Palpitation (palpitations) – causes, treatment & prevention

Palpitations (palpitations) can have different causes. The statement that palpitations are exclusively psychological and therefore not pathological and in need of treatment in the medical sense is wrongly circulating. But this is absolute misinformation. While it is not wrong that they can be of psychic origin. However, they can range from harmless to requiring treatment to being life-threatening as an accompanying symptom of another disease or pathological condition.

In any case, however, they are perceived as annoying, not infrequently even as a threat, which can lead to other accompanying symptoms. This applies to both harmless and dangerous palpitations. The heartbeat, which you otherwise don’t really notice in everyday life unless you pay attention to it, is suddenly felt to be very strong, fast and irregular. Those affected feel every heartbeat.

causes

There are many different causes that can trigger palpitations (palpitations). However, from a medical point of view, the causes are divided into two main causes: on the one hand, the cardiac triggers, i.e. those originating directly from the heart, and on the other hand, the extracardiac triggers.The latter are at least not directly related to the heart. Whereby the greatest caution is required when making a hasty diagnosis: an extracardiac cause is by no means to be equated with a purely psychological cause and therefore does not mean that this type of palpitations cannot be dangerous just because the heart is not the primary reason for them.

If the palpitations come directly from the heart, they may be due to cardiac arrhythmia , the causes of which must also be specifically investigated. Inadequate heart activity, also known medically as heart failure, can be the cause, as well as diseases of the heart valves (often congenital), inflammation of the heart muscle (myocarditis) or autoimmune heart actions such as can be found in vasculitis, for example.

Extracardiac causes can result from physical exertion in the most harmless form, but also from medication in therapeutic doses, their abuse, from drugs, and from diseases of the thyroid gland, such as hyperthyroidism, migraine, and hypoglycemia. Palpitations can also be triggered by the psyche, such as fear.

Diseases

• Inflammation of the heart muscle (myocarditis)

• heart failure

• hyperthyroidism

• The vasculitis period

• migraine

• hypoglycemia

• anxiety disorder

When to the doctor?

An unusual palpitations can be triggered by an excited situation. Infatuation, stress, nervousness or fear of the unknown trigger heart activity. In most cases, no doctor is required, since the person concerned often develops a coping strategy independently. If the emotional situation becomes a burden for the person concerned, it is advisable to talk to a doctor about possible techniques. However, relaxation techniques such as yoga or meditation are often sufficient.

If the palpitations persist for a long time, you need to see a doctor. The stress on the heart muscle can lead to other diseases and hazards. In severe cases, there is a risk of a heart attack or stroke. Since these are life-threatening situations, a doctor’s visit is necessary if the palpitations increase or blood pressure rises.

If your heart is beating all the time, all of the body’s systems are put under more strain. If there are functional failures, a doctor must be consulted urgently. Loss of function includes disturbances in vision or hearing, impairment of consciousness or disturbances of sensation in the skin. If other symptoms such as diarrhea , nausea or abdominal pain occur, a doctor should clarify the cause. There can be organic as well as psychosomatic reasons for the symptoms. Further research will provide information on what the sufferer needs for relief.

diagnosis and course

If the affected person finds the heartbeat to be noticeably strong, fast and/or irregular, the diagnosis of palpitations (palpitations) has already been made in itself. It is more difficult to diagnose the actual cause, as there is a whole range of differential diagnoses. The diagnosis should be as accurate as possible, taking all factors into account, because a misdiagnosis with subsequent mistreatment or possible non-treatment can have fatal consequences and even the death of the patient.

A detailed anamnesis is necessary here and the general condition of the person concerned can also provide clues to the cause. It must be determined whether the pulse can be felt evenly and whether any secondary heart sounds can be heard with the stethoscope. If mere exertion and underlying mental illnesses can be ruled out as the cause, an ECG and, if necessary, a heart echo must be carried out.

The ECG gives indications of disturbed processes in the heart action, a heart echo makes possible changes in the heart muscle itself and its coronary vessels visible and also shows whether the various atria and heart chambers have a normal size. If abnormalities become apparent in the diagnostics, further diagnostic measures, such as carrying out a heart catheter examination, may be necessary in order to finally diagnose suspected diseases or to rule them out.

complications

In many cases, palpitation, the clearly noticeable pounding of the heart, is a symptom that is harmless and is only treated if it bothers the person concerned very much. Nevertheless, there are sometimes complications that can either be related to the cause of the palpitations themselves or to a possible therapy. In rare cases, a palpitation can hide a serious cardiac arrhythmia or hypertension ( blood pressure ). It is therefore advisable to see a doctor if other symptoms such as a red face, headache, dizziness and fainting spells and chest pains accompany the severe heart palpitations.

The palpitations can also cause further problems for the patient from a psychological point of view. If the actually harmless and normal heart palpitations when you are nervous or after physical exertion are increasingly perceived as frightening, panic attacks are possible, which further aggravate the symptoms. Therapeutic support is sometimes necessary here in order to avoid the development of a massive cardiac neurosis.

The side effects and risks of treatments include intolerance to medications as well as problems in stopping them. The latter is not uncommon when the palpitations are due to thyroid problems.

If the palpitations are associated with a racing heart or another arrhythmia, electrophysiological treatment is sometimes used. Complications can also occur here, which in serious cases can lead to the need for a pacemaker.

treatment and therapy

The treatment of palpitations depends on their genesis and the general feeling of the patient. If no pathological causes that require drug treatment or more extensive diagnostics can be identified, unaccustomed physical or mental stress presumably preceded it. Here it is usually sufficient to let the patient calm down and to persuade him.

If factors such as fear play a major role and if the patient cannot be calmed down with mere persuasion and is breathing remarkably quickly and threatens to slide into hyperventilation tetany or is already in such a state, it is essential to encourage the patient to breathe calmly and regularly move and, if necessary, give him a mild sedative . Even if the palpitations have psychological causes, they can lead to a condition that requires treatment due to accompanying hyperventilation and should therefore not be downplayed.

Cardiac causes are usually treated with drugs, if necessary with surgery or with a combination of both. In some cases, sparing is enough. If the palpitations are due to the medication administered to the body and if they are found to be too annoying, the dose may have to be adjusted or the preparation changed or, if possible, discontinued completely. In the event of an accidental or intentional overdose of medication or drugs, it can be helpful to speed up the elimination of the substance from the body, for example by forced vomiting (only if you are fully conscious) or hemodialysis.

As a rule, in the latter case, the palpitations disappear on their own with the removal of the active substance from the body and then require no further treatment. However, there are cardiac causes that require lifelong medication.

prevention

Palpitations that do not result from a pathological heart disease or other illness can usually be prevented in advance or their duration can be shortened. For example, if you know that you react to caffeine with palpitations, you can easily prevent them by not consuming the substance in any form.Palpitations caused by mere physical exertion can be prevented by refraining from doing so or gradually reduced by training approved by a doctor. Psychologically caused palpitations can be treated with medication in acute phases, if necessary. For example, autogenic training or psychotherapy could be helpful in the long term.

If another extracardiac disease is the cause, such as the thyroid gland, appropriate medication will help and allow the disturbing palpitations to subside. However, regular blood tests should be carried out whenever medication is prescribed in order to detect any undesirable effects on other organs, such as the liver or kidneys, in good time to recognize and treat.