Dr Iftikhar Fazal answers FAQs on palpitations

18 February 2019

What are palpitations?

Palpitations are very common and for many people completely harmless although they can understandably be worrying and a nuisance. The term ‘palpitation’ is an awareness of your own heartbeat. This may be an increased awareness of the normal heart beating, or more commonly other symptoms such as skipping, fluttering, rapid heart beating, pulsations in the neck or feeling the heart beating in the ear, pounding or thumping in the chest.

What can make palpitations more likely?

The following lifestyle factors may make palpitations more likely to occur:

  • Anxiety, stress and poor sleep
  • Excess alcohol or caffeine, eg tea, coffee, fizzy drinks
  • Nicotine in cigarettes and e-cigarettes/vapourisers
  • Intense exercise

Medical conditions that can make palpitations more likely to occur include:

  • High blood pressure
  • Overactive thyroid
  • Hormonal changes related to the menstrual cycle and/or menopause
  • Electrolyte imbalances such as low potassium and magnesium
  • Lung disease such as asthma, bronchitis, emphysema and sleep apnoea
  • Heart conditions such as angina, heart attacks and heart failure

Are palpitations a sign of underlying heart disease?

Palpitations are very common and usually harmless in the majority of patients. A heart specialist can help to determine if underlying heart disease or a specific heart rhythm disorder is the cause of your palpitations. Heart conditions such as angina/coronary artery disease, previous heart attacks, heart failure, and inherited heart conditions can all cause palpitations.

What heart rhythm disorders cause palpitations?

Palpitations may be due to a variety of underlying rhythm abnormalities such as:

  • Ectopics – extra beats arising from the top chamber (atrial) or the bottom chamber (ventricular) of the heart
  • Atrial fibrillation (AF)
  • Atrial flutter
  • Supraventricular tachycardia (SVT)

What tests need to be done?

If you are concerned about palpitations, you should see your GP or a heart specialist. Further tests will depend on the suspected diagnosis but may include:

  • Routine blood tests, including checking salts in the blood and thyroid function
  • A tracing of your heart – Electrocardiogram (ECG)
  • A heart monitor such as a 24-hour ECG or a patient activated event recorder
  • An ultrasound scan of the heart – Echocardiogram
  • An exercise treadmill test for palpitations provoked during/after exercise
  • An implantable loop recorder – a small monitor implanted under the skin on the left side of the chest – useful to diagnose symptoms that don’t occur very often

What treatments are available?

Treatment depends on the underlying cause. Obtaining symptom rhythm correlation i.e. an ECG tracing at the same time as the symptoms of palpitations is essential to guide further treatment. Treatment may include:

  • Avoiding known triggers, eg coffee, alcohol, fizzy drinks
  • Reducing stress
  • Stopping smoking/e-cigarettes
  • Reassurance if no particular abnormality found
  • Medication such as beta blockers, calcium channel blockers, and more specific antiarrhythmics depending on cause
  • Catheter ablation of specific arrhythmias such as AF, atrial flutter, SVT

Dr Iftikhar Fazal specialises in cardiology and has a particular interest in heart rhythm disorders, pacemakers/defibrillators, and heart failure.

He can see you promptly at Spire Nottingham Hospital. A private consultation with Dr Fazal costs £200. To book an appointment call 0115 937 7735.

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