Categories: Cardiology

Palpitations: When are they serious? What can be done for them?

Palpitations are an abnormal awareness of one’s own heartbeats. Usually, it can be due to faster heart rate, stronger heart contractions, or both. This can be quite normal, for example, while running or experiencing extreme fear, excitement, etc. However, they are frequently abnormal when arising all of a sudden or when out of proportion to the physical exertion being done. While they can be due to problems like anemia, thyroid disease, and a large heart, mostly they are due to abnormally fast or irregular heart rate due to problems within the electrical connections within the heart.

While sometimes palpitations can be life-threatening as well, mostly they cause distressing symptoms and sometimes sudden collapse. Common symptoms can be severe discomfort, pounding in the chest and neck, dizziness, loss of consciousness as well as chest pain and shortness of breath. The consequences of palpitations can be serious. Some of them cause weakening of heart muscle and heart failure. Atrial fibrillation, a frequent cause of palpitations in older people, is a common cause of stroke or brain attack.

Palpitations should be taken seriously if they occur very frequently or cause severe symptoms like dizziness, fainting, or worsening of heart function. Any kind of palpitations should be taken seriously if the person has pre-existing heart disease. Palpitations or loss of consciousness is also a serious matter in extremes of ages i.e., in childhood and elderly people. Finally, palpitations that last for a prolonged duration or where medicines are ineffective (or cannot be taken) are also a matter of concern. Individuals with the above symptoms or problems should seek consultation with a Cardiologist or a Cardiac Electrophysiologist.

The initial treatment for palpitation is avoiding triggers and medications. However in several people, the symptoms may not be controlled, the drugs may cause side effects, or may not be convenient to take regular medication. In such cases, a better solution for these problems exists that is being increasingly used as the preferred treatment for palpitations. It is called Radiofrequency Ablation (RFA). In this procedure, similar to angiography, catheters with electric sensing are inserted into the heart chambers under X-Ray guidance and the source of the electric problem located. Once diagnosed, special heat emitting catheters called Ablation catheters are used to cause targeted damage to the abnormal electrical connection within the heart. This leads to a permanent cure from the problem in about 80-90% cases. The procedure is very safe with only about 1% complication rate in most cases. It is done under local anesthesia and sedation and the patient is usually discharged the same or next day. For these reasons, many people also opt for ablation as the primary treatment nowadays because it is safe, highly effective, and does not require long term medication.

Atrial Fibrillation (AF), is the commonest serious cause of palpitations and deserves a separate mention. In AF, the heart starts beating in a chaotic and fast manner. It can have symptoms as mentioned above but maybe silent as well especially in the elderly. It can be diagnosed simply by feeling the pulse at the wrist or by ECG. It increases with age and most often occurs in people with heart disease, diabetes, and high blood pressure. It’s the most dangerous complication is the formation of blood clots in the heart that then dislodge and cause blocking of blood vessels anywhere in the body. The vessels blocked most often are of the brain, causing brain attack or stroke. Besides, AF also frequently causes (or worsens) heart failure and can have very distressing symptoms. Depending on the risk for stroke, patients with AF have often been prescribed blood thinners which prevent the formation of blood clots in the heart. While some drugs are used for the treatment of AF, their success rate is low and there can be significant side effects. Radiofrequency Ablation (RFA), though not 100% effective, is currently the best method of treatment of this problem.

Dr. Vivek Chaturvedi, Senior Consultant – Cardiology & Director – Electrophysiology at Narayana Superspeciality Hospital, Gurugram

Narayana Health

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