Palpitations by definition are an awareness of the beating of the heart. The heart beats non-stop throughout life, but usually one does not feel it. When one can feel the heart beating, it is an uncomfortable sensation. It is commonly associated with a faster, more than normal, heart rate (i.e. 60 to 90 beats) per minute. Palpitations occur normally in persons following unaccustomed exertion, i.e. level of exertion to which one is not used. When one walks very fast or runs, the thudding sensation begins in the chest. Another condition producing palpitations commonly is anxiety or fear. When one is very tense like before facing an exam or interview, they would experience palpitations. This would be associated with dryness of the mouth, sweating, disturbed sleep, tremors, etc. Those suffering from chronic anxiety always have these symptoms. Tobacco, tea, coffee, alcohol, etc. can lead to palpitations by stimulating the sympathetic nervous system, which augments the heart rate. Women of menopausal age suffer from palpitations as part of the menopausal syndrome because of hormonal changes, though there may not be any underlying pathology. Heart diseases are the leading cause of palpitations. It may be the earliest manifestation of chronic cardiac failure, a condition where the functioning of the heart becomes sluggish. Similarly, ischemic heart disease like angina may also manifest as palpitations. Various abnormalities of heartbeat conduction also lead to troublesome palpitations. Infections of the layers of the heart, whether due to viruses or any other microbe, also lead to palpitations. Certain hypertension medications may cause a rapid heart rate as a side effect, leading to an uncomfortable awareness of heartbeats. Similarly, drugs used for treating asthma like salbutamol and aminophylline can also produce palpitations. Asthma improves with medication, but the individual may suffer from the discomfort of palpitations after taking them. Life-saving adrenaline when given in some emergency, like shock, is also known to produce palpitations. Some conditions influence the beating of the heart by various mechanisms leading to increased heart rate. High fever is one such cause. A state of low blood sugar is another condition commonly producing palpitations. Hyperthyroidism, an overactive thyroid gland, is a condition that can cause palpitations. In fact, palpitations may be the earliest symptom of an overactive thyroid gland long before other signs develop. Chronic anaemia or acute blood loss results in palpitations. Those suffering chronically from palpitations need to be investigated suitably to differentiate between anxiety and any organic disease-producing palpitations. Management focuses on addressing the cause of palpitations once diagnosed. This can be challenging for individuals with anxiety, as they often require significant reassurance and counselling to understand that they do not have an organic disease. Anxiolytic and antidepressant drugs would help them. Giving up alcohol and other addictions is useful for treating palpitations and also improving the general state of health of an individual. Those suffering from persistent palpitations benefit from taking a low dose of a drug that blocks the adrenergic response to anxiety. Taking a balanced nutritious diet, regular physical exercise, and adequate relaxation are lifestyle measures that help in preventing palpitations. If one already has this problem, lifestyle measures help minimise it. Occasional heart thudding is usually not a cause for concern; it may simply reflect stress or anxiety that requires relaxation. However, if it occurs regularly, a clinical examination and tests are necessary to identify and address the underlying cause. Dr Rachna Pande is a specialist in internal medicine.
