Palpitations are one of the commonest things that people come and see me about.

A palpitation is being aware of your heartbeat. It doesn’t have to mean that anything is wrong and most people are aware of their heartbeat at some point or other, even if it is just with exercise or if lying in bed quietly at night and the loudest thing is your heart.

Sometimes people find they are aware of their heartbeat at other times and that the speed or rhythm of the heart is different to normal. This can be worrying.

The commonest cause of palpitations is the occasional ectopic beat. These are variously termed as ectopics, which means that they are coming from a place they are not supposed to come from, or extrasystoles which just means that they are extra heartbeats. Whatever the terminology, the fact is they tend to come in either single beats or a few beats clustered together. The classical description is someone who says that they are aware that their heart skips a beat every now and again. It is often more prevalent when you are not doing very much because that is when your mind can be free to concentrate on these sensations.

The reason it feels as if the heart is skipping a beat is the extra beat usually comes at an earlier time than the normal beat would be expected. At this point the heart would not have had enough time to fill properly and therefore the amount of blood ejected in that heartbeat is low. There is a compensatory pause before the next normal heartbeat and this means that the heart has had more time to fill and therefore when it beats with that normal heartbeat, it tends to be stronger and therefore it feels as if it is a really strong beat, so this is why people tend to say that their heart has missed a beat because they do not feel the extrasystole but they feel the harder normal beat after the extrasystole. These beats tend to come from the ventricles usually but can come from the atria. It is completely normal to have a few of these every day.

Nobody really knows what tends to bring them on but there does seem to be some association with stress and certainly it is well recognised that people can become more aware of them during stressful periods in their lives and even after the stressor has gone, then the recurrence of these extrasystoles can be quite uncomfortable partly because it is associated with the feelings of stress that make them noticeable in the first place. The important thing is to make sure that there are not too many of them because very high numbers of these extrasystoles for example more than 20,000 a day are associated with heart failure.

It is also worth testing to make sure that there are not any other rhythm problems rather than these common extrasystoles. Atrial fibrillation is probably the commonest rhythm problem overall and this is associated with the heart beating irregularly irregularly. These episodes tend to be sustained so for longer than a few seconds and indeed must be at least 30 seconds to meet their definition. The heart often beats very quickly and irregularly and this is definitely worth picking up as its treatment is quite different. There are also other sustained rhythm problems which are regular such as supraventricular tachycardias or ventricular tachycardias and again these are worth picking up because the treatment is different, they can be associated with other heart disease and they can be treated with drugs and/or ablation treatment.

If someone does have common or garden palpitations/extrasystoles, then I usually try reassuring them in the first instance and hopefully that can be enough to make sure that no one is worried about it. Drugs such as beta blockers or calcium channel blockers can be helpful if they remain bothersome but these are used for symptom relief only. For those people who have so many ectopics that heart failure is an issue (usually where every 5th beat is an ectopic or more), ablation can be performed but in order to map these in the catheter laboratory they need to be happening very frequently.

So I hope that is some useful information on palpitations for you. If you have any further questions, please do not hesitate to get in touch so that we can make an appointment and get things sorted.

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