Heart palpitations: What do they feel like?

If you have this uncomfortable sensation that your heart is beating too fast, pounding too hard or skipping a beat, you may have a condition called heart palpitations. Though heart palpitations are usually harmless, it is important to rule out any serious arrhythmias (abnormal heart rhythms) or pre-existing heart problems.

“Heart palpitations are a very frequent symptom in the general population and it may account for about 15 per cent of clinic consultations here at NHCS,” says Adjunct Associate Professor Ching Chi Keong, Senior Consultant, Department of Cardiology and Director, Electrophysiology and Pacing, National Heart Centre Singapore (NHCS), a member of the SingHealth group.

NHCS has actually been seeing more patients with heart palpitations since 2008. “Our arrhythmia clinics have increased from five sessions a week in 2008 to nine sessions a week this year,” adds Dr Ching.

Symptoms of heart palpitations

  • Fluttering in the chest
  • Pounding heartbeat
  • Slow heartbeat
  • Chest discomfort
  • Shortness of breath
  • Light-headedness
  • Fainting sensation

What causes heart palpitations?

Heart palpitations are common in all age groups. “Heart palpitations among women and younger patients usually have a benign cause. Men and older patients are more likely to have palpitations caused by arrhythmias,” says Dr Ching.

Benign heart palpitations can be triggered by:

  • Stress
  • Anxiety and panic attacks
  • Excessive caffeine or alcohol
  • Nicotine
  • Stimulant medications (weight loss pills, cough and cold medicine)
  • Fever

An electrical short-circuit in the heart

Of greater concern are heart palpitations caused by cardiac arrhythmias. Cardiac arrhythmias occur when there is a short-circuit in the electrical impulses controlling your heartbeat. This is what will cause your heart to beat too rapidly, too slowly or irregularly.

When you have arrhythmia, your heartbeat either goes very fast, over 100 beats a minute (tachycardia) or very slow, less than 60 beats a minute (bradycardia).

Complications of heart palpitations

These arrhythmic heart palpitations can have serious implications:

Supraventricular tachycardia (SVT)

This is a prevalent arrhythmia in young adults This is experienced as a sudden burst of rapid heartbeats that begin and end abruptly, lasting for seconds or hours. SVT is usually not life threatening.

Atrial fibrillation

This fast and irregular palpitation occurs in the atria or upper chambers of the heart and could last a few minutes to an hour. Atrial fibrillation arrhythmias could become chronic and lead to stroke. It is seldom life-threatening, but the heart palpitations could indicate underlying coronary artery disease or heart valve disorders.

Ventricular tachycardia (VT)

Ventricular tachycardia is a very rapid, but regular heartbeat of 100 beats or more a minute occurring in the lower chambers (ventricles) of the heart.

Sustained heart palpitations lasting more than 30 seconds are considered a medical emergency. They could indicate pre-existing heart diseases such as coronary artery disease or heart valve disorders.

Ventricular fibrillation (VF)

If ventricular tachycardia is left untreated, it will lead to a life-threatening condition called ventricular fibrillation, characterised by very fast and very irregular heartbeats. It usually precedes a heart attack. You could lose consciousness within seconds and die within minutes.

Treatment of heart palpitations

Avoiding caffeine, alcohol and quitting smoking can help.

Doctors would normally prescribe oral medications such as beta-blockers and calcium channel blockers to slow down heart rates in arrhythmias.

For supraventricular tachycardia and atrial fibrillation arrhythmias, catheter ablation – a non-surgical procedure using radiofrequency energy – is a possible cure.

Heart valve disorders will require surgery.

When to seek emergency medical care

Seek immediate medical help if heart palpitations are accompanied by the following symptoms:

  • Severe chest pain
  • Shortness of breath
  • Unusual sweating
  • Loss of consciousness

It’s also important to consult a doctor without delay if you have pre-existing heart conditions or a family history of sudden death.

Ref: U11