Introduction

Palpitations cause the sensation of rapid, fluttering or heavy heartbeats. Heart palpitations are often harmless however it may be a nuisance when it is recurring often. Occasionally palpitations may be due to cardiac or metabolic causes. The common causes of heart palpitations include:

• Anxiety
  
  
• Stress
  
  
• Exercise
  
  
• Fever
  
  
• Nicotine
  
  
• Caffeine
  
  
• Hormonal changes due to - pregnancy or menopause
  
  
• Certain medications

Even after a wide range of tests the cause of heart palpitations often can’t be determined. Occasionally, heart palpitations can be due to serious arrhythmias. Arrhythmias may include very fast heart rates (tachycardia), unusually slow heart rates (bradycardia) or an irregular heart rhythm (atrial fibrillation).

Seek immediate medical attention if palpitations are accompanied by:

• Dizziness
  
  
• Fainting or near fainting
  
  
• Shortness of breath
  
  
• Chest pain or chest discomfort

Investigations

It may be difficult to investigate to arrhythmia, as they are episodic. However there are some tests as shown below to help clinch a diagnosis.

• 24 hour Holter monitoring
  This is a 'walkman' like device attached by ECG leads from your chest and this continuously records your heart beat for 24 hours. You can go about your normal activities and the device will continuously record your heart beats over a 24 hour period.
  
  
• Trans Telephonic ECG recording
  Sometimes if you have your 'good day', then the 24 hr recording may not capture the palpitation. This special device is attached to your chest by ECG leads when you have the palpitations and then it makes a record when you are having the symptoms. You fix this yourself as it is given to you to take home. Once an event is recorded, you then send it through the telephone to your doctor’s office or clinic.
  
  
• Tilt Test
  This test helps provoke the symptoms like dizziness or loss of consciousness. You will be lying on a table with 60 degree head up tilt. For your safety you will be strapped to the table as you may fall if you become dizzy. Your ECG, pulse and blood pressure are monitored and recorded. The test lasts for about one hour.

Treatment

Treatment depends on the diagnosis made from the ECG recordings after the investigations. You may be treated with any of the following modalities:

• Permanent pacemaker – single or dual chamber
  
  
• Automatic implantable cardioverter device - AICD
  
  
• Anti arrhythmic medications