Palpitations: causes and management of palpitations

By Cristiano Antonino On Jun 12, 2023

When you have a conscious perception of your heartbeat or feel an irregular rhythm of the same, we speak of palpitations

It is a rather common phenomenon that can be due to benign causes such as intense physical activity, the intake of exciting substances or very intense emotions and states of anxiety and which, therefore, should not cause particular concern.

In some cases, the onset of palpitations can cause a strong feeling of discomfort

Irregular heart activity can also be synonymous with an underlying cardiac pathology: palpitations are one of the main symptoms of many cardiac dysfunctions, which must be carefully monitored and treated with the appropriate therapies.
In order to exclude any doubts and diagnose the possible cause of the disorder, it is advisable to undergo a careful cardiological examination.

Palpitations: definition and characteristics

The term palpitations indicates a disorder, also known as palpitations, characterized by the conscious perception of one’s heartbeat: the sensation can be perceived as a sort of pounding in the chest, an excessive acceleration of the heartbeat or as a suspension of the beat.

Patients suffering from heart palpitations may feel a sensation of discomfort or discomfort in the chest, neck or throat due to the violent and irregular heartbeats.

Since it is not a habitual experience, the onset of palpitations can often be a cause for concern, however, in most cases, it is a phenomenon due to causes of a benign nature such as excessive physical effort or abuse of caffeine and other stimulating substances ; palpitations can also arise following particularly stressful periods or states of anxiety.

Some drug therapies can also induce an increase in heart rate as a side effect.

Although in most cases palpitations are not a serious condition, sometimes they could be the first symptom of other conditions.

In the event that you suffer from heart palpitations, it will be necessary to verify that the patient is not suffering from heart disease or other disorders, as it could be a sign of an arrhythmia or pathological tachycardia.

In the event that there is an alteration in the contraction rhythm, the anomaly may be due to extrasystoles or other disturbances affecting the electrical impulse conduction system of the heart.

What are the causes?

As already mentioned, palpitations can have causes of different nature, which can either be of organic origin or due to external factors.

Palpitations are often psychosomatic in nature and arise due to strong emotional stresses that cause hyperactivity of the autonomic nervous system.

There are also several predisposing pathologies and cardiac conditions that can be responsible for the onset of heart palpitations.

Among these, the main causes include:

Stress, agitation or nervousness;
Situations of discomfort;
Severe frights or panic attacks;
Intense pain;
Intake of stimulants;
smoking;
Alcohol abuse;
Certain drugs as therapies for the treatment of hypothyroidism; medicines for nasal congestion or anti-asthmatics; dietary supplements and slimming treatments.

Among the extra-cardiac conditions that can determine the onset of palpitations are:

Anemia: anemic subjects are often affected by tachycardia, i.e. they have a higher heart rate than normal which, therefore, can give the sensation of “heart in the throat”;
Hyperthyroidism: thyroid hormones play an essential role in regulating the activity of the heart, therefore patients with hyperthyroidism can develop palpitations;
Hiatal hernia: in some forms of hiatal hernia, a part of the stomach can pass the esophageal hiatus of the diaphragm arriving into the thoracic cavity; in these cases the hiatal hernia can come into contact with the heart muscle and compromise its functioning, triggering arrhythmic episodes especially after meals;
Hypoglycaemic crises;
Feverish states;
Electrolyte imbalances such as the lack of some micronutrients such as sodium, calcium, magnesium and potassium;

Heart diseases responsible for causing palpitations include

Extrasystoles, i.e. premature heartbeats due to an alteration in the electrical activity of the heart. It is a usually harmless phenomenon that affects non-heart patients. The extrasystole can originate both in the atrium and in the ventricle and is felt by the patient as a different beat than normal. This sensation is given by the fact that, after an extrasystole, there is a longer than normal compensatory pause: the ventricle has been able to fill with more blood and the beat is more intense.
Atrial fibrillation or flutter, a condition that can cause an increased heart rate
Paroxysmal arrhythmias, i.e. conditions characterized by isolated episodes with sudden onset and short duration;
Tachycardia, i.e. cardiac arrhythmias that cause an increase in heartbeats with a very high frequency;
Brachycardia, i.e. cardiac arrhythmias characterized by a very low heart rate; although this type of condition rarely gives rise to palpitations;
myocarditis;
Valvulopathies or pathologies of the heart valves;
myocardial infarction;
coronary artery disease;
heart failure;
Congenital malformations.

Symptoms and complications

Heart palpitations are not a real disease, but the manifestation of an underlying condition, not necessarily of a pathological nature.

Palpitations are characterized by an unpleasant sensation that determines an accentuated perception of cardiac activity, with particularly violent or abnormal beats.

The duration of the episodes is quite variable and can range from a few seconds to several minutes.

Other symptoms that may appear in association with palpitations include:

Dyspnea or difficulty breathing;
Angina Pectoris or chest pains;
Dizziness;
Asthenia or feeling faint;
Loss of consciousness;

If the episodes occur with a certain frequency even in conditions of rest and are characterized by rather intense symptoms, it is advisable to consult a cardiologist to ascertain the causes of the disorder.

In the event of arrhythmias and underlying dysfunctions, in fact, complications can arise which, if not intervened promptly with adequate measures, can also be serious.

If the heart beats too fast, the cardiac output can be compromised, causing an alteration in the blood supply to the body tissues which can give rise to fainting and syncope.

In subjects with previous pathologies, the protracted overload of the heart muscle can give rise to insufficiencies and decompensations, which compromise the correct functioning of the organs.

In addition, a very high heart rate increases the oxygen requirement of the organs, as a result of impaired blood supply to the tissues.

In severe cases, an untreated increase in heart rate can lead to a myocardial infarction.

Diagnosis

Although not all cases of palpitations originate from heart disease, it is always good to seek medical advice to rule out the presence of any pathological disorders.

Generally the diagnostic procedure includes a careful evaluation of the family history and a careful cardiological examination; the doctor may also prescribe specific tests including:

Electrocardiogram (ECG): allows you to detect the electrical activity of the heart;
Dynamic ECG according to Holter: useful for recording electrical activity continuously for a certain period of time (24 or 48 hours);
Echocardiogram: allows you to obtain an ultrasound of the heart in order to evaluate the health of the heart muscle;
Chest X-ray;
stress test;
Magnetic resonance imaging (MRI): More in-depth imaging diagnostics are sometimes required for people with heart disease;
Electrophysiological (PE) examination: An electrophysiological examination may be used if severe symptoms suggest cardiac arrhythmia. In these cases, the doctor introduces small electrodes into the heart through a vein and these record the heart’s electrical activity in much greater detail than the normal ECG.
Blood tests: they allow to measure the electrolyte values in the serum (sodium, magnesium, potassium and calcium), as well as to evaluate the presence of some substances defined as cardiac markers and to analyze the levels of thyroid hormones in the blood.

Treatment and prevention

As already mentioned, in most cases the palpitations disappear on their own without the need for any therapy.

For psychosomatic forms it is usually sufficient to reduce the sources of stress, resort to techniques to ease tension and, in general, adopt a less frenetic lifestyle; engaging in light physical activity and limiting the intake of substances such as caffeine, alcohol and nicotine can help combat the disorder.

In the pathological forms, on the other hand, the treatment is related to the disorder that gave rise to the palpitations and is therefore specific for each patient.

In the case of cardiac arrhythmias, a therapy based on beta-blockers and calcium channel blockers can be prescribed, to keep the heart rhythm under control; for the most serious cases it may be necessary to resort to more invasive techniques such as cardioversion or radiofrequency ablation.

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