Palpitations

Palpitations, according to British Heart Foundation, describe the sensation of feeling your own heart beating.

They often feel like a fluttering, pounding, a thud or movement in your chest that might last for a few seconds or minutes. You may feel this in your neck, throat or through your ear when you’re lying down.

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In order to establish the cause of palpitations a detailed history should be taken from the patient.

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Sometimes it could be that patient is complaining of palpitations but after doing monitoring tests (for 24 hrs or longer) it may appear that the palpitations are just a subjective feeling.

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Also, it might be that patient has occasional premature heart beats; this usually does not pose significant problems in the long term.

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If the patient has a history of heart failure (due to a previous heart attack or other heart conditions) they can experience palpitations that potentially can be dangerous long term. The broad name of these palpitations is Ventricular Arrhythmias. This usually happens when the pumping function of the heart is low; so called Ejection Fraction less than 35%. This can be measured during heart ultrasound scan. Patients with heart failure require detailed assessment and careful long term monitoring.

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The other category of palpitations is a condition called Atrial Fibrillation (or Atrial Flutter). It happens when the top chambers of the heart called ‘atria’ go into erratic contractions causing irregular heart beat. This condition has to be monitored long term in order to minimise the chances of long term complications. The most common complication of Atrial Fibrillation could be stroke. In order to prevent stroke, we assess the individual risk for every patient by calculating the CHA2DS2 – VASc score. If the CHA2DS2 – VASc is 1, then the patient has to be considered to take anticoagulation medications to significantly reduce the risk of stroke. If CHA2DS2 – VASc is 2 or above, we recommend anticoagulants in the majority of the cases. This decision is made after assessing risk of stroke against risk of bleeding. If atrial fibrillation is diagnosed, an ultrasound scan of the heart is very important to assess the structure of the heart: heart muscle function, valves’ function as well as size of all chambers of the heart.

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Sometimes patients may have additional very small fibres in the heart that may become active from time to time: usually there is a rapid onset and abrupt stop to these symptoms. An outpatient test like Event recorder is useful to confirm diagnosis. There are several possible pathologies under this umbrella, such as Atrioventricular Nodal Tachycardia, WPW and others. They can be managed either by medications or sometimes invasive keyhole therapy to eliminate additional fibres.

 

The above is an incomplete description of ‘Palpitations’, just to give you an idea of how vast this topic is.  It also helps to understand why, to establish the exact cause of palpitations, we need to know the patient’s detailed history and do appropriate tests. Only then will we be in a position to make a further management plan.