Formula Medical Group
Apple Valley, CA
760-242-1234


James Krider, MD


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Palpitations - cardiac dysrhythmias

The term palpitations is loosely applied to a variety of different symptoms having to do with the heartbeat. A person who is having palpitations is usually acutely aware of his or her heart, most frequently because it is beating rapidly. The heartbeats may also be irregular or more forceful than usual. Generally there is no pain, but the sensation is unpleasant.

Frequently, palpitations are temporary and harmless. For example, they may be the result of stress and anxiety, and they are sometimes induced by excessive caffeine, alcohol, and various illicit drugs (especially cocaine), as well as prescription medications. In some people, however, heart palpitations may be associated with an underlying disease. If they are caused by heart disease, palpitations may be less prominent than more severe symptoms such as shortness of breath and chest pain.

Causes of palpitations

Anemia
There are several forms of anemia, but the underlying problem in all of them is a reduced number of red blood cells. This deficiency can deprive the body's cells of adequate oxygen, since the red blood cells carry oxygen. Lack of oxygen, in turn, can cause sensations of breathlessness and palpitations.

Anxiety
Everyone experiences periods of anxiousness from time to time, but when the condition is so extreme that it interferes with the ability to perform normal day-to-day tasks, a doctor's care is needed. Symptoms include palpitations, exaggerated fear, Overbreathing, and a feeling of impending doom.

Caffeine
Excessive caffeine — the stimulant in coffee, tea, colas, chocolate, and a number of other products — can cause palpitations, nervousness, insomnia, tremors, and similar symptoms. Cutting back on caffeine or switching to decaffeinated coffee, soft drinks, and other products can resolve the problem.

Heart disease
A rapid heartbeat is the most common disturbance of the heart's rhythm. It may be absolutely harmless, as is the case when it occurs due to exercise, excitement, or sexual activity. It may also be a result of overindulgence in alcohol, coffee, tobacco, or illicit drugs. Fever can also cause a rapid

The arrows show the normal paths of the electrical impulses that generate heartbeats.

The arrows show the normal paths of the electrical impulses that generate heartbeats.

coffee, tobacco, or illicit drugs. Fever can also cause a rapid heartbeat. In some cases, a rapid heartbeat is a sign of true heart disease, especially if it is persistent. In a few cases, it can even be a sign of a life-threatening disorder.

If the heartbeat seems rapid and irregular, it could be a fibrillation, a potentially serious situation. An irregular beat, known as a cardiac arrhythmia, can be a sign of a significant heart problem, such as heart valve disease. A heart attack can also result in arrhythmias, including heart block, a blockage of the heart's electrical impulses.

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

Hypoglycemia
In this condition, blood-sugar levels in the body are too low. It occurs most often in people with diabetes who fail to balance their food intake with their insulin dosage. Consuming a source of sugar, such as orange juice, usually corrects hypoglycemia. In addition to palpitations, symptoms may include shaking, sweating, weakness, dizziness, blurred vision, headache, and abnormal behavior. In unusual instances, low blood sugar may occur in people without diabetes, a condition called reactive hypoglycemia. Although this condition has received considerable media attention and many people are convinced that it accounts for a variety of symptoms, including palpitations, irritability, and nervousness, it is actually rare, and many doctors question whether it even exists.

Stress
Excessive stress or inability to cope with everyday stress can cause a variety of physical symptoms, including palpitations, Overbreathing, chest pains, and feelings of anxiety. Often, simple distractions such as taking an exercise break or sitting quietly with the eyes closed can bring the symptoms under control.

Thyroid excess
Thyroid hormones regulate most of the body's metabolic processes. An overactive thyroid gland can cause a rapid heartbeat, as well as profuse sweating, nervousness, increased appetite, weight loss, hyperactivity and bulging eyes. A goiter (enlargement of the thyroid gland) may also develop, causing a swelling on the front of the neck.

Vitamin B deficiency
Insufficient vitamin B, specifically the B vitamin known as thiamine, or vitamin B1, can cause palpitations, loss of appetite and weight, difficulty breathing, fluid retention and swelling, numbness in the hands, legs, or feet, and emotional instability.

Advice about palpitations

  • Everyone occasionally experiences a disturbance in the normal pattern of heart­beats. This occurrence is usually temporary and harmless.
  • It is important to distinguish between insignificant palpitations and potentially serious changes in heart rhythm. Any change in the' normal heartbeat warrants a doctor's care.
  • Avoid caffeine, alcohol, and smoking to prevent palpitations and other heart disturbances. Stress reduction is also helpful.
  • If a prescription drug causes the heartbeat to speed up, get in touch with a doctor as soon as possible.
This article was last reviewed November 12, 2005 by Dr. James Krider.
Reproduced in part with permission of Home Health Handbook.
Anemias
Anxiety
Caffeine
Diabetes, type 1
Heart failure
Heart rhythm disorder
Heart valve disorder
Heart block
Hypoglycemia
Menopause
PMS
Stress
Thyroid, overactive
Vitamin B complex


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