Mental Health


Lesson 12

What are palpitations

The term palpitations is used to describe aware­ness of the heartbeat, or the sensation of having a rapid or unusually strong heartbeat. Generally, there is no pain, but the sensa­tion can be unpleasant.

Usually, palpitations are temporary and harmless.

Anything that makes the heart beat faster or harder than usual may cause an episode of palpitations, for example they may be the result of strenuous exer­cise, stress or anxiety.

When palpitations occur at rest, in the absence of any stress, they are usu­ally the result of prema­ture heartbeats, known as ectopic, followed by an abnormally prolonged pause before the next beat.

Ectopic beats are typically felt as a fluttering or thumping sensation in the chest. They are not usually due to any heart disease.

Palpitations from ectopic may be induced by caffeine, alcohol, heavy smoking and various illicit drugs as well as certain prescribed medications.     

In some people palpita­tions may be associated with disease. In a heart condition, they may be less significant than other symptoms such as short­ness of breath, dizziness and chest pain.

What are the causes of palpitations

Anaemia: There are sev­eral forms of anaemia, but the underlying problem common to all of them is that there is a reduced level of the oxygen-carry­ing pigment haemoglobin in the blood. This can result in an inadequate amount of oxygen being delivered to all of the body's tissues and organs.

This lack of oxygen may cause pal­pitations either due to the heart working harder to try to maintain the tissue's supply of oxygen, or be­cause the lack of oxygen in the heart muscle itself in­terferes with the transmis­sion of nerve impulses through it.

Anxiety: Everyone ex­periences periods of anxi­ety from time to time but when the anxiety is so ex­treme that it interferes with your ability to per­form normal day-to-day tasks, you should see a doctor. Symptoms may in­clude palpitations, exag­gerated fear, over breathing and a feeling of im­pending doom.

Caffeine: An excessive intake of caffeine, (the stimulant in coffee, tea, co­las, chocolate and a num­ber of other products), may cause palpitations, nervousness, insomnia, tremors and other symp­toms. Cutting back on caf­feine or switching to de­caffeinated coffee, fruit juices and other products, should cure the problem.

Heart disease: A rapid heartbeat is the most com­mon disturbance of the beat rhythm. It may be ab­solutely harmless, as when it occurs due to ex­ercise, excitement, or sex­ual intercourse.

It may be a sign of overindulgence in alcohol, coffee, tobacco, or certain other drugs. It may also be a complica­tion of a fever or of true heart disease, especially if persistent. In a few cases, it can signal a life-threat­ening disorder.

A palpitation in which the heartbeat is irregular could be a fibrillation, a rapid un-coordinated twitching of muscle fibres, potentially a serious situa­tion. An irregular beat, known as a cardiac arrhyth­mia can also be a sign of heart-valve disease.

Hypoglycaemia: In this condition, blood sugar levels in the body are too low. It occurs most often in people with diabetes, specifically as a result of taking too much insulin.

It can usually be corrected by consuming a source of simple sugar, such as a glass of orange juice. In

addition to palpitations, symptoms may include sweating, shaking, weak­ness, dizziness, blurred vision, headache and abnormal behaviour.

In some instances, low blood sugar may occur in people without diabetes in a condition called reactive hypoglycaemia. In this case, eating highly refined sug­ary foods induces a surge of insulin released from the pancreas, causing the level of sugar in the blood to drop in an exaggerated fashion.

This condition has received considerable media attention and many people are convinced it accounts for a variety of symptoms including, palpi­tations, irritability, inability to concentrate and nervous­ness. However, it is rare and many doctors question whether in fact it exists.

Hormonal causes in women: A rapid heartbeat may occur in response to hormonal changes, such as those occurring in preg­nancy. Many women also experience palpitations just before their menstrual periods as part of premen­strual syndrome (PMS); or during their menopause.

Stress: Excessive stress, or inability to cope with everyday stress, can cause a variety of physical symptoms, including pal­pitations, over breathing, chest pains, and anxiety. Often, simple distractions, such as taking an exercise break or sitting quietly with your eyes closed, will overcome such symptoms.

Overactive thyroid: Thy­roid hormones regulate most of the body's metabolic processes. An overactive thyroid gland can cause a rapid heart­beat, plus tremor, profuse sweating, nervousness, in­creased appetite with loss of weight, hyperactivity, and bulging eyes. There may also be a goitre (en­largement of the thyroid gland) that causes a swelling to appear on the front of the neck.

Vitamin B3 deficiency: Insufficient thiamine (vita­min B,) may cause palpita­tions, as well as loss of ap­petite and weight, diffi­culty in breathing, swel­ling and fluid in the tis­sues, numbness in the hands, legs or feet and emotional instability.

Monosodium glutamate (MSG): Some people have palpitations after heavy meals rich in carbohydrates, sugar, or fat. Sometimes, eating foods with a lot of monosodium glutamate (MSG), nitrates, or sodium can bring them on, too.

If you have heart palpitations after eating certain foods, it could be due to food sensitivity. Keeping a food diary can help you figure out which foods to avoid.


Sometimes, a blood test can help your doctor find the cause of your palpitations. Other useful tests include:

Electrocardiogram (EKG): This can be done while you’re at rest or exercising. The latter is called a stress EKG. In both cases, the test records your heart's electrical signals and can find unusual heart rhythms.

Holter monitoring : You’ll wear a monitor on your chest. It continuously records your heart's electrical signals for 24 to 48 hours. It can identify rhythm differences that weren't picked up during an EKG.

Event recording: You’ll wear a device on your chest and use a handheld gadget to record your heart's electrical signals when symptoms occur.

Chest X-ray: Your doctor will check for changes in your lungs that could come from heart problems. For example, if he finds fluid in your lungs, it may come from heart failure.

Echocardiogram : This is an ultrasound of your heart. It provides detailed information about its structure and function.

If necessary, your doctor may refer you to a cardiologist for more tests or treatment.

Should I see my doctor

Most disturbances in the nor­mal pattern of heartbeat are temporary and harmless.

It is important to distinguish between palpitations that are generally insignificant and changes in rhythm that could be serious.

If palpitations last for several hours or recur over several days, or if they are associated with chest pain, breathlessness or dizziness, see your doctor.

Avoiding caffeine, alcohol and smoking can all help prevent palpitations and other heart disturbances, as can reducing stress and anxiety.

If a prescription drug causes palpitations, or you have any medical concerns, contact your doctor immediately.


They can be bothersome or frightening. They usually aren't serious or harmful, though, and often go away on their own.

Most of the time, they're caused by stress and anxiety, or because you’ve had too much caffeine, nicotine, or alcohol. They can also happen when you’re pregnant.