What can cause heart palpitations?

heart palpitationsPalpitations are normal when we get excited  or exposed to a lot of stress. Palpitations can be associated with anxiety, depression and panic attacks. In these cases, the palpitations are accompanied by other symptoms such as restlessness, shortness of breath, tingling sensation in the body, dizziness, feeling of drowning, etc.

However, heart palpitations and rapid heartbeat(tachycardia) may also be a sign of heart disease, such as heart rhythm dysfunction (arrhythmia), such as atrial fibrillation. Some conditions of the thyroid as well as some medicines and caffeine can also give rise to tachycardias or to strong palpitations. On the other hand, an increase in the release of catecholamines can cause palpitations, for example, during intense exercise or during periods of great emotional stress.

Short-term loss of consciousness with spontaneous recovery (syncope) is preceded by palpitations, and should lead to ventricular arrhythmias with life-threatening events. Typically, those affected are carriers of heart disease and these types of episodes may be the prelude to sudden cardiac death.

Palpitations can be divided into four types:

  • Extra-systolic palpitations: feeling that a heartbeat is missing, it seems like the heart stops for a moment. It usually corresponds to premature atrial or ventricular beats.
  • Tachycardic palpitations: The heart seems to beat very fast and hard.
  • Palpitations of the neck: The perceptions of the heartbeat are felt in the neck. Common symptom of supraventricular arrhythmia. They are caused by atrial contractions with the mitral valve and closed tricuspid, causing a wave in the venous pulse.
  • Hyperdynamic palpitations: Intense regular heartbeats. Symptoms in cases of aortic insufficiency and states with high cardiac output such as fever or anemia. Palpitations may be accompanied by irregular heartbeat (also called arrhythmia), drowsiness, dizziness, short fainting or passing loss of vision or speech. In these cases, it is advisable to go to the GP to clarify the cause of the symptoms.

What Causes Palpitations?

The causes of palpitations are usually harmless and fleeting. Excitement and fear before an exam, joy, illusion or a stressful situation can lead to tachycardia and palpitations. Stronger palpitations and faster pulse (tachycardia) may also be due to harmful substances or the use of stimulants. These stimulants are caffeine from coffee, tea, energy drinks, soft drinks or chocolate and nicotine. Certain medications, such as thyroid hormones can cause palpitations or tachycardia.

With regard to caffeine-rich energy drinks, World Health Organization (WHO) warned in 2014 of the health hazard of excessive consumption of energy drinks, not only because of its caffeine content, but also because of other substances such as guarana or taurine; all exciting substances. It has been noted that these drinks can cause hypertension, palpitations and troubling changes in heart rhythm. It also highlights the concern of combining these drinks with alcohol, especially in young people, a mix that can exacerbate these problems much more.

Palpitations causes

Women during menopause also tend to experience heart palpitations and fast heart rhythms, as well as being more likely to have a cardiovascular event, all related to hormonal changes and loss of estrogen.

Severe palpitations or tachycardia may also be due to heart disease: tachycardia may occur due to so-called heart rhythm dysfunctions (arrhythmias), such as atrial fibrillation. Coronary heart disease, valvular heart valve dysfunction, or myocardial dysfunction (cardiomyopathy) may be the cause of such pulse irregularities. When there is a history of heart disease, the appearance of some arrhythmias increases, especially atrial fibrillation and monomorphic ventricular tachycardia. Special attention should be given to patients who have had a myocardial infarction or symptoms of heart failure.

Other possible causes of palpitations and irregular heartbeats are high blood pressure (hypertension), such as a drop in blood pressure, hyperthyroidism, hypoglycemia, hemochromatosis (an accumulation of iron in the body), or anemia. It has been observed that the onset of tachycardia may also be due to anxiety.


How To Diagnose Palpitations?

Severe palpitations or frequent or long-term tachycardia require accurate medical diagnosis. To diagnose whether it is harmless palpitations or a serious heart disease that requires treatment. In the context of an anamnesis, the doctor first asks some questions such as when the palpitations have appeared or if there has been or has been an event that caused them, such as professional stress or family burdens. Also, the doctor asks about other discomforts, if there have been other diseases such as coronary heart disease or hyperthyroidism and if there has been any type of cardiac arrhythmia. Also knowing the medications that could take a patient with palpitations or tachycardia helps the doctor to make a more accurate diagnosis.

The conversation is finally followed by different tests. The doctor measures the heart rate, blood pressure and temperature, evaluates the pulse, auscultates the patient’s heart with the stethoscope, requests blood tests and with the help of the electrocardiogram, the doctor can more accurately evaluate the heart rhythm and obtain information about different heart conditions.


How To Treat Palpitations?

The most appropriate treatment for palpitations attend to the causes that have caused this alteration. When palpitations and tachycardia are harmless, a treatment is usually not necessary. If palpitations are due to cardiac conditions, the treatment has to be adapted to the specific causes.

If the cause of palpitations or tachycardia is due to hyperthyroidism, the most appropriate treatment is based on antithyroid drugs. In case of cardiac arrhythmias such as atrial fibrillation can be treated by antiarrhythmic drugs (beta blockers and calcium blockers). Sometimes a transcatheter intervention, a cardiac pacemaker or surgery may be necessary, but in very exceptional cases.

Older people are more likely to develop side effects when taking antiarrhythmics. This is due to the decrease in the glomerular filtration rate (GFR) and the use of other drugs at the same time. If treatment is essential, dose reduction is recommended.

In some cases, no treatment is required for arrhythmias and patients can lead normal and active lives. Adopting lifestyle changes and leading to healthier habits, such as avoiding alcohol, caffeine (coffee, tea, energy drinks, chocolate or some painkillers) and doing moderate physical exercise often can help prevent palpitations and arrhythmias.

When palpitations or tachycardia are due to stress or mental exertion, relaxation exercises or measures to avoid stress may contribute to counteracting these symptoms. The use of tranquilizing or relaxing drugs are not recommended, only under medical prescription and in indispensable cases. The reduction in coffee and tobacco consumption is also very positive.

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