Dr Sukhjinder Nijjer
Consultant Cardiologist
Expert in diagnosing and treating Palpitations
Palpitations
Palpitations are common
The word palpitation means having an awareness of your heartbeat. This a very common symptom and everyone can have awareness of their heart beat from time to time. Whilst it is common to feel your heart beat pounding after a heavy run or after scary moment watching a movie, palpitations can also be a sign of a cardiac arrhythmia.
Arrhythmias are problems related to the heart’s electrical signals. The heart has a complex set of wires and signals that ensure it beats in sequence. Any disruption to the electrical pathways can cause arrhythmias, which in turn lead to palpitations.
On this page, we will discuss:
3.What tests are needed for patients with palpitations
4.How palpitations are treated
What are Palpitations?
Palpitations are an awareness of your heart beat. There are many ways in which palpitations may be felt and there are many ways to describe your symptoms. Some patients feel a pounding sensation, others a fluttering feeling. You may feel the heart is beating irregularly or it is missing beats.
You may feel a heavy pounding sensation followed by a period that feels as if your heart has stopped beating. There may be a heavy sensation followed by feeling of your chest beating very fast. Your heart beat may be beating so fast such that it can be difficult to feel how fast it is going.
Palpitations can last for a few seconds or may last minutes or even hours. In some cases, patients can have symptoms that last for many days. It is important to reflect on how the symptoms feel, as a clear description of them can help Dr Nijjer identify the cardiac arrhythmia that is causing them.
Think about whether the symptoms come on gradually or come on suddenly. Do they stop abruptly, or do they fade away over a number of hours? Are there are clear triggers for your palpitations – are they triggered by certain situations or foods? Do they come on at certain times of day?
It is important to note how you feel at the time of your palpitations. Are you able to get on with your normal activities? Or do you feel like you left unable to do anything? Have the palpitations ever made you pass out or lose consciousness? Do the palpitations ever cause a feeling of chest tightness or chest discomfort? Do you feel the palpitations make your breathless?
If you are having recurrent episodes of palpitations, it is worth having an assessment with a Cardiologist such as Dr Nijjer. He will take a detailed history from you to understand what your symptoms are like and what they are associated with. This can be challenging to determine, so it is worth reflecting upon before your appointment. If you feel like your thoughts are clearer after your consultation, then simply email Dr Nijjer on info@drnijjer.com and he will have more information to help make his assessment.
What causes palpitations?
There are many reasons for people to feel palpitations. There are simple and benign palpitations that can cause you to be aware of your chest pounding or fluttering. For example, you may be suffering from stress or anxiety. Work related stress is a common driver of symptoms – long hours, stressful commutes and lack of sleep can all drive palpitations.
Excessive caffeine or stimulant use can be common triggers. It is common to drink strong coffees such as espresso-based drinks or frequent cups of tea. Green tea and Matcha also contain caffeine. In some cases, your response to caffeine can change as you get older and although you may have tolerated frequent cups of coffees previously, your sensitivity may increase and trigger palpitations.
In some cases, alcohol, smoking and recreational drugs can be triggers for palpitations. Frequent alcohol intake can drive cardiac arrhythmias such as atrial fibrillation. Drugs like cocaine can drive arrhythmias such as supraventricular tachycardia (SVT) or ventricular tachycardia (VT).
There are a number of medical conditions that can increase the likelihood of palpitations. Having high blood pressure or hypertension is a common cause of atrial fibrillation or ventricular ectopy. Patients with heart failure or severe coronary artery disease may also develop atrial fibrillation which causes a jumping uncontrollable palpitations.
Other non-heart related medical problems can also cause palpitations. Asthmatics may take medications like salbutamol which can cause the heart rate to become elevated and give a sensation of palpitations. Those patients with endocrine problems such as an under-active thyroid require medications like thyroxine. Thyroxine is a stimulant which can cause an elevated heart rate, increase the number of ectopic heart beats and even trigger arrhythmias such as supra ventricular tachycardia (SVT) or atrial fibrillation.
Hormonal issues can frequently cause palpitations. Some women may suffer episodes of palpitations during their periods, pregnancy or the menopause. Pregnancy is normally associated with an elevated heart rate and some palpitations can be an awareness of this elevated rate. The menopause can be a difficult time in which there are significant body changes and palpitations are common. The use of hormone replacement therapy can settle symptoms such as hot flushes and sweats, but because it can cause high blood pressure, then other arrhythmias and palpitations may occur.
What tests are needed for palpitations?
Dr Nijjer will review your symptoms very carefully and discuss your case in detail. It is important to reflect on your symptoms, their frequency, their triggers and how they end. Do the palpitations stop suddenly or do they fade away over time.
Blood tests are important as this will help identify any deficiencies in blood electrolytes – including sodium, potassium, calcium and magnesium levels. Thyroid function tests are also essential as thyroid disorders are a common cause of palpitations.
All those suffering from palpitations should have an Electrocardiogram (ECG) and in most cases an Echocardiogram. The ECG helps to understand what the electricity of the heart does under normal conditions. The echocardiogram helps ensure the heart is structurally normal.
Most patients with palpitations will need to have Ambulatory ECG Monitoring. This is a special ECG monitor that patients wear under their clothes. Typically, the monitor is worn for at least 24-hours but modern monitors have the the capability of recording for longer. The duration of the monitor will depend on the frequency of your symptoms. In patients where the palpitations are less frequent, a longer monitor may be required. The key is to capture an episode of typical symptoms on the ECG monitor.
In some patients, with particular types of arrhythmia, Dr Nijjer may ask them to undertake an Exercise Stress Test. This test requires you to exercise on a treadmill while having an ECG performed continuously. This is done under medical supervision and may trigger the palpitations or arrhythmia. Exercise Stress Tests are also often performed to ensure patients are safe to undertake
What treatments are needed for palpitations?
The treatment of palpitations will depend upon the diagnosis and there are many types of arrhythmia that cause palpitations. In many cases, holistic approaches with changes to your lifestyle may be the key steps in your care. A reduction in caffeine and stress may be essential.
If an arrhythmia is diagnosed, then the treatment will be based upon the type found. Arrhythmias such as atrial fibrillation and atrial flutter will require medication to slow and regulate the heart beat. It is common to use blood thinning medications as these conditions are associated with higher risks of stroke. Blood thinning medications such as Rivaroxaban or Apixaban are easy to take and use and are more convenient than older medications such as warfarin.
Other arrhythmia, such as Supraventricular Tachycardia and Ventricular Tachycardia may require specialist medications and procedures to reduce the risk to you.
More Information from the British Heart Foundation
More information is available on the British Heart Foundation (BHF) website.
The page on palpitations is found here.
Click here to download a PDF discussing palpitations.
Help Your Heart
If you have any concerns regarding your heart health, then please seek a referral to Dr Nijjer.
Call the Team: Monika, Amy, Charlotte, Erin or Grace:
0203 9838 001
Email: Secretary@DrNijjer.com
Dr Nijjer can be seen at :
68 Harley Street, London, W1G 9QP
He also practices at Cromwell Hospital, Wellington Hospital, BUPA Clinics, BMI Syon Clinic as well as Imperial Private Healthcare.
