Palpitations & Arrhythmia

A palpitation is a sensation in the chest of the heart racing or causing extra or missed beats. An arrhythmia is the actual rhythm seen on an ECG which may occur at the time of palpitations. Palpitations are a very common symptom and do not necessarily mean that there is underlying heart disease and in deed often the heart is found to be normal after investigation. Other causes may be more important. Some of the causes the 'arrhythmia' problems leading to palpitations and their treatment are listed here:

Sinus tachycardia: This is simply the normal heart rhythm going faster, such as with exercise or anxiety. It can also be caused by an overactive thyroid gland.

Benign ectopics: These are very common and come from either the top or bottom of the heart. They are often felt as 'missed beats' even though it is the heart putting in an early or extra beat. They happen in all hearts from time to time and mostly people are unaware of them. Some people can have more than others, and some just become very sensitive to them. If there are no symptoms or signs of underlying heart disease they are nothing to be concerned over and the treatment is reassurance. Occasionally people need beta-blockers if they remain troublesome despite this.

 The ECG shows 2 ectopic beats from the bottom of the heart ('ventricular')

Atrial Fibrillation: Atrial fibrillation is a common irregular heart beat. See under its own section.

Surpaventricular tachycardia or SVT: This is a fast rapid 'short circuit' of the heart which cause palpitations and often some chest tightness at the same time. It can be quite frightening when it first happens but is a benign condition that does not do harm. It is due to a tiny extra bit of 'wiring' in the heart which most of the time does nothing, but can out of the blue become be caught up in a short circuit where the electrical activity goes around and around the middle of the heart causing it to race. If it happens very infrequently nothing may need to be done, but it can also be treated with medications such as beta-blockers and flecainide.

Wolf-Parkinson White Syndrome: This is like supraventricular tachycardia except that it can be seen on a resting ECG. Its treatment is the same as SVT by and large.

Ventricular Tachycardia: This is a more concerning rhythm problem where the bottom of the heart races. It is usually due to underlying heart disease such as coronary artery disease or heart failure and needs full investigation.

Medications for palpitations

Commonly used medications are:

  • Beta-blockers: there are many types but propranolol, bisoprolol and sotalol are frequently used
  • Flecainide: this is a very good tablet for supraventricular tachycardia or atrial fibrillation as long as there is no underlying heart disease such as coronary heart disease or heart failure
  • Amiodarone: this is a very powerful anti-arrhythmic agent, mostly used to control atrial fibrillation. It is used with caution as it can have side-effects in the long term (affecting the lung, liver and thyroid) which need six monthly monitoring with blood tests. It can also cause the skin to be much more sensitive to sunlight requiring sunblock and hats etc.

Please note:

Every effort has been made to ensure that the information on this website is up-to-date and accurate. However, it is intended to serve as a guide only. Symptoms may vary and if you have any medical concerns you should always consult a healthcare professional.