Heart palpitations represent the physical sensation of irregularities in the beating of the heart.
Many have experienced a seemingly endless fluttering in the chest, followed by a racing and pounding sensation. Just as you think that you are in the throes of a heart attack, the fluttering and pounding start to ebb. Within a few minutes you feel normal again, except for the lingering anxiety and concern.
Just about everyone has experienced a fluttering or racing heart. For people in generally good health, it probably does not signify a problem, More likely, the out-of-kilter rhythm is a simple palpitation - frightening at times but usually not dangerous.
Heart palpitations can produce a number of sensations. Most people describe the episode as a fluttering or racing feeling. Some characterize it as a momentary sensation that the bottom is dropping out of their chest. In some instances, palpitations produce a pounding sensation. Not uncommonly, racing and pounding occur together.
Benign palpitations tend to have a more gradual onset and ending than more serious arrhythmias. They also may be very brief.
Any number of circumstances can lead to a physical or emotional state conducive to heart palpitations. Many people who have palpitations are in situations that make them more aware of their heart and heartbeat. Some people may notice their heart beating more rapidly or forcefully because they are lying on their left side.
Common sources of heart palpitations include:
Fear or anxiety. Panic attack, in particular, can lead to symptoms commonly mistaken for a heart attack.
Stress. Being keyed up or in emotional turmoil for an extended period, or even depression, can cause the heart to skip a beat, race or pound.
Stimulants. Caffeine is a big offender. A variety of drugs can affect the heartbeat. Antihistamines and over-the-counter diet aids are common culprits.
Alcohol. Binge drinking is a fairly common source of palpitations, even in younger people.
Physical Activity. Heavy workouts or competitive activities can cause the heart to race beyond what normally would be expected. The possibility increases when the activity is accompanied by excitement, nervousness, or other emotional reactions.
Thyroid disorders. Heartbeat irregularities are a fairly common feature of an overactive thyroid (hyperthyroidism).
Mitral Valve Prolapse. The mitral valve controls blood flow from the upper chamber to the lower chamber on the left side of the heart. Prolapse occurs when the valve bulges or balloons out of shape. Usually not a serious condition, mitral valve prolapse causes a distinctive murmur (abnormal sounding heartbeat) and can predispose the heart to heartbeat irregularities.
A good medical history and physical exam can separate harmless palpitations from more serious disturbances in heart rhythm. The physical or emotional circumstances surrounding a palpitation often provides clues to the source, as do the patient's medication list and recent use of stimulants or alcohol.
The best way to evaluate a heartbeat disturbance is to document an episode with an electrocardiogram. A portable monitor can record heart rhythm over time, usually 24 to 48 hours.
If rhythm disturbances occur infrequently but are worrisome, a physician may recommend using a device called a transient symptomatic event recorder (known informally as cardiobeeper). Some of these devices resemble sports watches and are worn on the wrist. Others are similar to pocket beepers.
Cardiobeepers may be worn for extended periods. When a heartbeat disturbance occurs, the device is turned on to record the episode. The information is then transferred via the telephone to a physician.
Harmless palpitations generally can be identified as such without sophisticated monitoring. But anytime an unusual or prolonged palpitation causes concern, the episode should be reported to a physician.