One Doctor's Opinion
True Love Or Caffeine?
March 4th, 2011

"Hey doc...I am a little bit worried. Lately I've been feeling something fluttering in my chest. What's up with that?" "Well...Mr. W, let's take a look at you. I think I have an idea what is going on. You may be having palpitations."

Palpitations are noticeable, irregular heartbeats. In general, we all have occasional missed heartbeats or extra beats during the day. However, when we have many of them or prolonged episodes, we begin to become aware of them and feel them as a fluttering feeling in our chest.

What usually causes palpitations? There are many possible causes:

  • Anemia
  • Caffeine
  • Other kinds of stimulants--cocaine, amphetamines
  • "Diet" pills or weight loss medications with certain ingredients
  • Other common substances--alcohol, nicotine
  • Panic attacks or fear
  • Thyroid problems
  • Fever
  • Pregnancy
  • Low blood sugar
  • Heart valve problems--more specifically mitral valve problems
  • Low blood oxygen levels
  • Blood electrolyte imbalance--abnormal blood chemistry studies
  • Overexertion and fatigue
  • Dehydration
  • Lung disease or problems
  • Situations of extreme pain
  • Heart problems--including heart failure and heart attack
  • Various types of heart conduction abnormalities
  • Adrenaline from being physically stressed or overstimulated
  • Asthma medication
  • Hereditary abnormalities

So when do palpitations become worrisome? When palpitations are associated with these symptoms, always seek medical help immediately:

  • Chest pain or chest heaviness
  • Dizziness or feeling faint or light headed
  • Having trouble breathing
  • Having a loss of consciousness
  • Excessive sweating
  • Confusion or neurological problems

How are they diagnosed? Unfortunately, the exact cause of the problem is often not found at the office visit.  Most of the time, the palpitations are intermittent--and of course, they are not going to happen when the doctor is listening. Does a visit to your mechanic for an intermittent, weird car engine noise sound familiar here? The usual course of action is to first take a careful history--i.e. does it occur with drinking coffee or when the person is scared? Whenever they are overly tired?

The next steps usually include a heart tracing (electrocardiogram) and x-rays of the chest to see if anything really obvious is found. Blood tests can help to determine if something metabolic or hormone type of problems are present. Murmurs can be evaluated with a heart ultrasound (echocardiogram) to see if that may be a cause of the palpitations. For very elusive problems, a cardiologist may often use what is called a Holter Monitor (a prolonged heart tracing monitoring). There are several types of studies that vary according to the length of recording of heart activity that is done--for example, one day or one week long etc. These are more likely to capture the arrhythmia if it happens during the testing.

There are other methods of diagnosis that can be used by your personal physician or with the help of a cardiologist. As you can guess, the specific treatment of the disorder is best determined after the cause of the symptom is found.

As always, if you feel you are experiencing heart rhythm problems, make sure you discuss them with your personal physician so that he/she can investigate the cause of your symptoms.

So until next time.....Stay Healthy Hawaii!


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