Palpitations - Blog de CHI Health Better You (2023)

palpitations

People of all ages can experience heart palpitations.

At least once a week they see me for palpitations. Since this is such a common problem, I thought it might be a good topic to write about.

If we define palpitations as the abnormal sensation of one's own heartbeat, then I would propose that everyone has palpitations at some point in their lives. The most common descriptions I hear are the sensations of irregular or skipping heartbeats, palpitations in the chest, a racing heartbeat, or just the "awareness" of a normal heartbeat.

Palpitations can affect patients of all ages, although I think it is more common in younger people. For whatever reason, older patients may have noticeably irregular heart rhythms and experience few or no symptoms.

Common causes of heart palpitations

By far the most common cause of episodic palpitations is the presence of premature atrial (PAC) or ventricular (PVC) contractions. Virtually everyone has it from time to time. It is relatively uncommon to see a patient who can wear a 24-hour continuous ambulatory cardiac monitor (Holter monitor) and not show at least one pair of PACs or PVCs in a day. These are almost always benign.

Rarely, the presence of premature beats is a marker of a more serious underlying structural or functional problem that may endanger the patient's health. Previously unidentified problems, such as atrial septal defect or cardiomyopathy, may cause palpitations as initial symptoms. These can be easily detected with an echocardiogram.

How to detect heart palpitations

An electrocardiogram (ECG) is helpful, but will be normal in most people. In a small subset of patients, we will detect sustained arrhythmias such as atrial fibrillation or flutter. The substrate for some rare life-threatening arrhythmias may also appear on the resting ECG.

A 24-hour Holter monitor is usually the next assessment. The patient wears a monitor for one day, and every heartbeat during that time is recorded and analyzed. However, the 24-hour monitor has several limitations.

My experience is that most patients with frequent and severe palpitations will enjoy the calmest 24 hours they have had in weeks. In physics, this phenomenon is called an "observer" or "Hawthorne Effectbut I prefer to call it the “take your broken car to the shop and see how it runs like new when the mechanic calls”. for obvious reasons.

If the Holter monitor does not provide enough information and the patient has not yet completed the chest patches, we also have other monitors that can be used for up to one month.

Do you need treatment for heart palpitations?

Since PAC and PVC palpitations are universally benign (as long as the resting ECG and echocardiogram are normal), the question arises: Do we need to treat them? The answer depends on the patient.

For significantly symptomatic patients, I start with a low dose of a beta-adrenergic blocking drug (beta-blocker). This class of drugs essentially lessens the effect of adrenaline on the heart and can alleviate the symptoms that accompany an abnormal heartbeat. If the palpitations are nothing more than a nuisance, then perhaps the knowledge that they do not bode ill is all the patient needs. Most of the patients at my clinic prefer not to take medication every day (with the possible side effects associated) to treat something that poses no risk.

For very few, palpitations can be truly unfortunate and disrupt their quality of life. In most cases, we can provide some degree of relief with beta blockers or other more aggressive medications. The good news is that most young symptomatic patients will eventually "outgrow" this problem and the palpitations will lessen over the years. Furthermore, the frequent presence of PAC or PVC is not a contraindication to exercise, as most patients will haveany lesspremature beats as the heart rate increases.

In summary, I evaluate the patient with palpitations with an ECG and an echocardiogram to look for rare underlying problems. I ask for 24-hour monitoring only in the most symptomatic patients who have frequent episodes. Fortunately, most palpitations in young, healthy people arise for benign reasons and don't require treatment, except to know that it's not a dangerous problem.

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Palpitations - Blog de CHI Health Better You (1)

Dr. Eric Van De Graff

Dr. Eric Van De Graffis a cardiac and vascular specialist at CHI Health Clinic.

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26 comments

  1. Palpitations - Blog de CHI Health Better You (2)

    together with the industry

    Hi I have been having palpitations at least once a day for the last three years I am a 21 year old male I am a hypochondriac and suffer from anxiety there is usually just one big jump that makes me dizzy for a second although sometimes I feel shaky when i'm lying on my left side for ten minutes or so i had ecgs and an echo everything was fine should i be concerned?

  2. Palpitations - Blog de CHI Health Better You (3)

    michelle

    I had intermittent palpitations for many years. I usually only have a few a day, but sometimes I can have up to 10 palpitations a minute for days. And sometimes they are painful. I've had an echo and a stress echo with normal results, but I've never had an EKG. Earlier this month, I had palpitations that lasted a week and happened several times a minute the entire time. The first two days were painful with every heartbeat and I had chest pressure between them. They do it again every now and then. My doctor won't do any more tests, but I'm concerned about possible arrhythmia or fibrillation. If they happen often or are painful again, I'm considering going to the ER for an EKG. What is your opinion?

  3. Palpitations - Blog de CHI Health Better You (4)

    Dhruba Banerjee

    Forgot to say the halter report came out normal... except for that WPW delta wave!

  4. Dear Dr. VDG would like to explain all this to you...this started 3 years ago...at the time I consulted an electrophysiologist who prescribed dilzem...since then it happened for 10 seconds 15 seconds It's not a long episode. Meanwhile, another cardiologist prescribed me Metocard. but a few days ago i was studying and out of nowhere the palpitations started..but this time it didn't stop even after consuming two dilzems..so i went straight to the hospital..they gave me beta-blockers and hospitalized me for 2 days with the same electrophysiologist ...now he has prescribed me two beta-blockers a day...and secondly, he has also advised me to have an EPS+/- RFA...which is available in India! but the main problem for me is shortness of breath as I am an occasional singer!

  5. Palpitations - Blog de CHI Health Better You (6)

    Dr. Eric Van De Graff

    Dhruba, thank you for your comments and I am happy to hear that my blog electrons reach as far as Asia. It sounds like you are already knowledgeable about WPW and understand how it could be causing your palpitations. You may also be aware that beta-blocker medications can induce some shortness of breath in people with borderline asthma. The way I see it, you have two options: 1. Switching from a beta-blocker to another drug that might limit the onset of your palpitations. Another class of drugs that may offer benefit are calcium channel blockers (diltiazem and verapamil), and I'm sure these are also available in India. Treating your WPW with medication alone is not ideal, but it may improve your palpitations.2. Find a way to see a doctor (an electrophysiologist) who can ablate your bypass tract. This can be difficult where you live (I've never been to India and I don't know anything about the availability of sub-specialized cardiac care), but it's the only way to provide a definitive solution to the problem. Good luck Dhruba and please let us know how things are going.Dr. VDG

  6. Palpitations - Blog de CHI Health Better You (7)

    Dhruba Banerjee

    I am a 17 year old boy from India. I had already diagnosed WPW Syndrome! I often have rapid palpitations. I also have a significant delta wave on my ECG. But the doctor put me on beta blockers and I'm having trouble breathing. please suggest something

  7. Palpitations - Blog de CHI Health Better You (8)

    Dr. Eric Van De Graff

    Debra, the thyroid gland is an interesting machine. The hormone it releases has the ability to really mess with the rest of your body if it's produced in too large (or too small) an amount. Without examining your numbers in detail, it would be difficult for me to draw many conclusions about your specific case, but it's fair to say that your thyroid function can certainly affect the severity of your palpitations. While your symptoms can be really bothersome, your worries about a possible heart attack are unfounded. There is no relationship between benign palpitations and an increased risk of heart attack, even if the palpitations are quite severe. Heart attacks arise from cholesterol plaques in the coronary arteries, and this phenomenon has no structural or functional relationship to the causes of palpitations (for a more detailed discussion of this topic, see: http://blogalegent.com/Cardiology-Plumbing- Wiring -Drywall). Your water intake may also not be necessary. A single finding of a small LV cavity on an echocardiogram is relatively insignificant and should not dictate its continued activity. You can give up the gallon a day before it gets too saturated. If you continue to experience chest pain, you might want to do a stress test (if you haven't already). This is currently the best way to obtain an assessment of coronary status. All the best and good luck with that thyroid. Dr VDG

  8. Palpitations - Blog de CHI Health Better You (9)

    Dr. Eric Van De Graff

    Chris, thanks for the question and sorry I didn't see your comments sooner. Hope you get this answer. The only really comforting aspect of her story is that her echocardiogram was normal. This effectively rules out the really dangerous causes of palpitations in healthy young people who exercise (see http://blogalegent.com/Cardiology-Sudden-Cardiac-Death-in-Athletes). In your case, your palpitations, although annoying, are actually benign and won't cause you any significant problems. You did well to stop smoking and I congratulate you on your exercise habits; it's these changes that will really make a difference in your future longevity. There are medications that can be used to calm your palpitations if they are so frequent. discomfort that interferes with your quality of life and I recommend that you speak with a cardiologist if this is the case. Good luck with everything. doctor VDG

  9. Palpitations - Blog de CHI Health Better You (10)

    Laurie Theunissen

    Hil has experienced occasional palpations for the past 8 years. In the last 2 weeks, the palpitations have become much more frequent, every day, almost every hour. This is causing me a lot of anxiety. I am 50 years old and possibly in the beginning of my menopause. Could menopause be causing the palpitations?

  10. Palpitations - Blog de CHI Health Better You (11)

    Debra Sweistris

    I have palpations for approx. 3 years now, they got worse last year. I also have elevated thyroid antibodies. I had an EKG, an echo, a heart monitor and they said my heart was smaller in the lower left corner, which meant I was probably dehydrated. I now drink more than 1 liter of water a day and have been doing so for the last 6 months. I have palps from time to time and the note changes regularly. Sometimes I have chest pain and then I think I have jaw and back pain. (I'm not sure if I feel pain because of the palps) if all the tests are ok could I have heart problems or is it because of my high thyroid antibodies? I had blood tests every 4 months, so 3 blood tests and all antibodies are up. I just want to make sure I don't have a heart attack.

  11. Palpitations - Blog de CHI Health Better You (12)

    dr. Van de Graaff

    Katt, I wouldn't order a stress test unless you have chest pain or shortness of breath with exertion. The whole concept behind the stress test is to detect a coronary blockage of 70% or more and is best used in people whose symptoms are consistent with coronary disease. Take a look at this post for more details on stress testing: http://www.blogalegent.com/Cardiology-Stress-Testing Coronary artery disease and heart palpitations are in most cases unrelated problems. Palpitations are usually the result of CAP or PVC, or some type of arrhythmia originating in the upper chambers of the heart (atrial fibrillation, atrial flutter, SVT). None of these problems are fatal and none are associated with a coronary blockage. I think an echo is a sufficient assessment if your health is good. If your palpitations are severe enough to affect your quality of life, you should consult a cardiologist for more aggressive therapy. Good luck and I hope you feel better. Try not to get "freaked out", you'll be fine.Dr. VDG

  12. Palpitations - Blog de CHI Health Better You (13)

    katt

    Hi, I recently had an EKG for palpitations and was freaked out during the test. I could feel the palpitations happening at that moment. The test came back abnormal so I went for an echocardiogram. The test came back 100% normal. Do you think I should get a stress test because of this EKG or is the echo enough? Thanks

  13. Palpitations - Blog de CHI Health Better You (14)

    dr. Van de Graaff

    Sylvia, I'm not a pediatric cardiologist, so take everything I say with caution. The closest thing to interacting with 3-year-olds is when I attend contentious hospital staff meetings (I hope my medical colleagues aren't big blog readers). Your nephew's doctor probably heard a murmur during his routine exam. A murmur is the sound produced when blood flow through the heart is turbulent rather than smooth. In most children, murmurs are expected benign findings and are related to the forced contraction of blood through small valves. Sometimes, a murmur can be a marker of a previously undiagnosed congenital heart abnormality, such as a septal defect or narrowing of a valve. Pediatricians are very good at distinguishing which murmurs are benign and which ones need further evaluation. Your nephew's echocardiogram is probably nothing more than a routine precaution and probably won't reveal any problems. Thanks for the question. Dr VDG

  14. Palpitations - Blog de CHI Health Better You (15)

    Silvia Davalos

    My 3 year old nephew said he had a cough so my sister took him to Dr. After the scan, he said he would like an echo done. My nephew did not have any serious health problems. He is an active 3 year old boy. Why would you want an Echo and what would you be looking for? Thanks.

  15. Palpitations - Blog de CHI Health Better You (16)

    dr. Van de Graaff

    Christina, Congrats on the whole race. Looks like you're doing fine. I assume your symptoms are nothing more than frequent PACs. I say this because you mentioned that your heart rate remains normal despite the presence of palpitations. Potassium is probably not an issue as it has to be low enough to trigger arrhythmias. However, with all that running around, you might want to supplement your diet with electrolyte solutions or potassium-rich foods. WPW is a syndrome that arises from an abnormal tract of conducting tissue between the atria and ventricles. It causes problems in two ways: 1. atrial fibrillation with abnormally fast ventricular conduction (with rates greater than 200 bpm and possible fainting or even cardiac arrest) or 2. supraventricular tachycardia, a regular fast rhythm (usually around 200 bpm or less ) that produces dizziness, fainting or deep palpitations. None of these manifestations fit your description. The symptoms your doctor would look for are those associated with very fast and sustained heartbeats such as those described above, so I would feel pretty confident that you haven't had any real problems with WPW yet. He is probably fine (more than fine actually his entire career) and his symptoms are just benign CAP. If I were you, I would probably tolerate them and only go back to the doctor if they got worse. Good luck with your careers. Dr VDG

  16. Palpitations - Blog de CHI Health Better You (17)

    Christina Finn

    Hello, I'm a healthy 29 year old female. I'm a great runner and have run a marathon and a few half marathons. I had an EKG in September and I have a borderline WPW wave, but my cardiologist said not to worry and call if I have symptoms. I recently started running more because I'm training for a race. I ran about 30 miles last week and I'll probably run the same this week. I know that in the past I used to train a lot, I felt like I had some palpitations. , and last night while in bed I had the same thing. My resting heart rate was 82, but usually around 60 and earlier that day. It was very uncomfortable, but it went away after an hour or so. Could this be caused by low potassium? I've been maxed out in the past... Is this training related or could it be WPW? Thanks!

  17. Palpitations - Blog de CHI Health Better You (18)

    Casey

    I have a 3 year old and a 3 week old son and I have had palpitations since my first son was about 1 year old. I didn't even know what they were until my second pregnancy, when they got REALLY bad. I went to my primary care doctor and he referred me for an echocardiogram, the results were normal. However, I still have palpitations that are not as strong as when I was pregnant. Sometimes I only have one pair a day, sometimes no other days seem like much. My question is whether the echocardiogram was enough? I keep saying my heart is healthy, is this normal or should I get more tests done?

  18. Palpitations - Blog de CHI Health Better You (19)

    cris

    Hi, I'm a healthy 30 year old male who is not overweight. I smoke and drink occasionally (stopped both for 4 months and still have the same problem). I don't have caffeine. I've had palpitations for the last 10 years. My first episode, I was running in my 20s and decided to run the last 3 mile race, it was really hot and humid that day when I felt my heart race but it was still, it circled for 30 seconds. It scared me of physically pushing myself further. As time went on, I started having single palps 3 times a week on average. Then 2 years ago, at the age of 28, I also started experiencing palpitations during and after anything physically demanding, especially if I hadn't done anything physical for a while. I do my best to ignore them, but sometimes my anxieties get the best of me. I had an EKG, a stress echo test, and a Holter monitor twice and was told I had a healthy heart, but I never had any episodes while I was being tested. My question is if you think something might go undetected. Without having a clear idea of ​​what it is, I feel I may be at risk for atrial fibrillation or sudden cardiac death. I'd love to start working out, but I'm a little worried. Any input or advice would be greatly appreciated, thanks for reading.

  19. Palpitations - Blog de CHI Health Better You (20)

    Eric Van DeGraff

    Casie, a normal echo and EKG are enough to tell you what the problem isn't (essentially ruling out dangerous arrhythmias and structural heart disease), but they don't tell you what it is. PACs and PVCs are the most likely culprits and would be benign in your case. To find out specifically, you'd have to wear a monitor while you have active symptoms, something your doctor could easily fix. Whether you choose to receive treatment is a different matter. As I noted in the blog post, there is no harm done if you choose to simply live with the symptoms, and sometimes the medications used can have worse side effects than the palpitations. 🇧🇷 So, answering your question: yes, the echocardiogram is enough to prove that this is not a dangerous problem. Good luck and thanks for the feedback. doctor VDG

  20. Palpitations - Blog de CHI Health Better You (21)

    Dr. VDG

    Jaye, It sounds like you are actively trying to improve your health on many levels (quitting smoking, getting checked out by your doctor). It's comforting to know that you've had a normal stress test. One thing you didn't mention in your note is your exercise pattern. If you've read other blog posts I've written, you'll know that I'm a strong advocate of activity and exercise, and I hope you'll incorporate them in your quest for better health. Your palpitations are not uncommon but require further evaluation. (especially if you feel sick with them). I would suggest a Holter monitor (24 hours) or event (2-4 weeks) and echocardiogram. These are tests your primary care physician can order without the need for a cardiology referral. Chances are very high that your palpitations are benign and do not require treatment. Thanks for the comments and questions, and good luck with your decision to quit! Dr VDG

  21. Palpitations - Blog de CHI Health Better You (22)

    Jaye

    Dear Dr. Van De Graaff, Thank you for your great knowledge. I am a 32 year old white female. I've been at a healthy weight my entire life, except for the last two years. I have polysystic ovary syndrome, high trigonometry (which I am undergoing treatment for) and suffer from daily palpitations. I went in for a stress test and my doctor said it was fine. My GP said it was probably stress related and prescribed Zoloft. I've been taking it for a year and I still have daily palpitations. I also take Chantix to quit smoking. Sometimes I feel dizzy with the palps. I'm not sure what my next step should be. Any suggestion? It's scary. Thanks haha

  22. Palpitations - Blog de CHI Health Better You (23)

    Eric Van DeGraff

    Jane, congratulations on your new baby and especially on his sleeping through the night. Your heart is probably extremely healthy and you only suffer from the PACs and PVCs I described above. I find the echocardiogram to be the most useful test for distinguishing between patients with "bothersome" palpitations and "bothersome" palpitations. If the structure of the heart is normal, it is very unlikely that the palpitations are significant and do not need treatment. It appears from your note that your doctor did not do an echocardiogram. You may want to review the issue with your doctor and ask about the ultrasound in particular. Lack of sleep and stress can exacerbate palpitations, as can caffeine, decongestants, and diet medications. Your sleep seems to be improving and hopefully your palpitations will go away. Good luck with everything (enjoy your child!). doctor VDG

  23. Palpitations - Blog de CHI Health Better You (24)

    jane

    Dear Dr. Van De Graaff, I am the mother of a 5 month old baby. While luckily my son now sleeps through the night, unsurprisingly I have been getting very little sleep for over 4.5 months due to being a mom as well as night job responsibilities. I have been experiencing heart palpitations every day, ranging from 20 to 25 episodes a day, the most frequent I have experienced in my life. During the third trimester of my pregnancy, I had episodes where I nearly passed out and experienced milder palpitations, nothing like that. The cardiologist did a 24 hour dumbbell and EEG and found nothing significant. I'm hesitant to go back to the doctor because everything was fine and that was just 6-7 months ago. I'm thinking it's likely just lack of sleep is contributing to this, but I was wondering if you'd suggest I take a look. I am a 31 year old Caucasian female with no history of heart problems in my family. Thanks for your thoughts!

  24. Palpitations - Blog de CHI Health Better You (25)

    jane

    Dear Dr. VDG, Thank you so much for sharing your wise and reassuring response. I will follow up with my doctor regarding the echocardiogram, also keeping hope and peace in my "heart", as I am more aware that this experience is probably just, as you say, a "nuisance". Thanks again for your time and consideration. Blessings to you in your medical ministry! jane

  25. Palpitations - Blog de CHI Health Better You (26)

    dr. Van de Graaff

    Yes Megan, anything that "speeds up" your autonomic nervous system will make palpitations worse if you're already susceptible to them. Other triggers: sleep deprivation, illness, caffeine, alcohol, some decongestants and diet pills, even chocolate. This doesn't mean you necessarily have to avoid these things, just recognize that your palpitations can be made worse by enjoying a giant mocha latte or a night of partying and bars (which I'm pretty sure it isn't). to avoid heart palpitations, all you have to do is completely eliminate all stress and anxiety from your life. I'm sure that won't be a problem. Thanks for the feedback.

  26. Palpitations - Blog de CHI Health Better You (27)

    megan

    Can anxiety cause palpitations, irregular heartbeats or fluttering? I seem to experience them when I feel very anxious or stressed. Thank you for this information.

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