Heart Palpitations

What are heart palpitations?

Heart palpitations are the sensation of feeling your own heartbeat. People describe fluttering, pounding, racing, thumping, or a skip followed by a heavy thud. You may feel it in the chest, the throat or the neck. Palpitations are a symptom, not a diagnosis. They are also extremely common. Many come from ordinary triggers: caffeine, alcohol, nicotine, stress, poor sleep, dehydration, exercise, fever, hormonal changes and some cold or asthma medications. Others come from premature beats. These are early extra beats that make the following beat feel forceful. A smaller group comes from a true arrhythmia. That may be atrial fibrillation or a fast rhythm from the lower chambers. Thyroid problems, anemia and low blood counts also cause palpitations. Most palpitations are harmless. Still, the National Heart, Lung, and Blood Institute advises evaluation when they are frequent, prolonged, or paired with other symptoms.

Symptoms to watch for

The company palpitations keep is what matters most. Isolated flutters in an otherwise healthy person are usually benign.

Call the office to be seen if you have:

• Palpitations that happen most days, or last more than a few minutes.
• A pulse that feels irregular when you check it at your wrist.
• Palpitations with mild lightheadedness or breathlessness.
• Episodes that start and stop abruptly, like a switch.
• Palpitations that began after a new medication or supplement.

Call 911 if palpitations come with:

• Chest pain or pressure
• Fainting, or nearly passing out.
• Severe shortness of breath at rest.
• Confusion, or sudden weakness on one side of the body.

Fainting with palpitations is never something to watch and wait on. The American Heart Association treats it as a warning sign of a serious rhythm problem.

How Dr. Nanavati diagnoses it

The whole task is capturing your heart on a recording while you feel the symptom. Dr. Nanavati matches the monitor to how often your episodes happen.

• Electrocardiogram (ECG or EKG) is done in the office. It documents the rhythm at that moment.
• Holter monitoring records continuously for 24 to 48 hours. It is ideal when symptoms come daily.
• 7 to 10 day ambulatory rhythm monitoring is used when episodes occur a few times a week.
• Loop recorder implantation and interrogation places a small monitor under the skin for rare episodes or unexplained fainting. It can record for years.
• Echocardiogram rules out a structural cause such as a valve problem or weak pumping.
• Treadmill stress testing is used when palpitations appear specifically with exercise.
• Advanced lipid testing and routine blood work check thyroid function, electrolytes, blood count and cholesterol.
• Pacemaker interrogation or defibrillator interrogation retrieves stored recordings if you already have a device.

Monitors are fitted in the office. Readings from your smart watch are reviewed alongside them.

Treatment options

Most patients are treated by removing a trigger rather than by taking a new drug. Treatment follows the recording.

Lifestyle first. Cut back caffeine and alcohol. Stop nicotine, improve sleep, stay hydrated and address stress. Check labels on decongestants, energy drinks, diet aids and pre workout supplements. Stimulants are a frequent hidden cause. Treating sleep apnea reduces palpitations for many people. So does controlling blood pressure. The Life's Essential 8 habits give a practical framework.

Correct the underlying cause. An overactive thyroid, anemia, dehydration, fever or a medication side effect all have specific fixes. Reassurance itself is treatment when the monitor shows a normal rhythm. Knowing the beats are harmless makes them far less distressing.

Medication. A low dose beta blocker often settles premature beats that are frequent and bothersome. If the recording shows atrial fibrillation, rate control and stroke prevention become the priority. Some patients cannot take blood thinners. For them, left atrial appendage closure is considered.

Procedures. Catheter ablation can cure certain fast rhythms. It is done at an affiliated hospital. Cardiac rehabilitation helps patients regain confidence with exercise after an event.

What to expect at your visit

Keep a short symptom diary before you come. Note the time, the duration, what you were doing and what you had eaten or drunk. Bring your medication list including supplements, and any smart watch tracings. The visit includes an exam, blood pressure, pulse check and an ECG. If a monitor is ordered, staff apply it before you leave. They also show you how to log symptoms. When the report comes back you get a direct answer about what your heart was doing during each episode. The FAQs page explains what to bring.

When to see a cardiologist

Get evaluated for palpitations that are frequent or worsening. Do the same for palpitations with chest pain, breathlessness or fainting. Evaluation is also warranted if you have known heart disease or a heart murmur. A family history of sudden cardiac death at a young age is another reason. Request an appointment online or call the Bonita office at (619) 585-0476.

Dr. Vimal Nanavati, MD, FACC is board certified in cardiology and interventional cardiology. He has 32 years of experience. He founded Advanced Heart Care, Inc. in 1997. He sees patients at three locations. The Bonita office is in South San Diego. It serves Chula Vista, Eastlake, Otay Ranch, National City, Spring Valley, Imperial Beach, San Ysidro and Coronado. The North San Diego office at 5190 Governor Dr serves University City, La Jolla, Clairemont and Mira Mesa. The Redding office serves Shasta County, Anderson, Red Bluff, Palo Cedro and Cottonwood.

Other Related Diseases