Ask the Expert: Heart palpitations

Many of us have experienced the fluttering feeling in our chest of heart palpitations, but what are they? And are they anything to worry about?

Our Consultant Cardiologist, Dr S M Afzal Sohaib, answers your most frequently asked questions:

What are palpitations?

People usually say they have palpitations if they feel they are more aware of their heart beating than usual, if they feel their heart beating faster than usual, or if they feel their heart skipping a beat.

They can be caused by disturbances in your heart rhythm, but not always and sometimes you can have these when there is nothing abnormal with your heart.

Should I visit my doctor if I have palpitations?

If you find them troublesome then it is best to see your doctor. A doctor may ask you more about your symptoms and depending on what you describe, and whether you have any other medical conditions, the doctor may organise more tests.

I would advise you to see your doctor sooner rather than later if you also have any of the below:

• A history of heart problems
• Had blackouts
• Chest pain
• Breathlessness
• A family history of heart problems

What are they caused by?

Sometimes when people are stressed or anxious, they might be more aware of their heart beating, and there is actually nothing wrong with the heart.

Sometimes they are caused by extra heart beats called “ectopic beats”. With these you may notice your heart skipping a beat and it is usually harmless.

If you can feel your heart racing away, they can be caused by a fast heart rhythm known as a tachycardia. These usually require further investigation and may need treatment and different conditions can cause a tachycardia. A common group of these is called supraventricular tachycardia, often abbreviated to “SVT”.

If the heart is beating irregularly, it can be caused by something called AF (atrial fibrillation).

Are palpitations harmful?

This depends on the cause of palpitations. Some of these heart rhythm disturbances are completely harmless and do not require any treatment, and some may require further treatment with medication or procedures. This is entirely dependent on what the cause is, and how troubling you find the symptoms.

In the majority of cases, palpitations are usually harmless and are not life threatening, even though the symptoms can be very disruptive. There are exceptions which is why it is important to review your symptoms with your doctor.

Atrial fibrillation (AF), in certain groups of people, can increase the risk of having a stroke and your doctor might prescribe you blood thinning medication to reduce that risk.

Other, rarer, causes of palpitations can be potentially harmful. Examples are when there are abnormal electrical connections in the heart (e.g. Wolff-Parkinson-White Syndrome), or if palpitations are caused by certain underlying heart problems. These can, however, be successfully treated in many cases.

What kinds of tests will the doctor do?

The doctor may organise for you to have blood tests to see if there are any medical problems which might cause your palpitations, such as problems with your thyroid. They will try to evaluate your heart rhythm using an ECG (electrocardiogram).

Most people usually do not have palpitations at the exact moment they are seeing the doctor. In that case the doctor will organise for you to wear a heart monitor which you can take home for a period and then return to the clinic after one to two days, or longer in some circumstances. There are now new devices which can transmit information about your heart rhythm via a smart phone.

What treatments are needed for palpitations?

If your palpitations are due to heart rhythm disturbances, a range of different treatments are available. Again, the treatment will be individual to the cause of palpitations. This can include medications which you can take regularly or as a one off when the palpitations come on. With certain causes such as ectopic beats, if the symptoms are not troublesome, no treatment may be needed.

Certain lifestyle changes can be of some help, such as avoiding excessive caffeine or excessive alcohol, and developing approaches to manage stress. Some heart rhythm disturbances, such as SVTs and AF, can be treated with a curative procedure called “ablation”. This is where the area in the heart where the rhythm disturbance comes from is cauterised with special wires (catheters).

Can I drive if I have palpitations?

The DVLA have issued specific guidance on individual heart rhythm disturbances and how they might impact on your ability to drive. As a general rule, if the palpitations do not affect your capacity to drive, then you should be ok to drive, but check with your doctor first. If the palpitations do affect your ability to drive, they need to be under control for four weeks before you are allowed to drive again. Stricter rules apply if you have a Group 2 licence for buses and lorries.

If you’ve been experiencing heart palpitations, or have any other heart concerns, then Dr Sohaib is available to see at Spire London East Hospital. Contact our Private Patient Executives on 020 8709 7817 for his availability.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other health care professional.