Heart palpitations

An irregular heartbeat...

Several years ago I was sitting in my former surgery in Ballyfermot trying to explain the meaning of palpitations to a concerned middle-aged man. He was a car mechanic and had been experiencing occasional palpitations in recent months that were beginning to concern him. Everything was normal on physical examination and I was trying to explain to him the normal nature of his symptoms but I began to feel that I really wasn’t getting through to him.

Out of the blue we both heard a loud sound from a car backfiring on the street outside. We heard a loud bang followed in quick succession by a series of quick bangs before the car chugged away on its journey without further disturbance. I pointed my thumb over my shoulder and said: "that car engine is having palpitations". Without further explanation the middle-aged mechanic understood his condition by way of analogy with the irregular pumping of an internal combustion engine.

The human heart

Palpitations are a very common occurrence and everybody experiences them from time to time. Given the frequency with which the heart beats everyday of our lives it’s a wonder that we don’t experience palpitations more often. Just reflect on this calculation for a moment; if your resting heart beats approximately 4,000 beats per hour that amounts to 96,000 beats per day, which in turn amounts to 35,040,000 beats per year, which amounts to a final total of 2,628,000,000 beats in a lifespan of 75 years. You might like to play with this calculation by turning to our new "breaths and heartbeats" calculator, which is located at:


An astonishing pump

The massive figure I have just given is an underestimate of the true number of heartbeats that occurs in an average lifetime because it is based on the frequency of beating in a resting heart. The true figure on the number of heartbeats in an average lifetime would be even greater again. If we briefly return to the analogy of the backfiring car engine I can think of no man-made pump that is capable of performing at this extraordinary level. The human heart truly is an astonishing pump.

So, what are palpitations? Palpitations are defined as a conscious awareness of the beating of one’s own heart. Most of the time we are completely unaware of the beating of the heart but sometimes that unawareness is punctured by a sensation of skipped beats that can be felt in the chest or sometimes in the throat. The palpitation may be experienced either as a fleeting sensation or it may be more persistent. In that latter situation the person may be conscious of either a regular or irregular pounding in the chest.

Palpitations may be experienced after a bout of exercise.

Palpitations are often noticed when we are resting quietly or just about to drift off to sleep and many people are frightened by the experience. We have all experienced that sensation of the missed heartbeat followed by a brief pause when time itself freezes and you wonder for a split second if it is going to beat again. Then just before that unpleasant thought gets a grip, you notice that your heart has already resumed normal beating again.

If you take no other message from this article remember this: most cases of palpitation are normal and are not due to heart disease. As previously stated they are a common occurrence and certain situations increase their frequency. Strenuous exercise can increase the frequency of palpitations. Who has not heard of a person’s heart missing a beat when they were in a state of anticipation before receiving exam results? I’m sure that many people experienced palpitations when they watched the Irish soccer team measure up for the penalty shoot out during the recent World Cup.

Nicotine and coffee

What else can cause palpitations in a person with a normal heart? Cigarette smoking is a major cause of palpitations due to the stimulating effect of nicotine on the electrical conducting system within the heart. Regrettably the occasional palpitations experienced by the novice smoker can become more persistent as the heart begins to suffer as a result of the tar oils and other toxins contained in cigarette smoke. Excessive consumption of tea or coffee can also do it. Alcohol can do it, especially strong spirits. So that strong cup of coffee and glass of brandy after a special meal could explain that fluttering in your chest as you lay in bed trying to go asleep. Finally, who has not experienced that lump in the throat feeling accompanied by a pounding in the chest when experiencing strong emotions?

Inevitably some of the people who experience palpitations do so because of heart disease. If you are worried about palpitations and experience them on a frequent basis then it would be sensible to see your GP and have the matter evaluated. If you experience some additional symptoms such as dizziness, fainting, shortness of breath or chest pain then it is absolutely imperative that you visit your doctor. Some people might also experience a sense of weakness. If you experience any of these symptoms in addition to the palpitations you should see your GP.

Tests that can be done

So what is your GP likely to do? The first thing that will happen is that your doctor will simply talk to you about your symptoms. The doctor will feel your pulse and try to recognise if the rate and rhythm of the pulse is normal. Your blood pressure will also be measured in addition to listening to your heart and breath sounds with the aid of a stethoscope. We have all become so mesmerised by modern technology that we are in danger of overlooking the time-honoured skills of simple low-tech analysis. For example feeling the pulse alone may indicate to the doctor that the person has atrial fibrillation, which is the commonest abnormal rhythm disturbance that we encounter in general practice.

Your GP might also want to examine the electrical activity within your heart, which can be done with an ECG machine. Many GPs have invested in such equipment in their surgeries and can arrange for the test to be performed and can give you a result in the same visit.

In some cases the GP may have amassed sufficient information through this process of analysis that a diagnosis can be given and a treatment plan outlined. It is possible that you may never have to darken the door of your local hospital to have your concerns addressed.

However, some people will inevitably require referral to a consultant cardiologist but that group of people are a minority of the total number of people that experience palpitations in the community. I will return to a discussion of this group in a further article on this subject of palpitations.

Finally, I would like to put the topic of palpitations in its proper context by using one further analogy, which is referred to as the iceberg of illness. The tip of the iceberg represents those people with palpitations that present to the medical profession. Most of the iceberg above the waterline is dealt with by family doctors and only the pinnacle of the iceberg requires the services of a consultant cardiologist. As we all know the bulk of any iceberg is concealed beneath the water, which means that most people with palpitations are normal healthy people who do not need to see any doctor.

Dr Leonard Condren is the medical editor of irishhealth.com

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