The symptom of palpitations

My two-cents Rx

With BENJ S. BANGAHAN, M.D., FPCP, FPCCP

Quite a number of people do complain about palpitations, that disturbing feeling engendered by a person’s awareness of the beating of the heart. Usually they are brought about by an increase in the speed or rate of the beating, an alteration of the rhythm or the cadence of the heart beats, or by the enhancement of the strength of the heart’s contraction. Most people describe palpitations as pounding or skipping, and usually pain is a much less mentioned associated feeling compared to the fear that he or she may be having a heart problem, which naturally makes the person much more confounded.

While the generation of palpitations arises in the heart, they are not immediately considered a diagnostic basis of a heart’s abnormality per se, for there are non-cardiac factors that can be responsible for their presence.  A person with anxiety or with any form of psychological disturbance, even with a normal heart, is apt to complain of palpitations; the medical concern should be directed to the basic problem, and their relief will eliminate the palpitations. Then, a person who exerts effort  like in exercise or heavy work, which naturally increases his cardiac work, may experience palpitations.

Same is true when one has a non-cardiac condition that requires a compensation from the work of the heart, like anemia or hyperactive thyroid gland, whose successful medical therapy will eliminate the palpitations.  Some people are under different kinds of drug therapy for non-cardiac conditions, and some of  the drugs used might be potential causes of palpitations, for which reason doctors will routinely ask them to enumerate their medicines; alteration of the involved medicine is done if found necessary.  Then, other people have the habits or life style that can be the reason for the development of palpitations, like coffee drinking and smoking; they therefore need to be stopped.

The conditions that cause palpitations that arise from the heart itself, are themselves variable in location and are of different kinds of abnormality, but any one or more of the above-mentioned basic physiologic disturbances, nonetheless, are still the mechanisms involved – that is, it may be in the rhythm, in the rate of beats, or in the strength of cardiac function.  

A heart may have an abnormality in one of the doors of its compartments, or valves as more technically known in the medical field, in such a way that the doors are abnormally wide as a result of a disease, called regurgitant valve. Such condition can lead to an additional volume of blood to be pumped per beat, which naturally stimulates the heart muscle to push with more power. The volume and the strong power will be felt by a person as palpitations.  

The heart may beat, for one reason or another, quite slowly, like much less than 60 per minute, attaining  its rate that is described as bradycardic by doctors.  For the purpose of preventing an abnormal physiologic consequence as a result of inadequate supply of blood to the different anatomic parts due to the slow rate, the heart is naturally designed to compensate such condition as it is triggered to pump more strongly, therefore pushing bigger volume per beat, which becomes a potential cause for palpitations. The management of this condition is primarily to target the basic cause of the slow rate. This bradycardia is a condition that is normally  arrived at by professional athletes on account of their routine training, but athletes somehow adapt to the compensatory mechanism, becoming a part their normal lives.

The heart can go into an abnormally high rate per minute, which is termed as tachycardia. Whether the origin of the speed is in the area of the atrium, the smaller superior divisions of the heart, or the ventricle, the bigger portion located at the lower portion, the tachycardia can produce frequent irregular palpitations. This tachycardic conditions merit a very attentive medical management.

Sometimes, palpitations are due to the disruption of the normal cadence or rhythm, producing arrhythmia. Usually while the regular rhythm is normally functioning, premature beats get abnormally inserted between them, producing palpitations that

sometimes are described as “skipped” beats. If the premature beats originate from an area of the atrium, it is called “atrial premature beats”, and if the origin comes from the larger ventricle, it is termed “premature ventricular beat”. Either of them can engender palpitations, and may merit a form of therapy if the attending doctor finds it necessary.

Like any other symptoms, disturbing palpitations must be given attention and brought to a doctor for analysis and diagnosis, in order for the patient to be therapeutically ahead.

 Māassalāma.

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