Palpitations are the sensations of pounding or fluttering in the chest due to an abnormal heart beat. They can be unsettling and often prompt concern about underlying heart issues. While various factors can trigger palpitations, cardiac causes are significant considerations. Understanding the cardiac origins of palpitations involves taking detailed history, clinical examination anddiagnostic tools like electrocardiogram (ECG), Holter`s monitoring and echocardiogram.
Heart palpitations can arise from arrhythmias, , irregularities in the heart’s electrical impulses that regulate its rhythm. One common arrhythmia is atrial fibrillation (AF), characterised by erratic electrical activity in the top chambers of the heart, called atria. This chaotic activity results in rapid and irregular heartbeats, leading often to sensation of palpitations. ECG play an important role in diagnosing AF by recording it`s irregular pattern. Additionally, prolonged ECG recording, called Holter monitoring, which involves wearing a portable ECG device for an extended period of time, helps capture intermittent runs of this arrhythmia that may not be evident during a standard ECG. This is often referred to as paroxysmal atrial fibrillation.
Another possible reason for palpitations is supraventricular tachycardia (SVT), a condition marked by sudden episodes of rapid heartbeat originating above the heart’s ventricles. Supraventricular tachycardia can cause not only palpitations but also dizzy spells, breathlessness or chest pain. Holter monitoring aids in capturing these sporadic episodes, providing valuable data for diagnosis and treatment planning.
In addition to this, premature ventricular contractions (PVCs) or ventricular ectopy (VE) can lead to symptoms of palpitations. These are extra, abnormal heartbeats generated in the bottom chambers of the heart, called ventricles. While occasional extra heart beats originating from the lower chambers are common and often benign, frequent or symptomatic episodes may require medical intervention. There are also other causes of palpitations, described in more details in the `arrhythmia` section.
Finally, a common cause of palpitations is POTS, Postural Orthostatic Tachycardia Syndrome. This condition is described as an abnormal increase in heart rate on standing, often from sitting or lying position. POTS is associated with autonomic nervous system dysfunction. Treatment of POTS involves lifestyle modifications along with medications to prevent the symptoms,
In essence, palpitations should not be ignored and seeking medical attention would be recommended. Often after investigations patients are reassured and discharged, and only relatively small proportions of individuals experiencing palpitations require chronic treatment.
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