Palpitation

What is palpitation?

Normally our heart is beating regularly at a rate between 60-100 per minute. But we are not aware of it. In certain circumstances, we become aware of our own heartbeat. This is known as palpitation. Very often palpitation is just a manifestation of anxiety. When you are stressed or with exercise, the heart races and we become aware of our heart beating fast.

Though most often it is harmless, in some situations it could be a manifestation of a dangerous disease. For example, abnormal heart rhythms can cause palpitation. Very fast rhythms can be regular or irregular. Sometimes it may not be continuous palpitation but feeling of an occasional flutter in the chest. This is due to transient irregularity in the heart rhythm, which is often of not much significance.

A fast irregular heart rhythm called atrial fibrillation can occur after binge drinking. It is known as holiday heart syndrome. This is yet another reversible cause for palpitation.

When can it be an indicator of serious disease? Serious forms of palpitation occur in those with severe heart disease – either electrical or structural. Structural abnormalities of the heart which damage the heart muscle or heart valves can cause palpitation due to extra load which it gives the heart. Electrical disorders of the heart often produce either very fast rhythms or very slow rhythms, both of which can be life threatening if severe.

What tests are done for documenting the abnormal heart rhythm and its cause? One of the simple tests to analyse the heart rhythm in case of palpitation is an ECG. Structural damage to the heart can be assessed by ultrasound imaging of the heart known as echocardiography. Both these tests are commonly done for evaluation of heart disease. Other more advanced tests are needed only in selected cases.

If the palpitation is only occasional, it can be recorded by long term ECG monitoring known as Holter monitoring, typically 24-48 hours or event monitoring for one week to three months. Now wireless patches linked to mobile phones can monitor ECG continuously and transmit relevant events to a central server. Latest variety of patches can even withstand a shower during bathing and can be used for a few days at a time. There are also smart watches which can record the ECG.

If still longer recording is needed, we have implantable loop recorders – small devices which can be implanted under the skin under local anaesthesia, which can record electrical abnormalities of the heart for up to 3 years. These devices have wireless options which can relay the signals to a device at home which in turn can transmit it to a central server by mobile networks. The central server could be even located in another continent!