Feeling your own heartbeat is not normally something you notice. When you do, it is alarming, and most people immediately assume the worst. The reassuring truth is that the large majority of palpitations are benign. The important truth is that a specific minority are not, and they are identifiable.
What separates the two is mostly the company the palpitations keep.
What Palpitations Feel Like
Patients describe several distinct sensations, and the description guides the diagnosis more than people expect.
- A skipped or missed beat, then a thump: usually an ectopic beat, extremely common and generally harmless
- A sudden fast regular racing that starts and stops abruptly: suggests a supraventricular tachycardia
- An irregular, chaotic, fast rhythm: raises the question of atrial fibrillation
- A gradual pounding that builds and settles: typical of anxiety, fever, anaemia or thyroid overactivity
Tapping out the rhythm on the desk for your doctor is genuinely useful. So is checking your own pulse during an episode and noting whether it is regular.
Common Harmless Triggers
Before assuming a cardiac cause, consider the everyday triggers that account for most episodes.
- Caffeine, including tea, coffee and energy drinks
- Nicotine and alcohol, particularly a binge the previous evening
- Dehydration, common in Chennai heat
- Fever and acute infections
- Anxiety, panic and sleep deprivation
- Decongestants, some asthma inhalers and thyroid tablets
- Anaemia, which is very common in Indian women
An overactive thyroid deserves specific mention because palpitations may be its first sign, alongside weight loss, tremor and heat intolerance. A simple test through our laboratory settles it.
The Red Flags
These features change palpitations from a nuisance into something requiring prompt assessment.
- Fainting or near fainting during an episode
- Chest pain or significant breathlessness alongside
- Episodes lasting more than a few minutes with a very fast rate
- Palpitations during exercise rather than after it
- Known heart disease, previous heart attack or heart failure
- A family history of sudden unexplained death before fifty
Fainting with palpitations is the strongest single warning sign. It suggests the rhythm briefly stopped delivering enough blood to the brain, and it belongs in an emergency department the same day.
Atrial Fibrillation and Why It Matters
Atrial fibrillation is the most common sustained abnormal rhythm and its significance is often misunderstood. The rhythm itself is rarely immediately dangerous. The risk is stroke.
When the upper chambers quiver rather than contract, blood pools and can clot. If that clot travels to the brain, it causes a stroke, and AF related strokes tend to be severe. Appropriate blood thinning reduces this risk by roughly two thirds.
AF can be completely silent, which is why an irregular pulse found incidentally is worth investigating even without symptoms. If you have been told your pulse is irregular, arrange an arrhythmia evaluation.
The Tests, and Why a Normal ECG Proves Little
An ECG records about ten seconds of your heart's activity. If your palpitations happen twice a week, the chance of catching one in that window is very small. A normal ECG in clinic does not mean nothing is wrong, it means nothing was happening at that moment.
- Holter monitor: continuous recording for twenty four to forty eight hours
- Extended or event monitors: worn for one to two weeks for infrequent episodes
- Echocardiogram: checks whether the heart structure is normal
- Blood tests: thyroid function, haemoglobin, electrolytes
- Treadmill test: if symptoms are exertion related
Keeping a simple diary of when episodes occur, how long they last and what you were doing helps enormously in choosing the right monitor duration.
Treatment Depends Entirely on the Rhythm
There is no general treatment for palpitations, only treatment for the specific rhythm found.
Benign ectopic beats usually need reassurance, reduced caffeine and better sleep rather than drugs. Supraventricular tachycardia often responds to simple vagal manoeuvres such as bearing down, and recurrent cases can be cured by catheter ablation. Atrial fibrillation needs stroke risk assessment and rate or rhythm control. Slow rhythms causing blackouts may need a permanent pacemaker.
This is why the investigation comes before the prescription.
What You Can Do While Waiting for an Appointment
Cut caffeine to one cup daily and see whether frequency changes. Keep well hydrated. Address sleep, since sleep deprivation is a genuinely powerful trigger. Note the pattern in a diary.
If an episode begins, sit down safely, breathe slowly, and check your pulse for regularity. If it settles within a minute or two and you feel entirely well, it can wait for a clinic appointment. If it comes with chest pain, breathlessness or faintness, it cannot.
Most palpitations turn out to be extra beats in a structurally normal heart, and knowing that is often treatment in itself. The point of investigating is not to find something wrong, it is to be able to say with confidence that nothing is.
Our cardiology department offers ECG, echocardiography and Holter monitoring, and Dr. Imthiyaz T M sees rhythm referrals at our T. Nagar hospital.
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