Palpitation refers to an awareness of the heartbeat. It can
occur in a wide variety of circumstances but three common
scenarios are worth mentioning.
The first is the simple increase in heart rate and strength
of heart contraction commonly associated with increased
physical activity, emotion or other circumstances such as
fever. In this case, there is really no disturbance in cardiac
rhythm. In some individuals, this type of increased heart
rate can occur without any major activity and cause a sense
of uneasiness.
The second is the occurrence of premature beats. Premature
beats can arise either in the upper chambers (premature atrial
beats) or from the lower chambers (premature ventricular
beats). They may occur in an isolated fashion or in clusters.
The most common sensation associated with premature beats
is a pause that may feel like a missing heartbeat immediately
followed by a strong beat or thud within the chest. Sometimes,
this can be felt in the upper chest or neck area. It is not un-
common for premature beats to suddenly appear either during
late adolescence, early adulthood or middle age. In the majority
of instances, premature beats do not signify the development
of new heart disease nor do they cause any damage to the heart.
The third circumstance causing palpitation is the sudden and
intermittent occurrence of rapid heartbeat. Such inappropriate
and excessively rapid heartbeat is known as tachycardia and
can last for variable periods of time. In general, the more
benign forms are considered to arise from the upper chambers
while the more serious types arise from the lower chambers.
Atrial fibrillation is an example of a very common rhythm
disturbance arising in the upper chambers, which can be
associated with underlying heart disease.
Patients usually seek medical attention either because of the
new onset of palpitation or because it persists for a longer
period of time than they feel comfortable. In order to exclude
the possibility that underlying heart disease is present and to
provide reassurance, a history and physical exam are undertaken.
Your doctor may also want to perform an echocardiogram to
exclude any structural abnormalities of the heart. The most
important step is to document the nature of the perceived
rhythm disturbance. This can be done through the use of either
a 24-hour Holter monitor (when symptoms occur more frequently
than once daily) or with an event recorder (when symptoms are
less frequent than once daily). Once a connection between the
patient's symptoms and rhythm is established, the diagnosis
can be made and treatment, if necessary, can be instituted.
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patient problems.
Palpitations
