What are palpitations?
The first point to note about palpitations is the symptoms of palpitations cannot be diagnosed medically, it is reported by the patient.
Palpitations are heartbeats’ abnormality, which is characterised by the synchronised sensations of pulse & discomforts of the sufferer. The synchronised sensations are coupled with difficulty in breathing and dizziness. In some cases, the sufferer may have accelerated and/or skipped heart beats.
Palpitations are not an uncommon condition, it can even occur in most of the healthy hearts. Generally, if anyone is seen with palpitations, but without any underlying heart disease, is considered to be benign. But, in case there are symptoms of serious heart palpitations, they may be any of the cases like emphysema, asthma, or even coronary heart disease or the complexities of some of them.
How does a patient perceive the symptoms of palpitations?
Either the normal or abnormal awareness can be noticed by a patient.
What is the difference between any normal and abnormal awareness?
Normal awareness: - It causes almost when beating of one’s heart is taken note of or concentrated upon.
Abnormal awareness: - It causes interruptions on the person’s other thoughts.
Not to be panicky for ectopic beats: - In case there is any single skipped or missed beat or any isolated jolts felt in the chest, this is nothing but ectopic beats.
Ectopic beats: - Cardiac ectopy or ectopic beats is an irregular beat that symptomize because of variations in the heart’s electrical conductance system. This is generally a harmless occurrence, having no particular cause. Among adults, this ectopic beats are most common. In case the occurrences of ectopic beats are frequent, a medical check-up can be advisable, of course no treatment is required if it is diagnosed as ‘ectopic beats’.
There are two causes of ectopic beats:-
1) Atrial ectopic beats: Atrial ectopic beats are felt in the upper chambers of the heart or in atria.
2) Ventricular ectopic beats: Ventricular ectopic beats are felt in the lower chambers of the heart or in the ventricles
The details of these two types of ectopic beats:
Atrial ectopic beats are usually considered as the harmless variation in the heart’s normal beat pattern. The occurrences of this type of beat is occasionally sequenced or randomly sequenced. In most of the cases, it passes of without getting detected. The typical symptom is skipping of a beat or your heart may beat harder than normal. The situation is (in most probability) triggered by the stimulants like coffee, certain cold remedies, alcohol, nicotine and even by stresses.
Some times this may be due to some lung diseases or due to the enlargement of atria. ECG can detect Atrial Ectopic beats. In case the individual has significant discomfort from this, the treatment is required, otherwise not.
Any preventive measure is there?
There is no need of prevention in this condition, but reduction in the frequencies is possible by treating the causes from lung disorder or by controlling the stimulants.
Ventricular Ectopic Beats are normally known as premature ventricular contractions which may precede the ventricle’s normal beat. Ventricular Ectopic Beats are commonly seen among the people. They are never risky, unless the patient is already a heart patient.
There is no defined cause of this type of body condition, because it may occur randomly or by the trigger of any stimulant.
Symptoms of this Ventricular Ectopic Beats are feeling of a skipped or a strong beat, a sensation of fullness around neck or a shortness of breath. ECG can detect Ventricular Ectopic Beats. In case a person has occasional Ventricular Ectopic Beats, it is not to be worried about. But in case the problem is frequent, stimulants like alcohol, smoking, coffee, some medicines and stress should be limited.
In case a person is already with the history of heart disease and experiencing frequent Ventricular Ectopic Beats, the person is doubted to have some underlying heart disorder. In this condition, the testing of the person should be extensive, diagnosis should be fast and the treatment should be unavoidable. Treatments include the drugs like Antiarrhythmic and Beta-blocker. This treatment may also be associated with other heart conditions, such as blockage in artery.
Causes of palpitations (overall)
Other than Ectopic Beats, which has been discussed just above, the causes of palpitations are overexertion, adrenaline, alcohol, stress, anxiety, panic, nicotine, caffeine, drug abuses, previous chest surgery, cocaine, amphetamines, other disease (such as pheochromocytoma and hyperthyroidism) and many other factors. The cases of mitral stenosis can also be the cause of this condition.
The associated problems:-
Electrolyte imbalances for magnesium, calcium and potassium, kidney disease, thyroid malfunction, lowered stores or deficiencies of certain nutrients, asthma etc. can be the other associated problems of palpitations.
Besides these imbalances in the chemicals like, iron, potassium, taurine, arginine and magnesium can be the significant factors for causing this condition.
Duration & frequencies of the attack:-
The duration of attack can be from some seconds to hours. The frequencies are both infrequent and more than daily.
Signs of palpitations:-
A) Chest pain, sweating, faintness, dizziness, frequent headaches etc. are the common symptoms of palpitations. These problems indicate poor or irregular heart functions and required to be checked by a competent / expert doctor
B) Other related causes of palpitations are panic attacks, anxiety for which psychological consultation & assessment are essential. Since these types of problems are common, only common medications like anti-depressants are prescribed for this.
C) Lack of oxygen, excessive pain and blood loss can be the causes of palpitation.
Causes of palpitations (main)
4 main causes of palpitations are:
1) The sympathetic nervous system & its connection with the extra-cardiac stimulation
Stress due to chronic or acute elevation in catecholamine and glucocorticoids, coupled with anxiety is the cause of this problem. Gastrointestinal distresses like indigestions or bloating, along with poor posture and muscular imbalances can be responsible for nerve causing palpitations i.e. vagus.
2) Sympathetic over drive
They are hypoglycemia, hypoxia, panic disorders, antihistamines or levocetirizine, mitral valve prolapse, anaemia and heart failure.
3) Hyper dynamic circulation:
Pregnancy, pyrexia, anemia, thyrotoxicosis, valvular incompetencia and hipercapnia
4) Cardiac dysrhythmias:
Heart block, premature atrial contraction, ectopic beat, premature ventricular contraction, junctional escape beat, atrial fibrillation, ventricular tachycardia, supraventricular tachycardia, ventricular fibrillation.
How stress & anxiety are responsible for palpitation?
Level of cortisol and adrenaline in our body is elevated by stress & anxiety. This leads to interferences of the parasympathetic nervous system’s normal functioning, resulting to the extra stimulation of our vagus nerve. In case vagus nerve induces palpitations, an individual feels a hollow fluttery sensation or thud or a skipped beat. This is subject to the normal rhythm’s firing by the vagus nerve on that point of time.
Many cases have been studied to find that panic and anxiety of palpitation can cause an individual to further experience anxiety along with increased stimulation in vagus nerve. There is a solid link between palpitation and anxiety that can also be the reason of many to experience panic attack that lead to cardiac arrest. In the same manner, mental and physical stresses are responsible for the occurrences of palpitation. This is possibly due to the factor that certain micronutrients, which are contributors for physiological and psychological functions in our system, get depleted. Symptoms like indigestion, gastrointestinal bloating and hiccups are equally linked with the vagus nerve’s overstimulation and so, causing palpitation; because the underlying factor is the innervations in the GI tract, lungs and diaphragm.
Symptoms of palpitations, an anatomical discourse
It often occurs when either ventricle or atrium is prematurely contracted that follows the perceived ‘stop’ due to the contraction and there-after the start of the forceful contractions in subsequence. This may cause fluttering in the chest in a rapid way or to say the fluttering is experienced regularly.
Palpitation, associated with chest pain, is known as “ischemic heart disease”. In this situation, chest pain can be relieved by leaning forward. The palpitations of this type is known as pericardial disease
Life-threatening cardiac arrhythmia is also a type of palpitation. The sufferer, in this condition, has syncope, light headed ness or presyncope. This is the indication of hypotension and can cause cardiac arrhythmia, which is life-threatening. Regular palpitation, coupled with exertions means a hypertrophic cardiomyopathy or rate-dependent bypass tract. In case of concerned symptoms of a benign aetiology cannot be diagnosed at the initial level, the next thing will be imminent prolonged cardiac monitoring or ambulatory monitoring in the hospital.
Eliciting non-cardiac symptoms is also advised on the ground that the cause of the palpitations is due to the response of the normal heart to an inflammatory or metabolic condition. Hyperthyroidism may be the effect of weight loss.
Precipitations of palpitations can be indicated by diarrhoea or vomiting and resulting to hypervolemia or electrolyte disorders.
Symptoms like hyperventilation, nervousness and hand tingling are common in panic disorder or in anxiety; this indicates palpitations.
1) The initial diagnosis of palpitation is sufferer’s description of the body condition.
2) The sufferer’s approximate age and the circumstances, at the time of first noticing of the problem, are the important factors for diagnosing palpitations
3) Consumption of caffeine should also be a vital factor for this purpose
4) Changing body positions or a deep breathing can be the healer for palpitation.
5) Knowing about the start & stop of breathing in an abrupt way is also a vital point here
6) Knowing about the regularity of the pulse rate is also important
7) If there is an attack, what is the approximate fastness of the pulse rate?
8) Has the person been able to discover the means of stopping palpitation?
9) Routine medical examinations are not done for diagnosing palpitations, nor is ECG taken for electrically tracing the ability of the heart. The reason is the sufferer cannot demonstrate the symptoms when visiting a doctor. However, knowing about the murmuring of heart or any abnormal findings of the heart that can point towards the problem can be possible. This has special reference to the specific disturbance in the heart rhythm which is picked up by the ECG, so in case a person routinely takes ECG tests along with other routine physical examination, it will be easier for assessing the health condition of the person.
10) Thyroid gland functions’ test and blood tests are equally important, because, if the thyroid is overactive, it will lead to potential palpitations. (In this situation the over activity of thyroid glands’ treatments are required).
11) The diagnostic testing in the next level, normally takes 24 hours or in some cases it may be longer than this. Holter monitor can record ECG reading for more than 24 hours.
12) There are some other types of monitoring systems for monitoring about infrequent symptoms. For continuous monitoring ECG, a continuous-loop event recorder is used, but saving of data depends on the activation by the wearer.
13) Implantable loop recorder is used for monitoring the palpitations of the very infrequent yet with disabling symptoms. The skin of the front of the chest is the place where the recorder is planted. It is just like a pacemaker. The device is programmed, while the data gets examined by the externally attached device, which gets communicated through radio signals.
14) Heart structure investigations are equally very important. In most of the cases, people with palpitations have normal physical structure of their hearts, but with occasional abnormalities like valve problems. In usual condition in these types of cases (not always) a murmur can be detected by a cardiologist. An ECG is often taken for documenting the structure of the patient’s heart. The test is done through sound waves so it is a painless test. It is just like fetus scanning of a pregnant woman.