A palpitation is an abnormal awareness of the beating The pulse rates can also be measured at any point on the body where an artery's pulsation is transmitted to the surface - often as it is compressed against an underlying structure like bone - by pressuring it with the index and middle finger. The thumb should not be used for measuring another person's heart rate, as its strong pulse may interfere of the heart The heart of a vertebrate is composed of cardiac muscle, an involuntary striated muscle tissue which is found only within this organ. The average human heart, beating at 72 beats per minute, will beat approximately 2.5 billion times during a lifetime . It weighs on average 250 g to 300 g in females and 300 g to 350 g in males,^[1] whether it is too slow, too fast, irregular, or at its normal frequency. It can be caused by (but should not be confused with) ectopic beat It is a form of cardiac arrhythmia in which ectopic foci in the ventricular myocardium, or from finer branches of the electric transduction system, cause additional beats of the heart. Some medication may worsen the condition, which is a more specific diagnosis.

The difference between an abnormal awareness and a normal awareness is that the former interrupts other thoughts, whereas the latter is almost always caused by a concentration on the beating of one's heart. Palpitations may be brought on by overexertion, adrenaline Epinephrine is a hormone and neurotransmitter that participates in the "fight or flight" response of the sympathetic nervous system. It is a catecholamine, a sympathomimetic monoamine produced by the adrenal glands from the amino acids phenylalanine and tyrosine, alcohol An alcoholic beverage is a drink that contains ethanol . Alcoholic beverages are divided into three general classes: beers, wines, and spirits, nicotine Nicotine is an alkaloid found in the nightshade family of plants which constitutes approximately 0.6–3.0% of dry weight of tobacco, with biosynthesis taking place in the roots, and accumulating in the leaves. It functions as an antiherbivore chemical with particular specificity to insects; therefore nicotine was widely used as an insecticide in, caffeine Caffeine is a bitter, white crystalline xanthine alkaloid that is a psychoactive stimulant drug. Caffeine was discovered by a German chemist, Friedrich Ferdinand Runge, in 1819. He coined the term "kaffein", a chemical compound in coffee, which in English became caffeine. Caffeine is also part of the chemical mixtures and insoluble, cocaine Cocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is both a stimulant of the central nervous system and an appetite suppressant. Specifically, it is a dopamine reuptake inhibitor, a norepinephrine reuptake, amphetamines Amphetamine (amfetamine ) is a psychostimulant drug that is known to produce increased wakefulness and focus in association with decreased fatigue and appetite. Amphetamine is related to drugs such as methamphetamine and dextroamphetamine, which are a group of potent drugs that act by increasing levels of norepinephrine, serotonin and dopamine in, and other drugs Many natural substances such as beers, wines, and some mushrooms, blur the line between food and drugs, as when ingested they affect the functioning of both mind and body, disease A disease or medical condition is an abnormal condition of an organism that impairs bodily functions, associated with specific symptoms and signs. It may be caused by external factors, such as invading organisms, or it may be caused by internal dysfunctions, such as autoimmune diseases (such as hyperthyroidism Hyperthyroidism is the term for overactive tissue within the thyroid gland, resulting in overproduction and thus an excess of circulating free thyroid hormones: thyroxine , triiodothyronine (T3), or both. Thyroid hormone is important at a cellular level, affecting nearly every type of tissue in the body and pheochromocytoma A phaeochromocytoma is a neuroendocrine tumor of the medulla of the adrenal glands (originating in the chromaffin cells), or extra-adrenal chromaffin tissue that failed to involute after birth and secretes excessive amounts of catecholamines, usually adrenaline and noradrenaline. Extra-adrenal paragangliomas (often described as extra-adrenal) or as a symptom of panic disorder Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks . Panic disorder is not the same as agoraphobia, although. More colloquially, it can also refer to a shaking motion. It can also happen in mitral stenosis In normal cardiac physiology, the mitral valve opens during left ventricular diastole, to allow blood to flow from the left atrium to the left ventricle. Blood flows in the proper direction because during this phase of the cardiac cycle the pressure in the left ventricle is lower than the pressure in the left atrium, and the blood flows down the.

Nearly everyone experiences an occasional awareness of their heart beating, but when it occurs frequently, it can indicate a problem. Palpitations may be associated with heart problems, but also with anemias Anemia is a decrease in normal number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency and thyroid The thyroid is one of the largest endocrine glands in the body. This gland is found in the neck inferior to the thyroid cartilage (also known as the Adam's apple in men) and at approximately the same level as the cricoid cartilage. The thyroid controls how quickly the body burns energy, makes proteins, and how sensitive the body should be to other malfunction.

Attacks can last for a few seconds or hours, and may occur very infrequently, or more than daily. Palpitations alongside other symptoms, including sweating, faintness, chest pain or dizziness, indicate irregular or poor heart function and should be investigated.

Palpitations may also be associated with anxiety and panic attacks, in which case psychological assessment is recommended. This is a common disorder associated with many common medications such as anti-depressants.

Palpitations can also occur from blood loss, excessive pain, or lack of oxygen.

Causes of palpitation

Palpitations can be attributed to one of three main causes:

1. Hyperdynamic circulation (Valvular Incompetence, Thyrotoxicosis Hyperthyroidism is the term for overactive tissue within the thyroid gland, resulting in overproduction and thus an excess of circulating free thyroid hormones: thyroxine , triiodothyronine (T3), or both. Thyroid hormone is important at a cellular level, affecting nearly every type of tissue in the body, Hypercapnia Hypercapnia or hypercapnea , also known as hypercarbia, is a condition where there is too much carbon dioxide (CO2) in the blood. Carbon dioxide is a gaseous product of the body's metabolism and is normally expelled through the lungs, Pyrexia Fever is a frequent medical sign that describes an increase in internal body temperature to levels above normal. Fever is most accurately characterized as a temporary elevation in the body's thermoregulatory set-point, usually by about 1–2 °C (1.8-3.6 °F), Anemia Anemia is a decrease in normal number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency, Pregnancy Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside the uterus of a female. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets. Human pregnancy is the most studied of all mammalian pregnancies. Obstetrics is the surgical field that studies and cares for high risk pregnancy)
2. Sympathetic overdrive (Panic disorders Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks . Panic disorder is not the same as agoraphobia, although, Hypoglycemia Hypoglycemia or hypoglycaemia is the medical term for a pathologic state produced by a lower than normal level of blood glucose. The term hypoglycemia literally means "under-sweet blood", Hypoxia Hypoxia is a pathological condition in which the body as a whole or a region of the body (tissue hypoxia) is deprived of adequate oxygen supply. Variations in arterial oxygen concentrations can be part of the normal physiology, for example, during strenuous physical exercise. A mismatch between oxygen supply and its demand at the cellular level, Levocetirizine Levocetirizine is a third-generation non-sedative antihistamine, developed from the second-generation antihistamine cetirizine. Chemically, levocetirizine is the active enantiomer of cetirizine. It is the L-enantiomer of the cetirizine racemate. Levocetirizine works by blocking histamine receptors. It does not prevent the actual release of antihistamines A histamine antagonist is an agent that serves to inhibit the release or action of histamine. Antihistamine can be used to describe any histamine antagonist, but it is usually reserved for the classical antihistamines that act upon the H1 histamine receptor, Anemia Anemia is a decrease in normal number of red blood cells (RBCs) or less than the normal quantity of hemoglobin in the blood. However, it can include decreased oxygen-binding ability of each hemoglobin molecule due to deformity or lack in numerical development as in some other types of hemoglobin deficiency, Heart Failure Heart failure is a condition in which a problem with the structure or function of the heart impairs its ability to supply sufficient blood flow to meet the body's needs. It should not be confused with cardiac arrest (see Terminology, below), Mitral valve prolapse Mitral valve prolapse is a valvular heart disease characterized by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. There are various types of MVP, broadly classified as classic and nonclassic. In its nonclassic form, MVP carries a low risk of complications. In severe cases of classic MVP,.^[2])
3. Arrhythmias (Premature atrial contraction Premature atrial contractions are a type of premature heart beat, irregular heart beat, or benign arrhythmia which start in the upper two chambers of the heart, also called atria. These aren't as serious as a premature ventricular contraction (PVC), and usually require no medical care. Individuals with the condition may report feeling that his or, Junctional escape beat A junctional escape beat is a delayed heartbeat originating not from the atrium but from an ectopic focus somewhere in the AV junction. It occurs when the rate of depolarization of the SA node falls below the rate of the AV node. This dysrhythmia also may occur when the electrical impulses from the SA node fail to reach the AV node because of SA, Premature ventricular contraction A Premature Ventricular Contraction , also known as a premature ventricular complex, ventricular premature beat (VPB) or extrasystole, is a relatively common event where the heartbeat is initiated by the heart ventricles rather than by the sinoatrial node, the normal heartbeat initiator. The electrical events of the heart detected by the, Atrial fibrillation Atrial fibrillation is the most common cardiac arrhythmia (abnormal heart rhythm) and involves the two upper chambers (atria) of the heart. Its name comes from the fibrillating (i.e. quivering) of the heart muscles of the atria, instead of a coordinated contraction. It can often be identified by taking a pulse and observing that the heartbeats don', Supraventricular tachycardia A supraventricular tachycardia also known as paroxysmal supraventricular tachycardia (PSVT) is a rapid rhythm of the heart in which the origin of the electrical signal is either the atria or the AV node. This is in contrast to the deadlier ventricular tachycardias, which are rapid rhythms that originate from the ventricles of the heart, that is,, Ventricular tachycardia Ventricular tachycardia is a tachycardia, or fast heart rhythm, that originates in one of the ventricles of the heart. This is a potentially life-threatening arrhythmia because it may lead to ventricular fibrillation and sudden death. Although less common, some forms of this arrhythmia appear benign, especially in young individuals, Ventricular fibrillation Ventricular fibrillation is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them tremble rather than contract properly. Ventricular fibrillation is a medical emergency. If the arrhythmia continues for more than a few seconds, blood circulation will cease, and sudden cardiac death, Heart block A heart block is a disease in the electrical system of the heart. This is opposed to coronary artery disease, which is disease of the blood vessels of the heart. While coronary artery disease can cause angina or myocardial infarction (heart attack), heart block can cause lightheadedness, syncope (fainting), and palpitations)

Types

Palpitations may be associated with feelings of anxiety or panic. It is normal to feel the heart thumping when feeling terrified or scared, but it may be difficult to know whether the palpitations or the panicked feeling came first. Unfortunately, since it can take some time before a clear diagnosis is made in a patient complaining of palpitations, people are sometimes told initially that the problem is anxiety.

Stressful situations cause an increase in the level of stress hormones, such as adrenaline Epinephrine is a hormone and neurotransmitter that participates in the "fight or flight" response of the sympathetic nervous system. It is a catecholamine, a sympathomimetic monoamine produced by the adrenal glands from the amino acids phenylalanine and tyrosine, circulating in the blood, and there are some types of abnormal heart rhythm that can be stimulated by adrenaline excess, or by exercise. It may be possible to diagnose these sorts of palpitations by performing simple tests, such as an exercise test, while monitoring the ECG Electrocardiography is the recording of the electrical activity of the heart over time via skin electrodes. It is a noninvasive recording produced by an electrocardiograph. The etymology of the word is derived from electro, because it is related to electrical activity, cardio, Greek for heart, graph, a Greek root meaning "to write".

Some types of abnormal heart rhythm seem to be affected by posture. For many people, standing up straight after bending over can provoke a rapid heart rate. Often these attacks can be abolished again by lying down. Many people, if not all, are more aware of the heartbeat when lying quietly in bed at night. This is partly because at that time, the attention is not focused on other things, but also because the slower heart beat at rest can allow more premature beats to occur.

Symptoms

Many times, the person experiencing palpitations may not be aware of anything apart from the abnormal heart rhythm itself. But palpitations can be associated with other things such as tightness in the chest, shortness of breath, dizziness or light-headedness. Depending on the type of rhythm problem, these symptoms may be just momentary or more prolonged. Actual blackouts or near blackouts, associated with palpitations, should be taken seriously because they often indicate the presence of important underlying heart disease.

Diagnosis

The most important initial clue to the diagnosis is one's description of the palpitations. The approximate age of the person when first noticed and the circumstances under which they occur are important, as is information about caffeine Caffeine is a bitter, white crystalline xanthine alkaloid that is a psychoactive stimulant drug. Caffeine was discovered by a German chemist, Friedrich Ferdinand Runge, in 1819. He coined the term "kaffein", a chemical compound in coffee, which in English became caffeine. Caffeine is also part of the chemical mixtures and insoluble intake (tea or coffee drinking). It is also very helpful to know how they start and stop (abruptly or not), whether or not they are regular, and approximately how fast the pulse rate is during an attack. If the person has discovered a way of stopping the palpitations, that is also helpful information.

The diagnosis is usually not made by a routine medical examination and electrical tracing of the heart's activity (ECG), because most people cannot arrange to have their symptoms while visiting the doctor. Nevertheless, findings such as a heart murmur Murmurs are extra heart sounds that are produced as a result of turbulent blood flow which is sufficient to produce audible noise. Murmurs may be present in normal hearts without any heart disease. These types of murmurs, often referred to as innocent murmurs, usually cause no trouble for the patient. Murmurs may also be the result of various or an abnormality of the ECG, which could point to the probable diagnosis, may be discovered. In particular, ECG changes that can be associated with specific disturbances of the heart rhythm may be picked up; so routine physical examination and ECG remain important in the assessment of palpitations.

Blood tests, particularly tests of thyroid gland The thyroid is one of the largest endocrine glands in the body. This gland is found in the neck inferior to the thyroid cartilage (also known as the Adam's apple in men) and at approximately the same level as the cricoid cartilage. The thyroid controls how quickly the body burns energy, makes proteins, and how sensitive the body should be to other function are also important baseline investigations (an overactive thyroid gland is a potential cause for palpitations; the treatment in that case is to treat the thyroid gland over-activity).

The next level of diagnostic testing is usually 24 hour (or longer) ECG monitoring, using a form of tape recorder (a bit like a Walkman) called a Holter monitor In medicine, a Holter monitor , named after its inventor, Dr. Norman J. Holter, is a portable device for continuously monitoring the electrical activity of the heart for 24 hours or more. Its extended recording period is sometimes useful for observing occasional cardiac arrhythmias that would be difficult to identify in a shorter period of time, which can record the ECG continuously during a 24-hour period. If symptoms occur during monitoring it is a simple matter to examine the ECG recording and see what the cardiac rhythm was at the time. For this type of monitoring to be helpful, the symptoms must be occurring at least once a day. If they are less frequent, the chances of detecting anything with continuous 24, or even 48-hour monitoring, are substantially lowered.

Other forms of monitoring are available, and these can be useful when symptoms are infrequent. A continuous-loop event recorder monitors the ECG continuously, but only saves the data when the wearer activates it. Once activated, it will save the ECG data for a period of time before the activation and for a period of time afterwards - the cardiologist Cardiology is a specialty dealing with disorders of the heart and blood vessels. The field includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology. Physicians specializing in this field of medicine are called cardiologists. Cardiologists should not be who is investigating the palpitations can program the length of these periods. A new type of continuous-loop recorder has been developed recently that may be helpful in people with very infrequent, but disabling symptoms. This recorder is implanted under the skin on the front of the chest, like a pacemaker A pacemaker is a medical device which uses electrical impulses, delivered by electrodes contacting the heart muscles, to regulate the beating of the heart. The primary purpose of a pacemaker is to maintain an adequate heart rate, either because the heart's native pacemaker is not fast enough, or there is a block in the heart's electrical. It can be programmed and the data examined using an external device that communicates with it by means of a radio signal.

Investigation of heart structure can also be important. The heart in most people with palpitations is completely normal in its physical structure, but occasionally abnormalities such as valve problems may be present. Usually, but not always, the cardiologist will be able to detect a murmur in such cases, and an echo scan of the heart (echocardiogram An echocardiogram, often referred to in the medical community as a cardiac ECHO or simply an ECHO, is a sonogram of the heart. Also known as a cardiac ultrasound, it uses standard ultrasound techniques to image two-dimensional slices of the heart. The latest ultrasound systems now employ 3D real-time imaging) will often be performed to document the heart's structure. This is a painless test performed using sound waves and is virtually identical to the scanning done in pregnancy to look at the fetus A fetus is a developing mammal or other viviparous vertebrate, after the embryonic stage and before birth. The plural is fetuses.

Treatment

Treating heart palpitations depends greatly on the nature of the problem. In many patients, caffeine intake triggers heart palpitations. In this case, treatment simply requires caffeine intake reduction. If it's been determined that caffeine is not the cause, another dietary consideration is too little magnesium, particularly in pre-menopausal women. A supplement of equal dosages of magnesium and calcium may be helpful in eliminating palpitations. For severe cases, medication is often prescribed.

A variety of medications manipulate heart rhythm, which can be used to try to prevent palpitations. If severe palpitations occur, a beta-blocking drug Beta blockers are a class of drugs used for various indications, but particularly for the management of cardiac arrhythmias, cardioprotection after myocardial infarction (heart attack), and hypertension. Propranolol was the first clinically useful beta adrenergic receptor antagonist. Invented by Sir James W. Black, it revolutionized the medical is commonly prescribed. These block the effect of adrenaline on the heart, and are also used for the treatment of angina Angina pectoris, commonly known as angina, is severe chest pain due to ischemia of the heart muscle, generally due to obstruction or spasm of the coronary arteries (the heart's blood vessels). Coronary artery disease, the main cause of angina, is due to atherosclerosis of the cardiac arteries. The term derives from the Greek ankhon (" and high blood pressure. However, they can cause drowsiness, sleep disturbance, depression, impotence, and can aggravate asthma. Other anti-arrhythmic drugs can be employed if beta-blockers are not appropriate.

If heart palpitations become severe, antiarrhythmic medication can be injected intravenously. If this treatment fails, cardioversion may be required. Cardioversion is usually performed under a short general anaesthesia, and involves delivering an electric shock to the chest, which stops the abnormal rhythm and allows the normal rhythm to continue.

For some patients, often those with specific underlying problems found in ECG tests, an electrophysiological study may be advised. This procedure involves inserting a series of wires into a vein in the groin, or the side of the neck, and positioning them inside the heart. Once in position, the wires can be used to record the ECG from different sites within the heart, and can also start and stop abnormal rhythms to further accurate diagnosis. If appropriate, i.e. if an electrical "short circuit" is shown to be responsible for the abnormal rhythm, then a special wire can be used to cut the "short circuit" by placing a small burn at the site. This is known as "radiofrequency ablation" and is curative in the majority of patients with this condition.

Atrial fibrillation has been discussed in a separate article. Treatment may include medication to control heart rate, or cardioversion to support normal heart rhythm. Patients may require medication after a cardioversion to maintain a normal rhythm. In some patients, if attacks of atrial fibrillation occur frequently despite medication, ablation of the connection between the atria and the ventricles (with implantation of a pacemaker) may be advised. A very important risk of atrial fibrillation is the increased risk of stroke. Management of atrial fibrillation usually includes some form of blood thinning treatment.

Generally speaking, serious arrhythmias occur in patients who are known to have heart disease, or carry a genetic predisposition for heart disease or related abnormalities and complications.

Palpitations, in the setting of the above problems, or occurrences such as blackouts or near blackouts, should be taken seriously. Even if ultimately nothing is found, a doctor should be contacted immediately to arrange the appropriate investigations, especially if palpitations occur with blackouts or if any of the above conditions are noticed.

See also

• Electrocardiogram – graphic records of the electrical voltage in the heart
• Holter monitor – device monitoring electrical activity of the heart
• Tachycardia – an abnormally rapid beating of the heart
• Bradycardia – an abnormally slow beating of the heart
• Premature Ventricular Contraction – a form of irregular heartbeat

References

1. ^ palpitation at Dorland's Medical Dictionary
2. ^ MedlinePlus Medical Encyclopedia: Heart palpitations

External links

• Abnormal Heart Rhythms, BHF
• British Heart Foundation
• Medic8 Family Health Guide
• MedlinePlus Medical Encyclopedia, NIH

Categories: Cardiology | Symptoms

See Also:

• Heart Palpitations
• Heart Attack

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