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Site FeedbackUnderstanding Heart Palpitations
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Each year millions of Americans become momentarily aware of something that silently happens 100,000 times a day: the beating of their heart. Some may feel a sudden racing of their heart, while others become aware that their heart has skipped a beat. These abnormal sensations are usually referred to as palpitations, a common complaint at any age, but increasingly prevalent as we get older.
A "Fluttering" Heart Is Common
Abnormal heartbeats, or arrhythmias, tend to fall into three broad categories: A racing heartbeat is referred to as tachycardia, a slow heartbeat is bradycardia, and isolated "extra" heartbeats are ectopic beats.
These broad categories encompass a vast array of arrhythmias, arising from various locations within the heart. For example, atrial fibrillation, the most common arrhythmia, is a tachycardia that occurs when rapid irregular electrical impulses from the upper heart chambers (the atria) replace the heart's normal electrical signals. According to the American Heart Association, about 2.2 million Americans have this condition. Many arrhythmias are benign and some do not require treatment, but several others are potentially dangerous. A proper medical evaluation is essential to determine the difference.
Causes Can Determine Severity
Arrhythmias have many causes. According to Krishna Moorthy, M.D., a cardiologist on staff at John Muir Health, conditions unrelated to specific heart disease are sometimes the cause. Those conditions include anemia (low iron), stress, pregnancy, perimenopause, high blood pressure, thyroid problems, and even gastric reflux. In addition, caffeine or excessive alcohol use, tobacco use, and many over-the-counter or prescription medications, dietary supplements and herbal remedies can cause arrhythmias.
Another source of the arrhythmia can be the heart itself. Some people are born with abnormal electrical pathways or connections that can cause tachycardia, while others can be born with blocked electrical pathways causing bradycardia. In other cases, acquired changes in the heart chamber size or function can result in virtually all forms of arrhythmias.
"Congestive heart failure and coronary artery disease are among the most serious causes of arrhythmias," says Dr. Moorthy. In people who have congestive heart failure or a prior heart attack, a rapid heartbeat or other symptoms such as shortness of breath, chest pain or pressure, lightheadedness or fainting (syncope) may be due to a potentially life-threatening arrhythmia called ventricular tachycardia. In these cases, recurrent arrhythmias can result in a cardiac arrest, a condition referred to as "sudden cardiac death" (SCD).
Because of the potential danger for some types of arrhythmias, and because arrhythmias can be indicators for other health conditions, it's always a good idea to discuss palpitations with a physician. "From the patient's point of view, there are really three levels of response," says John Krouse, M.D., a cardiologist on staff at John Muir Health.
If there are no other symptoms that accompany the palpitations, Dr. Krouse advises patients to call their primary care physician and allow him or her to decide whether there is a need for an immediate appointment. "In the majority of cases, there is no urgency and a next-day appointment is fine," says Dr. Krouse.
But if other moderate symptoms accompany the palpitations - such as dizziness, exhaustion, shortness of breath, or minor chest pressure - patients are advised to make a same-day, urgent care appointment. "And if the accompanying symptoms are very severe - including intense chest pain, fainting, or the inability to breathe, you should call 911," says Dr. Krouse.
A Careful Diagnosis
In most cases, a primary care physician can determine whether the palpitations are the common, benign variety. But according to Dr. Moorthy, if the primary care physician has reason to believe the palpitations indicate a more serious arrhythmia, he or she may refer the patient to a cardiologist or cardiac electrophysiologist (a cardiologist with advanced training in diagnosis and treatment of arrhythmias). Depending on the patient's history, additional testing may be helpful to properly characterize the arrhythmia and its cause. These tests can include an electrocardiogram (ECG), cardiac ultrasound (or echocardiogram), outpatient rhythm monitoring, and exercise treadmill testing.
If treatment for the arrhythmia is necessary, there are medications that provide substantial relief for many types of heart rhythm disorders. Other times, medication may be ineffective or poorly tolerated. In these cases, other treatments are available. According to Dr. Moorthy, in some cases of tachycardia, cardiac electrophysiologists can provide a treatment called radiofrequency ablation to eliminate the arrhythmia. This treatment uses specialized catheters that are placed into the heart from the veins and arteries of legs, and delivers radio waves that destroy the abnormal electrical tissue responsible for the arrhythmia. In many cases, neither medications nor catheter ablation provide satisfactory control of certain arrhythmias. In these cases, surgically implanted pacemakers or defibrillators are used to control the heart's rhythm.
Drs. Moorthy and Krouse emphasize that palpitations experienced by otherwise healthy individuals are rarely life threatening. Consulting with a physician who can properly diagnose and manage the various types of arrhythmias is the key to successfully managing palpitations when they occur.
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