Diagnosing Heart Palpitations
What are heart palpitations?
Heart palpitations are when you start feeling your own heart beating. You will feel as if your heart is beating too fast, slow, forcefully, or irregularly. You will feel as if you missed a beat. The frequency and severity of heart palpitations will vary from one person to another. They may last for a few seconds, minutes, hours, and sometimes even days. You may just experience one episode, a few occasional episodes, or frequent episodes.
Heart palpitations occur when there is a problem with your heart’s electrical system. Your heart is a muscle that continuously pumps blood throughout your body. These regular contractions of the heart muscle are stimulated by the discharge of electrical signals from a conductive tissue. The place where these electrical signals generate is the sinoatrial node, which is also known as the pacemaker. The sinoatrial node is located in the right atrium. The electrical signal will cause the heart muscle to contract and pump blood throughout the body.
Palpitations occur when this electrical system goes haywire. Palpitations can be caused by any of the following ways:
- An oddly rapid but regular heart rate
- Extra beats of the heart
- A missed beat
- An abnormal heart rhythm
- Combination of any of the above
In most cases, heart palpitations can cause slow, irregular, and less effective heartbeats. For this reason, you must consult a doctor when you first experience heart palpitations.
How are heart palpitations diagnosed?
Although most cases of heart palpitations are benign, it is still important that you get yourself checked to rule out other serious conditions. To diagnose heart palpitations, your doctor will first take a complete history from you. Your doctor will ask you several questions to decide what investigations to do to make an accurate diagnosis. Keep a record about your symptoms including how long your episodes last and how frequent you get these episodes. Also, note what factors may have triggered the symptoms.
Your doctor will also ask you more questions regarding any changes in your diet or lifestyle, especially if you have been in situations, which may have caused you stress or anxiety. Further, the doctor will ask you about your drug history, past medical history, and family history of similar heart problems.
After taking a good history from you, your doctor will then order tests, which will help reach an accurate diagnosis. The doctor may order the following tests:
1. Electrocardiogram or ECG
This test is done to measure your heart's electrical activity. Several chest leads will be attached to your chest and the other end will be connected to an electrocardiogram. These leads will measure the electrical signals generated by your heart and from different angles of the heart.
An echocardiogram is like an ultrasound scan of your heart. Your doctor will do this test to visualize if there are any structural problems in your heart and also to check how well your heart is contracting. An echocardiogram can be combined with a stress test to get a better understanding of how your heart functions while you are stressed out or after exercise.
3. Stress test
Sometimes, you may develop heart palpitations only when you are stressed out or while exercising. A stress test is useful in such situations. A stress test is used to diagnose heart problems that only arise while you are stressed out, while you exercise, or soon after exercise.
In a standard stress test, your doctor will ask you to exercise for a few minutes, often using a treadmill, so that your heart begins to beat faster and harder. You will be given a target heart rate depending on your past medical conditions and your age. You will have to exercise until you reach this target range.
During the stress test, you will be attached to an electrocardiogram machine, where it will produce a continuous strip of your heart’s electrical activity. If you develop any heart palpitations during the test, this can be demonstrated on the ECG. However, if you find it difficult to continue the stress test, or if you develop dramatic changes to your chest or blood pressure, then you should tell your doctor and immediately stop the test.
When patients cannot physically exert themselves by walking on a treadmill for the standard stress test, a nuclear stress test may be performed. A nuclear stress test is performed by giving the patient medication by way of IV, which will increase the flow of blood to the heart. This essentially simulates what it would be like if the patient were exercising normally during a standard test.
4. Holter Monitoring
If your doctor fails to identify any problem during the above tests, then he or she might recommend you to do a Holter monitoring. This is a simple test where you will be attached to the electrocardiogram machine for 24 hours to continuously measure your heart’s electrical activity. The length of the time of this test will be determined by your doctor. Usually, it is only done for 24 hours, but this may be different depending on what your doctor decides.
A Holter monitor is a small and wearable heart monitor that will record your heart activity throughout the day while you go through your daily activities. It is very important that you avoid strong electrical magnetic fields while wearing the monitor since it measures electrical signals.
What is the treatment for heart palpitations?
The treatment for heart palpitations depends on the underlying cause. For instance, if your heart palpitations are a result of anxiety or increased levels of stress, then your doctor will focus on reducing your anxiety and stress. If the palpitations are due to the excessive consumption of caffeine, then your doctor will advise you to cut down the amount of caffeine you drink.
Cases of heart palpitations like these are usually managed by a general practitioner. However, if your heart palpitations are due to an underlying heart condition or arrhythmias, then you will be referred to a doctor who specializes in the field of heart diseases known as a cardiologist. In either case, the treatment will be decided depending on the underlying cause of your heart palpitations.