Understanding Palpitations: When your heart skips a beat

Palpitations are the sensations of feeling your heart beating irregularly, too fast or hard. While they can be alarming, palpitations are often harmless. However, they can also indicate underlying health issues. Here, leading consultant cardiologist Dr Amar Mistry explores the causes, symptoms, diagnosis and treatment options for palpitations.

What are Palpitations?

Palpitations are the feeling that your heart is:

• Skipping a beat: Also known as premature beats, where an extra beat disrupts the normal rhythm.
• Racing: Known as tachycardia, where the heart beats faster than normal.
• Fluttering: Irregular or erratic heartbeats that can be felt in the chest, throat or neck.

 Palpitations can last for a matter of seconds, minutes or even longer.

What causes Palpitations?

Palpitations can be triggered by various factors, including:

• Stress and anxiety: Emotional distress can cause your heart to race.
• Stimulants: caffeine, nicotine and certain medications.
• Hormonal changes: Pregnancy, menstruation and menopause. 
• Exercise: Physical activity can cause temporary increases in heart rate.
• Medical conditions: Hyperthyroidism, anaemia, low blood pressure or heart disease
• Substance use: Alcohol, recreational drugs and over-the-counter medications.

What are the symptoms of Palpitations?

Palpitations may also be accompanied by:

• Dizziness: Feeling lightheaded or faint.
• Shortness of breath: This is when you have difficulty breathing or feel like you are catching your breath.
• Chest pain: Discomfort or pain in the chest area.
• Sweating: Excessive sweating without physical exertion.
• Fatigue: Feeling unusually tired or weak.

How are Palpitations diagnosed?

To diagnose the cause of palpitations, your healthcare provider may:

• Take a medical history: Discuss your symptoms, lifestyle, and medical history.
• Perform a physical exam: Check your heart rate, blood pressure, and other vital signs.
• Arrange an electrocardiogram (ECG): A simple, non-invasive test to record the electrical activity of your heart to identify any abnormalities.
• Conduct blood tests: Check for thyroid function, electrolyte levels and other potential causes.
• Arrange a heart monitor: Wear a portable device that can either continuously or periodically records your heart's electrical activity.
• Arrange an echocardiogram: An ultrasound used to create images of your heart to assess its structure and function.

Treatment options for Palpitations

Treatment for palpitations depends on the underlying cause. Often, palpitations are harmless but, occasionally, it can be due to a heart condition which may require treatment.

Depending on the cause, advice and treatment could include

• Lifestyle changes: Reduce caffeine and alcohol intake, quit smoking, manage stress, and maintain a healthy diet and exercise routine.
• Medications: Beta-blockers, calcium channel blockers, or antiarrhythmic drugs may be prescribed to regulate heart rhythm.
• Medical procedures: In some cases, procedures like catheter ablation or implantation of a pacemaker may be necessary.
• Treating underlying conditions: Addressing issues like hyperthyroidism or anaemia.

When is the right time to seek medical attention?

Whilst palpitations are often benign, it is important to seek medical attention if you experience:

• Severe chest pain: Persistent pain that does not go away.
• Fainting: Loss of consciousness or extreme dizziness.
• Shortness of breath: Difficulty breathing or severe breathlessness.
• Frequent episodes: Regular Palpitations that disrupt your daily life.
• Pre-existing heart conditions: If you have a history of heart disease or other cardiovascular issues.

Understanding the potential causes and symptoms of palpitations can help you recognise when to seek medical advice. While many cases are harmless, persistent or severe palpitations warrant a consultation with your healthcare provider to rule out any serious underlying conditions. With appropriate diagnosis and treatment, most people can manage palpitations effectively and maintain a healthy, active lifestyle.

Require expert treatment for Palpitations? Arrange a consultation with Dr Mistry via his Top Doctors profile.