Prescription: When the heart is not beating properly

Every fortnight Dr Sunita Agarwal highlights a common, but often ignored, medical problem


What are palpitations?

It is a sensation in which a person is aware of an irregular, hard, or rapid heartbeat. Palpitations mean that the heart is not behaving normally. It can appear to skip beats, beat rapidly, beat irregularly, or thump in the chest. Although palpitations are very common and often harmless, they can be frightening to the person, who is usually unaware of his or her heartbeat.

Palpitations can also be a sign of serious heart trouble. Palpitations that are caused by certain types of abnormal heart rhythms or arrhythmias can be serious, and even fatal if left untreated. Recognisable arrhythmias are present in a small number of patients who have palpitations. Immediate medical attention should be sought for palpitations that feel like a very fast series of heartbeats, last more than two or three minutes, and are unrelated to strenuous physical activity, obvious fright, or anger and accompanied by chest pain, breathlessness, dizziness or weakness.

Most people have experienced a skipped or missed heartbeat, which is really an early beat and not a skipped beat at all. After a premature heartbeat, the heart rests for an instant then beats with extra force, making the person feel as if the heart has skipped a beat. This type of palpitation is nothing to worry about unless it occurs frequently. Severe palpitations feel like a thudding or fluttering sensation in the chest.

What are the possible causes?

Heart disease maybe one of the possible causes. Arrythmias — any variation from the normal rhythm of the heart. Any structural abnormality, such as mitral valve prolapse, diseased blood vessels — coronary heart disease, congenital heart defects — defects present at birth, such as a hole in the heart chambers, high blood pressure or thyroid disease.

Hypoxemia or conditions that lower blood oxygen levels, such as lung disease. Acidemia — an increase in the acid content of the blood as seen in some lung problems. Low blood sugar, anaemia, smoking, amphetamine use, XTC, caffeine, vigorous exercise, stress, anxiety, panic attacks, lack of sleep, over eating, medications including over-the-counter cold remedies, overdose of thyroid medication, asthma drugs or antidepressants.

How are palpitations diagnosed?

Palpitations are diagnosed through a medical history, medical examination, electrocardiogram (ECG), and screening for psychiatric disorders. It is often difficult to distinguish palpitations from panic disorder, a common problem in which the person experiences frequent and unexplained "fight-or-flight" responses, which is the body's natural physical reaction to extreme danger or physical exertion, but without the obvious external stimulus.

To accurately diagnose palpitations, one of the irregular heartbeats must be "captured" on the ECG. Because the palpitations are unlikely to occur during a standard ECG, another procedure in which the patient wears a small, portable tape recorder that is attached to a belt or shoulder strap and connected to electrode disks on his or her chest and monitored by the Holter monitor records the heart's rhythm during normal activities. Some medical centres are now using event recorders that the patient can carry for weeks or months. When the palpitations occur, the patient presses a button on the device, which captures the information about the palpitations for physician evaluation.

What does the treatment involve?

Most palpitations require no treatment. Persistent palpitations can be treated with small doses of a beta blocker which are drugs that lower blood pressure. They slow the heart rate and decrease the force with which the heart pumps. If the cause of the palpitations is determined to be an arrhythmia, medical or surgical treatment may be prescribed.

What is an alternative treatment?

Alternative treatments for palpitations should be used only as a complement to traditional medicine. Alternative treatments include aromatherapy, Chinese herbs, herbal therapies, homeopathic medicine, exercise, mind/body medicine, and diet and nutrition. Mind/body medicine such as meditation and yoga can help the person relax, eliminating or reducing palpitations caused by stress. Reducing or eliminating tea, cola, coffee, and chocolate, and consuming adequate amounts of calcium, magnesium, and potassium can help reduce or eliminate palpitations.

Prognosis

Most palpitations are harmless, but some can be a sign of heart trouble.


— Dr Sunita Agarwal can be contacted on dr_Agarwal@vsnl.com or visit website www.agarwalhospitals.com