Content

Introduction

Palpitations are caused by rapid heartbeat. They can result from stressful situations, from too intense physical activity, from drugs or, in some rare cases, from illness.

Although they are a cause for concern, palpitations are generally of no consequence and only in rare cases may they be the signal of a serious heart disorder, such as an irregular heartbeat (arrhythmia).

Symptoms

When palpitations are felt, it is as if it were:

  • a jump in the heartbeat, which causes a feeling of shaking in the chest
  • an abnormal rhythm of the heartbeat, like a flicker
  • an acceleration of the heartbeat
  • a completely irregular heartbeat rhythm

These sensations can be felt in the throat, neck and, in general, in the chest both in conditions of rest and in movement. If we are dealing with infrequent phenomena, which last a few moments, there is no need to worry; if, on the other hand, disorders associated with heart pain appear and palpitations are felt with increasing frequency, then it is appropriate to contact a doctor who may suggest undergoing heart rate monitoring, or an examination of the cardiac holter to verify that there are no serious heart problems.

In particular, it is good to consult a doctor in case of:

  • chest pain
  • fainting
  • short and labored breathing
  • feeling dizzy or lightheaded

Causes

The most frequent causes of palpitation are:

  • intense emotional states, due to stress, anxiety or panic attacks
  • depression
  • excessive physical activity
  • use of psychostimulants, such as caffeine, nicotine, cocaine, amphetamines, and pseudoephedrine-based nasal decongestants, used for colds or coughs
  • fever
  • changes in hormone levels, due to menstruation, pregnancy or menopause
  • high or low thyroid hormone levels

The causes can also be linked to an excessive function of the thyroid gland (hyperthyroidism) or to an abnormal heartbeat (arrhythmia) which, sometimes, is responsible for a rapid heart rhythm (tachycardia) or, on the contrary, too slow (bradycardia) or an irregular heart rhythm.

Risk factors

Palpitations may occur, especially in the case of:

  • high stress
  • anxiety and panic attacks
  • pregnancy
  • use of drugs based on psychostimulants, for example to treat asthma or some febrile syndromes
  • hyperthyroidism
  • heart disease, with arrhythmia or impaired cardiac function
  • heart attack
  • heart surgery

Diagnosis

Investigations to discover the origin of palpitations focus on looking for any changes in the functioning of the heart and the thyroid to see if an enlargement of the gland has occurred.

If the doctor suspects that the cause is attributable to a suffering affecting the heart, he can prescribe:

  • electrocardiogram (ECG), an absolutely non-invasive examination that detects the electrical impulses generated by the beat through sensors applied to the chest. This test is used to identify any heart rhythm abnormalities that may explain the appearance of palpitations. It can be done at rest or putting the heart under stress (electrocardiogram under stress)
  • cardiac holter (or dynamic electrocardiogram), an exam consisting in the application of electrodes on the chest connected to a portable device that allows you to monitor the functioning of the heart for 24–72 hours. During this period, the appearance of palpitations should be noted in a notebook
  • recording of the electrocardiographic trace (event recorder), examination to check the heart rhythm carried out through the implant, under the skin of the chest and under local anesthesia, of a small device (the size of a USB stick) with batteries. The test is prescribed when the arrhythmias are not constant, but discontinuous (for example, they appear only once a week). This device is activated through a button when a disturbance is felt; the device generates a trace, stores it and transmits it, usually by telephone, to a decoder that reads it
  • echocardiogram, an examination that uses ultrasound to visualize the flow of blood inside the heart cavities. It allows you to see moving images of the functioning of the heart and its internal structures on a monitor

Therapy

Palpitations as an occasional phenomenon rarely require therapy. If they manifest as signs of heart pain or disease (such as arrhythmia), then corrective therapeutic measures are needed.

Complications

We speak of complications when the palpitations derive from a state of fatigue and suffering of the heart; in these cases there may be:

  • fainting, the heart beats faster and the pressure is lowered; these are situations related to heart disease already present at birth (congenital heart disease) or to problems with the functioning of the heart valves
  • cardiac arrest, although rarely, palpitations can occur due to severe arrhythmias that actually cause a block of heartbeats
  • stroke, palpitations derive from atrial fibrillation, due to an abnormality in the heart's contraction mechanism, which can cause the "release" into the circulation of blood clots (thrombi) that obstruct the cerebral arteries causing stroke
  • heart failure, occurs when the heart contracts asynchronously, for example in the case of atrial fibrillation, for a prolonged period and is unable to perform its role as a blood pump in the arteries; in this case it is necessary to treat the arrhythmia in order to restore the correct functioning of the heart

Living with

The most effective system to prevent and contain the risk of having palpitations is to follow some precautions:

  • reduce stress, through relaxation techniques, meditation, deep breathing, or medications (e.g. anxiolytics)
  • avoid psychostimulants, such as caffeine, nicotine, or colds medicines based on these substances; or, energy drinks (energy drinks) which can generate accelerations or abnormalities of the heartbeat
  • do not use abusive substances, based on cocaine and amphetamines, responsible for addiction phenomena

Bibliography

Mayo Clinic. Heart palpitations (English)

Palmieri L, Veronesi G, Corrao G, Traversa G, Ferrario MM, Nicoletti G, Di Lonardo A, Donfrancesco C, Carle F, Giampaoli S. Cardiovascular diseases monitoring: lessons from population-based registries to address future opportunities and challenges in Europe. Archives of public health. 2018; 76:31 

Vanuzzo D, Giampaoli S, Fedele F, Mercurio G, Gulizia MM, Romeo F, Gabrielli D, Di Lenarda A. Cardiovascular prevention in the change of epoch [editorial]. Italian Journal of Cardiology. 2017; 18: 541-546 

Giampaoli S. 1978-2018: from epidemiology to cardiovascular prevention. In: Ricciardi W, Alleva E, De Castro P, Giuliano F, Salinetti S, ed. 1978-2018: forty years of science and public health. The voice of the "Higher Institute of Health.Rome: Higher Institute of Health; 2018. p.44-60

In-depth link

HEART Project (ISS). Epidemiology and prevention of brain and cardiovascular diseases

Monzino Cardiology Center. Palpitations, what to do?

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