Heart Palpitations: Causes, Treatment

Brief overview

• Causes: Strong emotions such as excitement or anxiety, physical exertion, heart disease, hypertension, hyperthyroidism, hormonal fluctuations, shock, pulmonary embolism, poisoning, medication, drugs, nicotine, caffeine, alcohol
• Treatment: Depending on the underlying cause, relaxation exercises, medications (sedatives, heart medications), catheter ablation, cardioversion.
• When to see a doctor? In case of prolonged or recurrent palpitations. In case of additional shortness of breath, chest tightness or pain, alert emergency physician!
• Diagnosis: Medical history, physical examination, ECG, long-term ECG, possibly cardiac ultrasound.
• Prevention: Use relaxation techniques if you have a known tendency to palpitations; avoid alcohol, nicotine and caffeine.

What are the possible causes of palpitations?

Palpitations can have different causes. Often, palpitations are harmless and temporary, such as during excitement, stress or physical exertion. Sometimes, however, there is a disease behind it. Then the cause lies in the heart, another organ or external influences.

Harmless causes of palpitations

Psychological causes of palpitations

In some cases, psychological causes also trigger physical symptoms such as palpitations. Doctors speak of psychosomatic causes. These can be, for example, persistent stress or anxiety and panic disorders.

The heart as the cause of tachycardia

The main cause of tachycardia is the heart itself. To understand, here is a brief look at how the vital muscle works: Specialized heart muscle cells generate electrical impulses (excitations). These travel along conduction pathways in the heart and trigger a muscle contraction – the heartbeat.

The main role is played by the so-called sinus node in the right atrium of the heart with a frequency of 60 to 80 excitations per minute (in adults). If this excitation conduction system is disturbed, for example by reduced blood flow, additional conduction pathways or malfunctions of the sinus node, heart palpitations often occur.

The most important heart-related (cardiac) causes of tachycardia are:

Coronary heart disease (CHD): This refers to circulatory disorders of the heart caused by narrowing of the coronary arteries as a result of arteriosclerosis. In some cases, they lead to cardiac arrhythmias (such as tachycardia) and heart attacks.

Ventricular flutter/ventricular fibrillation: This is where the heart chambers contract very rapidly (between 200 and 800 times a minute). As a result, the blood no longer reaches the circulatory system – unconsciousness, respiratory and circulatory arrest are the consequences. There is an acute danger to life!

Sinus tachycardia: Here, the sinus node works at an accelerated rate of more than 100 excitations per minute. This form of palpitations is often seen in anxiety, panic attacks or fever.

AV node reentry tachycardia: During reentry, circular excitations spread between the heart’s chambers and atria, accelerating the pulse rate. Sudden heart palpitations that disappear on their own are typical.

Ventricular tachycardia: Additional impulses in the ventricles cause the heart to beat faster and more inefficiently. The dangerous consequence may be ventricular fibrillation.

Wolff-Parkinson-White syndrome (WPW syndrome): Affected individuals have extra conduction between the atrium and ventricle from birth. This often leads to sudden palpitations and even unconsciousness.

High blood pressure: High blood pressure sometimes triggers a high pulse rate.

Other causes of palpitations

In some circumstances, the cause of palpitations is other medical conditions. Examples include:

• Hyperthyroidism (overactive thyroid gland)
• Hormone fluctuations during menopause
• Shock after injury with large blood loss
• Anemia (anemia of the blood)
• Pulmonary embolism

External influences that can trigger palpitations

In addition to harmless and heart-related causes, external influences can also trigger palpitations.

• Poisoning
• Certain medications such as stimulants (stimulants)
• drugs
• Alcohol
• Nicotine
• caffeine

What to do for palpitations?

The appropriate treatment for palpitations depends on the cause.

What you can do yourself

The following tips can help stop or at least calm the racing or racing heart:

Neck massage: Where you feel the pulse on the neck is where the carotid nerve is located. It senses pressure in the carotid arteries and controls blood pressure. Massage this area lightly with your index and middle fingers. This can slow down the heartbeat. But be careful: usually the blood pressure also drops a little, so it is best to use this technique only when lying down or sitting.

Valsalva maneuver: Here you hold your nose and try to breathe out gently with your mouth closed. This increases the pressure in the chest and slows the heartbeat.

Avoid alcohol, coffee and cigarettes: If you suffer from heart palpitations more often, it is better to avoid substances that increase heart rate and blood pressure. These include alcohol, caffeine and nicotine.

Reduce stress: The main cause of palpitations is stress. Slow down in your daily routine and use relaxation techniques. These include progressive muscle relaxation, autogenic training or yoga, for example.

Home remedies have their limits. Consult a doctor if the symptoms do not improve or even worsen!

Treatment by the doctor

Once it has been determined what is causing the palpitations, the doctor will initiate appropriate treatment. If the doctor determines an organic cause for the symptoms, the first step is to treat the underlying disease. This can be, for example, the treatment of hyperthyroidism or heart disease.

Medication

Medications often help against palpitations. For example, in the case of atrial fibrillation, the doctor prescribes anti-arrhythmic drugs (antiarrhythmics such as adenosine). They help to restore the heart rhythm to normal. In most cases, he or she also prescribes anticoagulants to counteract the increased risk of stroke associated with atrial fibrillation.

Other treatment options for tachycardia include beta blockers or calcium antagonists. They lower the heart rate and thus slow down the heartbeat.

If psychological factors such as stress or anxiety trigger the palpitations, sedatives such as benzodiazepines help in more severe cases.

Other treatment options for palpitations

In WPW syndrome, for example, it is sometimes necessary to obliterate the supernumerary conduction pathway (catheter ablation).

If the tachycardia is due to life-threatening ventricular fibrillation, an attempt is made to stop it as quickly as possible with the aid of electric shocks (electrocardioversion).

In some cases, the surgical use of an automatic defibrillator may be advisable.

What does palpitations feel like?

In healthy adults, the heart normally beats between 60 and 80 times a minute at rest. In the case of palpitations (tachycardia), the heart beats more than 100 times per minute in adults – without a physical exertion such as sports or physical work or an emotional reaction such as joy, fear or excitement as a trigger (in these cases, an accelerated pulse is normal).

At what point do we speak of palpitations?

How fast the heart normally beats also depends on age. Children, for example, usually have a higher pulse rate than adults. Therefore, there is usually no cause for concern in young children with a heart rate of 100 beats per minute.

Normal heart rates (per minute) at rest are:

• For infants/newborns: 120 to 140 beats.
• For children and adolescents: 80 to 100 beats
• For adults: 60 to 80 beats
• Older people often have a slightly higher heart rate again

If the heart rate is higher than normal, doctors call it tachycardia. Above 150 heartbeats per minute, adults have marked tachycardia. The increased palpitations associated with tachycardia can often be felt as far up as the throat. Those affected clearly perceive their own heartbeat, which doctors refer to as palpitation.

Palpitations are not necessarily dangerous. Benign palpitations, colloquially known as heart palpitations, usually occur as a side effect of harmless disorders. One example is so-called AV node re-entry tachycardia, in which the propagation of excitation between the heart chambers and atria is disturbed.

Benign tachycardia always occurs suddenly and just as unexpectedly disappears all by itself. This is, for example, the sudden heart palpitations at rest. In this context, tachycardia also occurs after waking up or tachycardia while falling asleep.

It can also be recognized by the following signs, for example:

• The symptoms usually appear at rest or some time after physical exertion. Heart palpitations while lying down are possible.

• Dizziness, pressure on the chest or nausea sometimes accompany the racing heart.

In general, if the heart is healthy, it can cope well with sudden, benign palpitations.

Nevertheless, it is advisable to have even benign palpitations clarified by a doctor in order to rule out more serious causes and to avoid problems in everyday life. After all, the ability to work and drive is restricted during an attack. In some cases, fainting may even occur.

Tachycardia may occur during or after meals, tachycardia at night is just as possible as tachycardia during the slightest exertion or after drinking alcohol. The decisive factor is not necessarily when the palpitations occur, but how often they happen, whether it is possible to calm the palpitations quickly and whether there are any accompanying symptoms. If in doubt, have a doctor clarify recurring heart palpitations in particular.

Forms of palpitations

Depending on where the palpitations originate, a distinction is made between:

1. Ventricular tachycardia: This is when the accelerated pulse occurs in the ventricle of the heart. This is the dangerous form of tachycardia, as it can result in life-threatening ventricular fibrillation.

When to see a doctor?

In principle, it is advisable to always have recurring or constant palpitations – even if they disappear on their own – examined by a doctor. Only a physician can correctly identify the causes and initiate appropriate treatment steps.

In the following cases, call an emergency physician immediately if you experience palpitations:

• Tachycardia does not go away on its own, and actions such as pressure on the carotid artery do not help.
• Shortness of breath, shortness of breath, and a tightness in the chest accompany the tachycardia.
• Severe chest pain, anxiety and shortness of breath are added.
• Unconsciousness and even circulatory arrest occur.

Diagnosis

The doctor will first talk to you to obtain important information about your medical history (anamnesis). To do this, he asks the following questions, for example:

• When did the palpitations first occur and when did they last occur?
• Does the palpitations occur exclusively in situations involving stress, anxiety or physical exertion, for example?
• How often do you suffer from palpitations?
• Does the palpitations occur suddenly or gradually? And how does it disappear?
• What is the pulse rate during this time? Does the heart beat regularly during palpitations? How long does a seizure last?
• Have you ever been unconscious during a seizure?
• Do you manage the tachycardia yourself (for example, with medication or your own actions)?
• Are there any cases of tachycardia in your family?
• Do you have any additional symptoms such as shortness of breath or a feeling of pressure in your chest?

This is followed by a physical examination, during which the doctor will also listen to your heart. Other examination methods may also be considered, for example:

• Long-term ECG: In contrast to the snapshot of the classic ECG, the long-term ECG records the heart’s activity continuously for 24 hours. This allows irregularities to be reliably detected.
• Heart ultrasound (echocardiography): This examination is performed from the outside through the skin or from the inside through the esophagus. It provides information about the function and shape of the heart valves as well as the size of the heart.

Prevention

If you already know that you are prone to sudden benign palpitations (and have already had the exact cause clarified by a doctor), you may be able to prevent attacks by avoiding stress and integrating relaxation techniques into your daily routine. It is also beneficial to avoid alcohol, nicotine or caffeine to prevent attacks of palpitations.