What to expect

If the patient is in distress, cardiac rhythm will be monitored and emergency intervention will be performed as necessary to restore normal cardiac rhythm. Otherwise, the doctor will want to know the exact pulse rate and whether or not the rhythm was regular at the time the problem occurred. Often the symptoms will disappear by the time the doctor sees the patient.

Medical history questions documenting palpitations in detail may include:

• Type
• Do you feel skipped or stopped beats?
• Is there a slow heart rate?
• Is the heartbeat rapid, racing, pounding, or fluttering?
• Is there a regular pattern to the unusual heartbeat sensation?
• Is there an irregular pattern?
• Is the heartbeat sensation induced by a change in body position?
• Time pattern
  • Did the palpitations begin or end suddenly?
  • Did they occur in response to reminders of a traumatic event?
• Associated complaints
  • Was the pulse (heart rate) fast?
  • What was the heart rate (how many beats per minute)?
    • Normal is less than 100 for adults, slightly faster for children and infants.
• What other symptoms are present?

Vital signs (temperature, pulse, rate of breathing, blood pressure) will be measured.

Diagnostic tests that may be performed include:

• ECG
• Chest X-ray (seldom needed)
• Holter monitor (for 24 hours)
• Ecochardiogram

After seeing your health care provider:

If a diagnosis was made by your health care provider related to palpitations, you may want to note that diagnosis in your personal medical record.

Thomas G. Stovall, M.D.

Dr. Stovall is a Clinical Professor of Obstetrics and Gynecology at the University of Tennessee Health Science Center in Memphis, Tennessee and Partner of Women's Health Specialists, Inc.

Date Published: 2002-05-29

7800 Wolf Trail Cove, Germantown, TN 38138
Phone: (901) 682-9222; Fax: (901) 682-9505

Home • About Our Practice • Patient Services • Patient Education

The recommendations and information provided by this Web site are for educational purposes only. This Web site does not contain comprehensive coverage of the topics addressed, and is not a substitute for direct consultation with your health care provider. Always consult a health care provider regarding your specific condition. Trademarks referred to are the property of their respective owners.

© 2008 Women's Health Specialists. All Rights Reserved.