Our hearts are amazing organs, and we can often take them for granted. They steadily pump away, rhythmically beating life into our bodies. But what happens when your heartbeat becomes irregular, erratic, or even skips a beat? These incidents of an altered heart rhythm are called arrhythmias, and people can often sense these alterations in heart rhythm, sensations known as heart palpitations. These can feel like a pounding, or racing sensation in the chest, or just a “funny” feeling in the chest. Some patients describe palpitations as “fish flopping,” or “drums beating” in the chest. Others report an overall heightened sensation of their heart rhythm.
For most people, heart palpitations are a once-in-a-blue-moon occurrence. However, some may have dozens of these heart flutters a day, sometimes so prominent that they can be confused for a heart attack.
If you have palpitations, it is important to have your heart rhythm evaluated. Most palpitations are caused by a harmless hiccup in the heart’s rhythm. But these minor hiccups may be a sign of a problem in the heart or elsewhere in the body. In some cases, the palpitations could be a symptom of a dangerous arrhythmias that requires prompt management.
When to Seek Care
Every person has a different resting baseline for their heart rate and rhythm, so it is important that you know what’s normal for you. Factors such as age and activity level often affect our resting numbers, however generally, a resting heart rate of 60-80 beats per minute (BPM) is in the normal range. If you are an athlete, a normal resting heart rate can even be as low as 40 BPM.
During an arrhythmia, the heart either beats too slow (bradycardia), too fast (tachycardia), or irregularly (atrial fibrillation). Almost everyone experiences an occasional skipped heart beat, fluttering, or racing heart beat. While most events are harmless, some people have arrhythmias that are bothersome and sometimes dangerous. If your heart rate is too fast, too slow, irregular, and especially if you are also experiencing other symptoms such as shortness of breath and lightheadedness (or passing out), make an appointment with your doctor.
Diagnosis and Treatment
Palpitations and arrythmias can appear out of the blue and disappear just as suddenly. They can be linked with certain activities, events, or emotions and have various other triggers including dehydration, low blood sugar, and too much alcohol or caffeine. The problem with diagnosing palpitations or arrythmias is that the noticeable rhythm change and symptoms usually subside by the time you get to the doctor’s office. One of the most helpful pieces of information is your story of how your heart palpitations feel, what brings them on and how long they last, so be sure to record that information for your doctor.
A physical exam may reveal some signs as to what is causing your heart condition. Your doctor may hear a murmur or other sound when listening to your heart that suggests a problem with one of the heart’s valves. Your doctor may also order blood tests if he or she suspects a thyroid imbalance, anemia, or low potassium, or other problems that can cause or contribute to heart rhythm disorders.
An electrocardiogram (ECG) is a standard tool for evaluating the heart’s rhythm. This recording of your heart’s electrical activity shows the heart’s rhythm and any overt or subtle disturbances, but only over the course of 12 seconds or so. Your doctor may order additional testing to record your heart for longer periods of time using a mobile ECG called a Holter monitor. These units are battery powered and worn on the body for 24 to 48 hours so that your doctor can see and compare your heart activity throughout the period.
If your palpitations come with chest pain, your doctor may want you to have an exercise stress test. An exercise stress test is used to determine how well your heart responds during times when it’s working its hardest. During the test, you’ll be asked to exercise — typically on a treadmill — while you’re hooked up to an electrocardiogram (EKG) machine. This allows your doctor to monitor your heart rate.
Treatments come in a variety of forms depending on the cause and seriousness of your condition. Some people benefit from simple lifestyle modifications and at-home therapies such as deep breathing and meditation, while others may require medications, medical devices such as pacemakers or defibrillators, or catheter-based surgical procedures known as ablations.
Don’t Delay When It’s a Matter of the Heart
Delaying care can have devastating consequences to your health, as time is one of the biggest factors with treating and potentially overcoming the effects of cardiovascular emergencies. If you are experiencing mild symptoms related to an arrythmia – racing heart, dizziness, or fainting – call your doctor. If you or a loved one are experiencing heart attack symptoms including shortness of breath, sharp pain in the chest or back, or a tingling sensation in your arm, don’t delay treatment – call 911 immediately. Even when the signs are subtle, the consequences can be deadly, especially if treatment is delayed. Recognizing the signs and symptoms of a heart attack and seeking care quickly go a long way to potentially improving your outcome.
What Happens When Your Heart Skips a Beat
By Kashif Chaudhry, MD
UPMC Heart & Vascular Institute
Kashif Chaudhry, MD, is an electrophysiologist with UPMC Heart and Vascular Institute and sees patients at UPMC Williamsport, 740 High St., Williamsport. To schedule an appointment with Dr. Chaudhry, call 570-321-2800. For more information, visit UPMC.com/HeartNCPA.
