![]() If you have discovered a way of stopping the palpitations, that is also helpful information. It is also very helpful to know how they start and stop (abruptly or not), whether or not they are regular, and approximately how fast the pulse rate is during an attack. Your age (approximately) when you first noticed them, and the circumstances under which they occur are important, as is information about caffeine intake (don't forget tea and coca cola, as well as coffee). The most important initial clue to the diagnosis is your description of the palpitations. ![]() Actual blackouts or near blackouts, associated with palpitations, should be taken seriously because they often indicate the presence of important underlying heart disease. Depending on the type of rhythm problem, these symptoms may be just momentary or more prolonged. Often you may not be aware of anything apart from the abnormal heart rhythm itself, but palpitations can be associated with other things such as tightness in the chest, shortness of breath, dizziness or light-headedness. This is partly because our attention is not focussed on other things, but also because the slower heart beat at rest can allow more premature beats to occur. Many people, if not all of us, are more aware of the heartbeat when lying quietly in bed at night. Often these attacks can be abolished again by lying down. Some types of abnormal heart rhythm seem to be affected by posture, and you may notice that standing up straight after bending over provokes a rapid heart rate. It may be possible to diagnose these sorts of palpitations by performing simple tests, such as an exercise test, while monitoring the ECG. Stressful situations cause an increase in the level of stress hormones, such as adrenaline, circulating in the blood, and there are some types of abnormal heart rhythm that can be stimulated by adrenaline excess, or by exercise. Unfortunately, since it can take some time before a clear diagnosis is made in a patient complaining of palpitations, people are sometimes told initially that the problem is anxiety. Palpitations may be associated with feelings of anxiety or panic it is normal to feel the heart thumping when you are terrified of something, but it may be difficult sometimes for people to know which came first, the palpitations or the panic feeling. The ventricles are activated more rapidly than normal (tachycardia) and in a very irregular pattern. During this type of rhythm abnormality, the atria beat so rapidly and irregularly that they seem to be quivering, rather than contracting. If the fluttering in the chest feels very irregular, then it is likely that the underlying rhythm is atrial fibrillation (see item on atrial fibrillation). ![]() A rapid, regular fluttering in the chest may be associated with sensation of pounding in the neck as well, due to simultaneous contraction of the upper, priming chambers of the heart (the atria) and the lower, main pumping chambers (the ventricles). The heart is "fluttering" in the chestĪny rapid heartbeat (or tachycardia) can give rise to this feeling. The beat after the pause is more forceful than normal, giving the "thumping" sensation. People are not usually aware of the early, extra beat, but may be aware of the pause, which follows it (the heart seems to stop). Usually this feeling is caused by an extra beat (premature beat or extrasystole) that happens earlier than the next normal beat, and results in a pause until the next normal beat comes through. You may have the feeling that your heart stops beating for a moment, and then starts again with a "thump" or a "bang". People may describe their palpitations in lots of different ways, but there are some common patterns: The heart "stops" ![]() decongestants and cold cures, or avoiding excessive alcohol use. Even if treatment is required, the cure may be quite simple, such as avoiding caffeine (coffee, tea, coca cola), avoiding drugs which can make the heart race e.g. The first thing to emphasise about palpitations is that they usually do not mean that you have a significant heart problem, and in many cases do not even require treatment, although just occasionally they can be an indicator of a potentially serious condition. The heart muscle can continue to contract effectively even if the electrical system is "misfiring" from time to time. The heart beats in response to an electrical stimulus (a bit like the way a car engine fires in response to a spark from a spark plug), and palpitations usually stem from a problem in this electrical system that generates the heartbeat. Normally, of course, you are not aware of your heart beating at all. An abnormal heart rhythm is referred to as an arrhythmia. Palpitations are an awareness of your own heartbeat, usually because the heartbeat seems irregular, or unusually rapid, or in some other way "different" to normal.
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