Heartbeat sensations

Definition:

Heartbeat sensations involve a regular or irregular pounding of the heart. It is a conscious, unpleasant awareness of one's own heartbeat, or a sensation of skipped or stopped beats. Palpitations can be felt in the chest, throat, or neck. See tachycardia and pulse (heart rate).

Alternative Names:

Irregular heartbeat; Palpitations; Heart pounding

Considerations:

Normally the heart beats between 60 and 100 times per minute. In people who are physically very fit (those who exercise routinely) and in people who take medications that slow the heart, the rate may drop below 55 beats per minute.

Palpitations may be felt accompanying emotions such as excitement or fright, and also accompanying a fever, an overactive thyroid gland, anemia, or other illnesses. They may or may not be associated with a fast heart rate (tachycardia), with the heart beating faster than 100 times per minute, or with an extra heart beat (called extrasystole).

Everyone experiences palpitations at some time in life. Pounding of the heart, brought on by strenuous exercise or strong emotions, is rarely associated with serious disease.

Often, people who complain about palpitations do not have heart disease, but are concerned about the possibility of heart disease, and become overly sensitive to normal heart actions. Extra heart beats are commonly noticed just before going to sleep, when resting quietly, or when changing positions.

The significance of palpitations usually depends on the presence of an abnormal heart rhythm or other symptoms of heart disease that accompany it.

Common Causes:

Anxiety and fever are the most frequent causes of heart pounding (other than exercise)
Being frightened
Medication such as thyroid pills, caffeine, appetite suppressants, anti-asthmatics (such as Theo-Dur), the nicotine in tobacco, anti-arrhythmics, beta blockers, cocaine, psychotropics, and sympathomimetics
Mitral valve prolapse (more common in women)
Metabolic and respiratory disorders (respiratory acidosis, metabolic acidosis, hyperventilation, hypoxemia)
Congenital heart disease
Overactive thyroid
Diagnostic procedures on the heart

Home Care:

Heart pounding/palpitations may be normal or may accompany stress and anxiety. If these are present, they may need to be reduced.

Palpitations may also indicate a cardiac rhythm disorders. However, not all cardiac rhythm disorders are treated with medications. Every anti-arrhythmic medication currently available can produce side effects, some of which are potentially more dangerous and troublesome than the arrhythmia itself.

Except for those who need to monitor their heart rate for specific reasons (such as taking digitalis or a beta blocker, or to monitor for aerobic exercise), monitoring the pulse on a regular basis is not necessary.

Call your health care provider if:

A rapid heartbeat continues for more than an hour, or if there is shortness of breath, chest pain, unusual sweating, dizziness, or fainting.
There are very frequent extra beats (more than 6 per minute or coming in runs of 3 or more).
The pulse is more than 100 beats per minute (without exercise, anxiety, or fever).

What to expect at your health care provider's office:

If the patient is in distress, cardiac rhythm will be monitored and emergency intervention will be performed as necessary to restore normal cardiac rhythm. Otherwise, the doctor will want to know the exact pulse rate and whether or not the rhythm was regular at the time the problem occurred. Often the symptoms will disappear by the time the doctor sees the patient.

Medical history questions documenting palpitations in detail may include:

Type
- Do you feel skipped or stopped beats?
- Is there a slow heart rate?
- Is the heartbeat rapid, racing, pounding, or fluttering?
- Is there a regular pattern to the unusual heartbeat sensation?
- Is there an irregular pattern?
- Is the heartbeat sensation induced by a change in body position?
Time pattern
- Did the palpitations begin or end suddenly?
- Did they occur in response to reminders of a traumatic event?
Associated complaints
- Was the pulse (heart rate) fast?
- What was the heart rate (how many beats per minute)?
  - Normal is less than 100 for adults, slightly faster for children and infants.

What other symptoms are present?

Vital signs (temperature, pulse, rate of breathing, blood pressure) will be measured.

Diagnostic tests that may be performed include:

ECG
Chest X-ray (seldom needed)
Holter monitor (for 24 hours)
Ecochardiogram

After seeing your health care provider:
If a diagnosis was made by your health care provider related to palpitations, you may want to note that diagnosis in your personal medical record.

Review Date: 10/5/2001
Reviewed By: Elena Sgarbossa, MD, Department of Cardiology, Rush-Presbyterian St. Luke's Medical Center, Chicago, IL. Review provided by VeriMed Healthcare Network.

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