The medical word for palpitations is arrhythmia (pronounced 'ay-rith-me-ar') meaning a change in the beating rhythm of the heart.

All of us feel the heart pounding away when we have to run for a bus, have seen an exciting film or had a fright: this is the normal response to exertion or excitement which causes the adrenaline in the blood to increase and stimulate the heart to beat faster. Being aware of the heartbeat, when there is no obvious explanation, can be alarming and lead to anxiety and panic, all of which makes the situation worse.

What doctors mean by palpitations is an undue awareness of the heartbeat. People see it in less matter-of-fact terms: 'missed beats', 'big beats', 'pounding', 'fluttering', 'as if my heart was going to jump out of my chest' are some of my patients' descriptions. Underlying these sensations the questions really bothering people are:

• Am I going to die?

• Will I have a heart attack?

• Will my heart stop beating?

• Will it damage me?

First, it is very rare for any form of palpitations to be dangerous or life-threatening. It is true that they are frightening and the fear can make them worse, but, for most people, all they have to fear is the fear, because palpitations do not usually mean disease.

For the vast majority of people, palpitations are just one of the ways that stresses and strains on the body show themselves, so they tend to be more common in people experiencing stress at home or work, in those with family anxieties and in those who are run down or overworked.


I often feel that my heart has missed a beat. Is this serious?

Missed beats are a common sort of palpitation and are invariably harmless. They can be brought on by too much caffeine, for example in tea, coffee, Coca-Cola or chocolate. Of these, coffee is by far the most important source of caffeine. Sometimes alcohol is the cause. If there is another disease present, missed beats may well be important, for example after a heart attack (see your doctor if you get these), but in 9 out of 10 people the heart is sound.

I drink rather a lot of coffee. I have heard that caffeine is bad for the heart and I must admit that sometimes I feel that my heart has missed a beat. Am I about to have a heart attack?

The control of the heart is like an electric circuit with a master switch. Occasionally, short circuits cause extra beats but the master switch is always in charge, even though it lets one or two extra beats escape. You may feel this more when your heart is slow, or when you are resting or just before going to sleep. It can also occur when the heart has been stimulated by caffeine, alcohol, stress, or as a side effect of medication, such as inhalers for asthma. The extra beat arrives early and there is then a pause (the missed beat) whilst the next normal beat comes along. The extra beat may not be felt ('as if the heart skips a beat') but, after the pause, the pump of the heart will be fuller than usual, so the next normal beat will feel like a big beat -a 'kick' or a 'thump'. A beat hasn't really been missed, it just feels like it, and the big beat is the heart making up for the one that came a bit early. This is not dangerous - the heart is compensating for the early beat.

When I was at work the other day, I suddenly felt my heart was working overtime -1 hadn't even been rushing up the stairs! What was happening?

Rapid palpitations may be normal, such as when you are running or excited, but sometimes they occur abruptly ('out of the blue') and can cause mainly fear, but also a sweaty feeling, light-headedness, breathlessness or, rarely, pain. Just as the cause of extra beats can be thought of as short circuits, so these palpitations are best thought of as caused by a sensitive area in the wiring of your heart. Again, it may be responding to stress, cigarettes, caffeine or alcohol. Remember that the wiring is only part of the building of the heart, a problem here or there is not going to affect the structure. However, palpitations which lead to chest pain, light-headedness or blackouts need a thorough medical check, so go to your doctor if you get these symptoms. Some people - a small number - have persistent troublesome rapid palpitations which carry on even when you have stopped drinking caffeine or alcohol or when you are no longer stressed. The cause can invariably be identified and treated and is rarely more than an awkward nuisance. Although there may be no major problem with the heart, there is no point in feeling ill if treatment can help you.

I've been very worried when I had two attacks of rapid heartbeats recently. Are there any types of palpitations that are dangerous?

Some very rare palpitations are so fast that a blackout occurs. If they occur because your heart muscle is not working very well {ventricular tachycardia - tachycardia just means rapid heartbeat), you will need medication to make them stop as they can be fatal. A common medication used is amiodarone. Your doctor will explain what is happening and it will be very important to follow his advice. You will need close hospital supervision. A defibrillator may also be advised {see p. 191). I must emphasise that this is rare.

I am in my twenties and am getting rapid heartbeats every so often. I work in the type of job where results are all important. My husband has just lost his job as well, so sometimes I feel really stressed. Should I go to the doctor?

Rapid palpitations are a bit more of a problem because they are more scary. Again, younger people can be under stress, and the heart is behaving in an exaggerated variation of normal, as if you are running all the time, owing to higher adrenaline levels in the blood. A visit to your doctor and an ECG are necessary if symptoms are a problem (dizziness, breathlessness). The doctor will test you for various things such as anaemia, an overactive thyroid gland; he may also check to see whether you are pregnant, because pregnancy makes the heart beat faster in order to feed the baby. Very rarely, the ECG shows evidence of a specific 'extra wire' in the heart, which conducts beats much faster than the usual circuit; you will need to go to hospital in this case.

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