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Palpitations need to be taken seriously and evaluated if:
More than six abnormal beats occur in a minute or if they are perceived to be clustered in groups of three
There is underlying diabetes or hypertension
There is a concomitant loss of consciousness
There is chest pain radiating to the arm and neck or unusual sweating
Even if they are not that frequent, if the palpitations affect your lifestyle, they need to be tackled |
Our heart functions just like a fan, telephone, refrigerator or the other numerous silently efficient machines around us. It is only when such machines make a noise or stop altogether that they impinge on our consciousness. Similarly, as long as our heart — which is responsible for maintaining all the vital organs essential for life — keeps beating efficiently at a rate of 60-100 beats a minute (in adults), we are not aware of its silent, steady and rhythmic function.
Sometimes, it misses a beat, races ahead or produces uncomfortable, unexpected, thumps in our chest. This is when it encroaches on our consciousness. If you lie on your left side and concentrate, you can feel the heart beat. This is normal.
The unexpected thumps or palpitations may be accompanied by chest pain, giddiness, sweating or fainting. These symptoms may be a one time occurrence or they may recur with frightening regularity. Although heartbeat irregularities occur to everyone at some point, if it becomes a recurring phenomenon it is a cause for concern. Women, particularly between the ages of 18-65, tend to experience such symptoms more frequently than men.
A perceptible increased thumping of the heart can also be normal. About 10-15 per cent cases of palpitations fall into this category. Such palpitations can occur during or soon after vigorous exercise. The heart’s response may also produce a choking feeling, particularly if the person is not used to exercise. With fever, the racing pulse may produce uncomfortable feelings in the chest. In pregnant women, blood volume increases and there is a similar response.
Caffeine in coffee and tea increases the heart rate and can produce irregularities. Tolerance to caffeine varies, is idiosyncratic and not necessarily dose dependent. Some people become jittery, and develop an increased heart rate with a single cup. (This is particularly true of children). Others may consume 6-8 cups of coffee or tea without a problem. Many aerated beverages and cola drinks contain caffeine in varying concentrations. Some “sports” drinks have caffeine. “Energy” beverages may contain other chemicals in addition, which in synergy can cause dangerous increases in the heart rate. Nicotine (cigarettes, beedis, chewing tobacco and snuff) can cause irregularities, missed beats and even heart attacks. Certain medications such as diet pills, thyroid replacement therapy (particularly an overdose), salbutamol (to treat bronchial asthma) or pseudoephedrine (allergy medication) can have a similar effect.
Heart palpitations may not be a symptom of underlying disease. In 30 per cent cases the cause may be psychosomatic — a physical manifestation of psychological stress. The palpitations may have been precipitated by anxiety, anger, a frightening episode on television or a near-death experience.
In 45 per cent of cases, the palpitations have a proven cause. They may be due to anaemia, high blood pressure, diabetes, abnormal heart valves, heart disease, thyroid malfunction or electrolyte imbalance.
To evaluate palpitations a complete physical examination is done to rule out anaemia, thyroid disease, electrolyte imbalance, fever and other causes not related to the heart. Then a 12 lead ECG (electrocardiogram) is done. This may be completely normal, particularly if the palpitations occur suddenly and unexpectedly. They cannot be produced on demand for the ECG. To overcome this problem, the behaviour of the heart can be recorded for 24 hours by wearing a portable Holter monitor. A diary can also be kept to physically record times and dates. The heart structure and size can be evaluated with a chest X-ray and an echocardiogram.
Any underlying undesirable habit (smoking or drinking) or any disease precipitating the palpitation needs to be tackled first for any medication or intervention to succeed. Simultaneously, drugs may be administered to keep the heart rate within the normal range.
In 15 per cent of people, no diagnosis is reached for the palpitations. All blood tests and other parameters are found to be normal. The rapid abnormal beats may have been caused by anger, tension and anxiety.
Walking an hour a day, meditation, yoga, music and Tai chi can help you to cope with life without palpitations or dependence on “calming medications” or “sleeping pills.”
Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in
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