That funny feeling in your chest could be heart palpitations

That funny feeling in your chest could be heart palpitations

Ever feel like your heart is acting funny? You could be experiencing heart palpitations - and they should not be ignored.

Heart palpitations are most commonly described as an unpleasant awareness of your heart beat, according to cardiologist Alan Morrison, MD, PhD, at Cape Cod Healthcare Cardiovascular Center - Falmouth. They can either be a forceful pounding sensation, a rapid fluttering sensation or an irregularity in the beating of the heart.

"People describe all kinds of things: a fluttering, a pounding, a flip-flopping sensation," he said. "Sometimes it radiates to the neck, but most of the time it's right over the area where the heart is, on the left side."

Palpitations occur for a wide variety of reasons, and there are treatments for each one, he said. The most common scenario is a cardiac situation like skipped beats or heart arrythmias, which consist of a rapid irregular beating that is out of sync with the normal conduction of electrical activity in the heart.

"One thing I would emphasize is it is really important when you're experiencing these symptoms not to ignore them but to bring them to the attention of your medical provider," he said. "They can get an EKG as a first-line assessment, and oftentimes on the EKG can identify what it is that's causing that sensation."

Sometimes patients' palpitations occur at irregular times, which can be frustrating for patients because the EKG will look normal on the specific day it occurs. In those cases, doctors will order a Holter monitor or an event monitor, which is a simple patch that can be worn for days or up to a month.

Treatments

Treatment will depend on the underlying cause of the palpitations. For example, skipped beats that don't interfere with life or are not uncomfortable may not require treatment at all. Depending on how much they interfere with a patient's life, arrythmias like atrial fibrillation or supraventricular tachycardia (SVTs) may require an ablation to stop the arrythmia.

"Palpitations and arrythmias live in a spectrum where, for some patients, it doesn't interfere with their lives or bother them much at all," said Dr. Morrison. "There are other people that can't get out of bed without having profound symptoms that limit them or slow them down. That may include additional symptoms, like shortness of breath and lightheadedness."

As a cardiologist, Dr. Morrison has seen the whole spectrum of palpitations, so he comes up with very individualized treatment strategies that depend on whether they are caused by something relatively benign or more severe, and how much the palpitations interfere with a patient's life. For example, it would be dangerous for a patient who experiences lightheadedness to drive a car or work as a roofer.

Sometimes other chronic medical conditions can cause palpitations. It is important for these patients to have their thyroid function checked because hypothyroidism can cause arrythmias. Poor control of blood sugar is another possible cause. Lung diseases like COPD are another cause, because the heart and lungs communicate all the time and there can be a lot of excitability in the heart when the patient is having difficulty exchanging air, Dr. Morrison said.

"In those situations, patients can often feel palpitations and have very rapid heart rates that require medical therapy and treatment," he said. "And while some of the medical therapy will focus on the heart rate and helping the heart to calm down, some of the medical therapy should also be focusing on the lungs and making sure that the breathing is stabilized."

Other Causes

Lifestyle choices can also cause heart palpitations. Using substances like alcohol, nicotine, caffeine, cocaine and marijuana can all trigger palpitations. For those causes, stopping the substance use should cure the problem, he said.

Anxiety is another possible cause of palpitations. Panic attacks in particular can cause profound and frightening palpitations. In those cases, treating the underlying anxiety is the best treatment.

"Occasionally heart palpitations are the presenting symptom of a structural problem with the heart and that is why it is so important to get it evaluated," Dr. Morrison said. In addition to ordering an EKG, the examining cardiologist may then go on to order an imaging study of the heart, like an echocardiogram.

"A good rule of thumb is anything involving the heart or brain should be evaluated by a physician," he said.