Anyone can experience palpitations, irrespective of age. They can be quite normal during stressful periods of our lives, but sometimes they may signal a heart problem. Medical student Sahra Abdallah Haji explains how we can reduce such occurrences and when we need to seek help.

LUB DUB…LUB DUB…LUB DUB…is how a normal beating heart typically sounds, beating at 60 to 100 beats per minute (bpm). However, a palpitation sounds and feels much faster – LUB DUB LUB DUB LUB DUB – or feels like you skipped a beat – LUB…… LUB DUB…… DUB...

Heart muscle is myogenic, meaning that the heart can use its own natural electricity to contract the heart muscle and create a steady rhythmic pulse that lasts throughout your life.

Like a clock ticking away, the heart can beat at its own regular pace. Each separate part of the heart has its own unique rhythm that add up to give an overall heartbeat, which can be heard with a stethoscope.

A palpitation is the weird fluttering feeling you get in your chest when you have a sudden different heartbeat. You don’t normally feel or hear your heart beating but a palpitation causes your heartbeats to suddenly become more noticeable. This can happen at any time whether one is active, resting, standing, seated or even lying down. For the majority of people, even though palpitations can feel unpleasant, they’re usually harmless and have no cause unless you have a heart condition, which may actually be undiagnosed.

With a palpitation, the heart is either beating too slow (bradycardia), or beating too fast without exercise (tachycardia) or it beats with an irregular pattern (arrhythmia). This can lead to the conscious feeling of a skipped or an ‘extra’ heartbeat sensation.

An extra heartbeat can be caused by any part of the heart especially if that part gets out of synchrony with other parts. A racing heart can cause you to faint or collapse because the blood pressure is either too high or too low in the brain; so blood is not staying in the brain long enough to supply it with oxygen.

What creates the sensation?

There are four chambers in the heart, two small chambers at the top known as the atria and two large chambers at the bottom known as the ventricles. Extra beats in the atria are less dangerous than extra beats in the ventricles. This is because the blood from the atria can use gravity to pass through to the ventricles. The ventricles in the heart are larger and more muscular because they need to beat with a stronger and more evident force to push blood to the lungs and the rest of the body. Extra beats in the atria would not be as noticeable or as dangerous as an extra beat in the ventricles.

The main reason for palpitations is a surge of adrenaline in the blood, which causes your heart to start racing

Types of palpitations

Sometimes, palpitations are associated with chest pain, shortness of breath, sweating, nausea, vomiting, low blood pressure and a feeling of fullness in the throat. These symptoms can be either due to angina, a heart attack or a less life-threatening panic attack.

Also, palpitations are normal during a stressful or exciting occurrence because the heartbeat gets really fast and only slows down once you relax. In an emergency, the heart can beat incredibly fast and suddenly stop – in this case, an electric shock of direct current must be applied to the chest and get the stable regular heart rhythm back. This use of external electricity on the heart is known as defibrillation and a machine known as an automated external defibrillator (AED) is needed.

Surprisingly, even athletes can get abnormal palpitations depending on their age and the type of sport they play. A condition known as atrial fibrillation (AF) can account for up to nine per cent of rhythm disturbances in elite athletes and up to 40 per cent in those with long-standing symptoms. On the other hand, elderly people tend to feel their heartbeat anyway but they are also more likely to have heart disease and associated diseases like hypertension and high cholesterol. Thus, palpitations in elderly people can be more serious.

Causes of palpitations

There are multiple causes of palpitations but the main reason is a surge of adrenaline in the blood, which causes your heart to start racing. Adrenaline is a hormone released into your bloodstream when you are stressed, overexcited, nervous, anxious, panicked or frightened. This leads to a fight or flight response.

Adrenaline travels to your heart and causes all parts of your heart to beat faster so that your heartbeat becomes more noticeable. Anything that acts like adrenaline has the potential to cause palpitations. These include tobacco, alcohol, stimulant drugs, caffeine and some medications such as pseudoephedrine, which is used to treat colds. Conditions such as hyperthyroidism, thyrotoxicosis, heart failure, chronic lung disease and anaemia can also lead to palpitations.

Furthermore, abnormal electrical activity in the heart can change the pace at which the heart beats. This can be caused by imbalances in the amount of electrolytes (salts of the body like sodium, potassium, magnesium and calcium) around the heart muscle. Restoring these electrolytes to their normal biological level usually helps return the heart rate back to normal.

Medical conditions that may cause palpitations include:

• Premature atrial and ventricular contractions (PAC or PVC);

• Supraventricular or ventricular tachycardia (SVT or V tach);

• Atrial or ventricular fibrillation.

Women who are pregnant often experience palpitations, which are usually not dangerous. However, it is always safest to visit your GP.

Diagnosis and treatment

Since there are many different types of palpitations and conditions that cause them, the treatment required for each situation is unique. However, the reduction of caffeine intake, including coffee, cola and energy drinks as well as reducing the amount of alcohol, nicotine and cold medications is beneficial for treating the symptoms of palpitations.

Palpitations in elderly people can be more serious

Carrying out relaxing activities that will reduce the amount of adrenaline released into the body will also help. This will help slow down your heart and will make you less likely to experience palpitations.

If these do not work, medications such as adenosine, beta blockers and calcium channel blockers (CCBs) may be administered by the doctor or in hospital. These medications will slow down the heart more and allow it to beat at its normal, regular pace.

Those who get regular palpitations are encouraged to keep a record, usually in the form of a journal, of where, when, how often, the duration and in what circumstances their palpitations occur.

This will allow their GP to tell them whether their palpitations are serious or not. The best way your doctor may diagnose, detect and classify palpitations is via a 12-lead ECG or a 24-hour ECG known as a Holter monitor.

So stay calm and don’t panic the next time you become aware of your heart thumping away inside your chest.