Heart palpitations: reasons, what to do, how to treat

general information

Heart palpitations are the sensations of palpitations. Patients may describe their sensations as throbbing, fluttering, accelerating heart rate, or skipping beats. Other symptoms, such as chest discomfort or dyspnea.

Heart palpitations - a common occurrence. Some find them unpleasant and disturbing, but they rarely indicate life-threatening heart disease. Palpitations also occur in many people without cardiovascular disease.

Causes and risk factors

Normally, people do not notice how their heart beats. However, many people can feel their heartbeat when something causes their heart to beat more forcefully or faster than usual. Such fast, strong blows are a normal reaction of the heart (sinus tachycardia). Reasons include the following:

• exercise stress;
• strong emotions (such as anxiety, fear, pain);
• low number of blood cells (anemia);
• low blood pressure;
• fever;
• dehydration.

In other cases, palpitations are caused by an abnormal heart rhythm (arrhythmia).

- Types of arrhythmias.

Arrhythmias range from harmless to life threatening.

The most common arrhythmias relate:

• atrial premature beats;
• early ventricular premature beats.

Both of these types of arrhythmias usually occur in individuals without heart disease and are not dangerous. The extrasystole itself is not felt. The next normal contraction is felt, which occurs after some delay and is characterized by slightly more force than usual. Although it seems to people that the heart has skipped a beat, in reality it is not.

To other arrhythmiasthat causes a sensation of palpitations include:

• paroxysmal supraventricular tachycardia (PNVT);
• atrioventricular nodal reciprocal tachycardia;
• atrial fibrillation and atrial flutter;
• ventricular tachycardia.

These arrhythmias are associated with a significantly increased heart rate. Arrhythmias in which the heart beats too slowly rarely cause palpitations, although some do feel a slowdown.

- Causes of arrhythmia.

Certain arrhythmias (eg, atrial premature beats, ventricular premature beats, or PNVT) often occur in the absence of a serious underlying disease. Others are often due to serious heart or other organ disease.

Serious heart disease include angina, myocardial infarction (acute coronary syndrome), congenital heart defects (for example,Brugada syndrome or congenital prolongation of the QT interval), heart valve disease, and disorders of the conduction system (for example, Wolff-Parkinson-White syndrome).

Disorders not related to the heartthat can cause arrhythmias include:

• overactive thyroid (hyperthyroidism)
• low oxygen levels in the blood (hypoxia)
• low levels of potassium in the blood (hypokalemia)
• low levels of magnesium in the blood (hypomagnesemia)
• certain drugs, including alcohol, caffeine, digoxin, nicotine, and certain stimulant drugs (eg, salbutamol, amphetamines, cocaine, epinephrine, ephedrine, and theophylline)
• adrenal cancer (pheochromocytoma)

Complications

Arrhythmias with a high heart rate can cause complications (especially in the elderly). If the heart beats too fast, it may not be able to pump blood satisfactorily, and it may feel weak and fainting or develop heart failure. Heart failure occurs mainly in people with a history of heart failure or myocardial infarction, although this may otherwise occur if the heart rate is very high, or tachycardia has been around for a long time. A rapid heart rate increases the oxygen demand of the heart muscle. In the presence of narrowing of the arteries in the heart muscle (coronary heart disease) may develop chest pain due to angina pectoris or myocardial infarction (which can lead to death).

Some arrhythmias, especially ventricular tachycardia, are unstable and can lead directly to cardiac arrest.

Survey

Although not all heart palpitations are due to heart disease, the effects of some heart diseases are so serious that patients with palpitations usually need to be evaluated a doctor. The following information can help patients decide whether to see a doctor and what to expect during a doctor's assessment.

- Warning signs.

Certain symptoms and signs accompanying palpitations are cause for concern. They include:

• light-headedness or fainting;
• pressure or chest pain;
• dyspnea;
• heart rate more than 120 beats per minute or less than 45 beats per minute;
• heart disease a family history of sudden death or sudden death, recurrent syncope, or unexplained seizure disorder;
• symptoms occur during exercise, especially if they cause unconsciousness.

When to see a doctor?

If a strong heartbeat is combined with any warning signs, or if a constant, ongoing heartbeat develops, you should immediately go to the emergency department. With the development of fainting, burning sensation in the chest or shortness of breath, call emergency services.

If you have a single episode of palpitations that have already stopped, but there are no warning signs, you should call your doctor. The doctor will determine if an urgent examination is required, taking into account the patient's age, underlying disease, and other symptoms. A delay of a day or two is usually acceptable without much harm to health.

- What does the doctor do?

Doctors first ask the patient about their symptoms and medical history. They then do a physical examination. The history and results of the physical examination will help determine the possible cause.

Doctors ask:

• How often do palpitations occur?
• How long does a strong heartbeat last?
• What factors (for example, emotional experiences, activities, consumption of caffeine or medications) cause or increase the palpitations?
• What medications, including caffeine, is the patient taking?

Sometimes the doctor may ask the patient to beat off the heartbeat rhythm and heart rate, as the picture of the heartbeats can help determine the cause of their occurrence.

The physical examination begins with a check of vital signs (pulse, temperature, and blood pressure). Heart rate and regular or irregular heartbeat can help in finding the cause. A fever suggests fever is the cause. Low blood pressure does not indicate a cause, but indicates an emergency.

Your doctor will listen to your heart for abnormal sounds that could indicate valve disease or inflammation of the heart muscle (myocarditis). The lungs are listened to for sounds that indicate the development of heart failure. The doctor will examine and palpate the front of the neck to check for enlargement or inflammation of the thyroid gland.

Palpitations that develop in conjunction with other symptoms such as shortness of breath, chest pain, weakness, fatigue, or fainting is most likely caused by an irregular heartbeat or a severe disease.

- Carrying out analyzes.

Although most causes of palpitations are not serious, testing is usually done.

• electrocardiography (ECG), sometimes with outpatient monitoring;
• laboratory research;
• sometimes imaging studies, exercise testing, or a combination of both;
• sometimes electrophysiological examination.

Performed ECG. If an ECG is performed at the time of a strong heartbeat or rhythm disturbance, the diagnosis is usually clear. However, only a few of the possible causes can be identified by ECG abnormalities if a person does not have strong heartbeats at that moment. Thus, to detect short or irregular episodes of abnormal heart rhythm, individuals with intermittent heartbeats may need wear an ECG monitor for one or two days (Holter monitoring - Holter monitor: Continuous ECG recording), or for a longer period (recorder events). For some people, your doctor may insert a heart rate monitor under your skin. This device is called an ECG loop recorder, and it continuously monitors the patient's heartbeat. The doctor can then use an external monitor to check the ECG loop readings for abnormal heart rhythms. Some commercially available smartphone and watch products may be used, such as fitness trackers that monitor heart rate and other trackers that monitor heart rate.

Necessarily appointed laboratory research. Doctors order a complete blood count to measure serum electrolyte levels, including potassium, magnesium and calcium. If there are symptoms that suggest a possible acute coronary syndrome, other substances in the blood (cardiac markers) can be measured. If an increase in the activity of the thyroid gland is suspected, the level of thyroid hormones in the blood is measured, and if a pheochromocytoma is suspected, the levels of other hormones are determined. Other tests may be performed depending on the cause the doctor suspects.

Sometimes required imaging studies. If ECG results suggest heart disease, prescribe echocardiographyand sometimes magnetic resonance imaging (MRI) of the heart. If symptoms develop with physical activity, exercise testing is required, sometimes with stress echocardiography or radioisotope scans.

If serious symptoms develop and the doctor suspects a dangerous heart rhythm disorder not identified by other tests, a electrophysiological (EF) study. In this test, doctors pass small electrodes through a vein into the heart. Electrodes record the electrical activity of the heart in more detail than when taking an ECG.

Treatment

Stop taking medications and compounds, such as caffeine, that are known to aggravate palpitations. If dangerous or severe arrhythmias are due to the necessary therapeutic agents, doctors try to prescribe another drug.

Doctors usually simply reassure patients with atrial or ventricular premature beats that are not due to heart disease. If these harmless palpitations are very bothersome for the patient, doctors sometimes prescribe a beta blocker (a type of antiarrhythmic drug). Other identified rhythm disturbances and underlying diseases (heart rhythm disturbances) are studied and treated. The doctor will often prescribe drugs to control the rhythm first (for example, digoxin, flecainide, verapamil, diltiazem, or amiodarone). However, many of these drugs themselves can cause rhythm disturbances and other side effects.

For some arrhythmias (eg, atrial flutter, PNVT, and atrioventricular junctional reciprocal tachycardia) radiofrequency ablation (a more invasive treatment) is often option of choice. In addition, if drugs are not effective, or if some dangerous rhythm disturbance develops, doctors may use more invasive procedures such as DC cardioversion or combined pacemaker implantation, and defibrillator. The choice of procedure depends on the specific disease causing the problem.

- The main thing that older people need to know.

The elderly are especially at risk for the side effects of antiarrhythmic drugs. As you age, you are more likely to have multiple health problems and take multiple drugs, and these drug combinations can increase your risk of side effects. In older people, the kidneys are less effective at filtering drugs from the blood, which also contributes to the risk of side effects. For some older adults, even a pacemaker should be considered before antiarrhythmic drugs are prescribed.