Irregular heartbeat

By palpitations, different people mean sometimes different things, but generally it is an unpleasant awareness of fast, forceful or irregular heartbeat. Palpitations can be very annoying and worrying but in majority of cases these are not harmful and do not indicate any heart problem.

Some people may observe clusters of dropped or skipped beats followed by a stronger beat. This is called ectopic beats and it is a common problem, especially among young people. The ectopic beats are present to some extent in everybody and in absence of underlying structural heart problem are benign and nothing to worry about. Often, ECG taken at the time of palpitations shows normal heart rhythm with no irregularities and the palpitations and just due to anxiety and increased awareness of normal heartbeat.

Possible causes of benign palpitations


Lifestyle triggers

Palpitations are generated due to surge of adrenaline. Adrenaline is a hormone as well as a neurotransmitter (transmits nerve signals). Our body releases adrenaline when we are anxious, excited or upset. Palpitations may be caused by caffeine in excessive consumption of tea, coffee, coke or chocolate.

If palpitations are associated with lifestyle factors, you need to try and reduce stress, cut down on caffeine and energy drinks. Avoid any recreational drugs! You may suffer from panic attacks when under stress. Panic attacks may feel awful but they are not dangerous.

Medication

Palpitations may be the side effects of some medicines like asthma inhaling agents or drugs for thyroid problems. Visit your GP if palpitations happen while you take these medicines.

Periods, pregnancy and the menopause

Other causes of palpitations in women are menstrual periods, pregnancy and menopause- when women stop their menstrual cycle. Such palpitations are temporary and self limiting.

Medical conditions

There are some medical conditions which may cause palpitations:

  • Low blood sugar level (hypoglycaemia)
  • Overactive thyroid (hyperthyroidism, thyrotoxicosis)
  • Fever and infection
  • Anaemia (low blood count)
  • Dehydration and low blood pressure (hypotension)
  • Heart rhythm problem - see below

When you may have a heart problem

If palpitations occur on exertion or are associated with other symptoms like chest tightness, breathlessness and blackouts, see your GP. If it is problem of the heart rhythm, it is called arrhythmia.

Your GP will arrange ECG (electrocardiogram) to assess the heart rate and rhythm. ECG may confirm a heart rhythm problem in which case you will be referred to a cardiologist for further management and treatment. If you do not have palpitations at the time of ECG, there should be entirely normal ECG.

The most common cause of abnormal heart rhythm is atrial fibrillation (AF). At present, approximately 500,000 people in the UK suffer from AF. It is irregular and usually fast heartbeat which is responsible for tiredness, breathlessness and increased risk of strokes. Atrial fibrillation may require anticoagularion (blood thinning medication, warfarin) and tablets to regulate the heart rate. Some people with atrial fibrillation need catheter ablation or pacemaker. in the episodic form, feeling like a persistent flutter.

Supraventricular tachycardia (SVT) is another problem of the heart rhythm, but it is steady and regular fast heart rate. SVT episodes are usually not dangerous but can be very unpleasant. Supraventricular tachycardia can be treated with medication but in most people, best treatment is catheter ablation.

There are some other heart conditions which cause palpitations that can be ruled out by running some tests including heart rhythm monitor, echocardiogram and exercise ECG. The need for further tests and treatment will be normally decided by your GP or cardiologist.