Palpitation is the feeling of heartbeats in a way that causes discomfort. Disturbing beats felt are not always abnormal beats. Most of the time, normal beats can create the perception of palpitations for various reasons. The heart muscles contract at a rate of 60-100 beats per minute at rest with the regular, rhythmic electrical current emanating from the sinus node.
The most common causes of palpitations are summarized below. In our patients who applied to our outpatient clinic with the complaint of palpitation, non-physical-psychological causes are almost the most common. Even in those who are due to a physical illness, psychological causes often appear as a factor that aggravates the picture and makes the complaint more disturbing.
Palpitations are a harmless symptom that often develops without serious heart disease. However, it can also be the first manifestation of a life-threatening problem. Therefore, it is important to evaluate the palpitations and determine that it is eye-related to rule out a heart problem that may be of particular importance.
The most valuable data in the evaluation of palpitations is actually a heart chart taken at that very moment, that is, coinciding with the moment when the palpitation existed. However, most of the time, this is not possible due to the short duration of palpitation, its rarity, or the lack of a health institution that can be reached in a short time. In this case, the most valuable data source for the physician is what the patient will tell about his palpitations.
An EKG (electrocardiography=cardiogram) that we will take during an ongoing palpitation will make us the diagnosis. However, if the past is in a flutter that we don’t know when it will happen again, there is often no evidence. So to speak, there is an unsolved situation, and we are detectives trying to reach the perpetrator by making our inquiries based on clues. For a detective, the place and time of the incident, before and after the incident, the moment of the incident are as valuable as the story of the palpitation for us.
Therefore, we ask some questions to assess what heart rhythm is causing the palpitations and why. Let’s write these questions here so that those who come to us with the complaint of “palpitations” come prepared. 🙂
1.) How would you describe the palpitations you feel?
Our patients often describe palpitations in many different ways:
– I can hear my heartbeat.
– It beats so strong, it shakes my body
– It’s like it’s about to pop out, like a butterfly flutters, it beats so fast
– A surge of excitement, a warmth, a feeling of falling into a void
and then a strong knocking, thumping
– Beats slow but strong
– beating erratically
2.) When, What do you do, In what situation? Triggers caught your attention?
Palpitations that occur for no reason, in ordinary times, without a trigger factor, and palpitations that occur with trigger factors such as excitement, stress, excessive tea-coffee-alcohol intake, exercise give us clues for different situations.
3.) How often does it happen? How long does it take ?
There may be repetitive palpitations of two to three seconds, as well as a constant feeling of palpitation.
4.) Did you notice any other accompanying situations-complaints?
Chest pain, shortness of breath, sweating, nausea, vomiting, dizziness, fainting, or the presence or absence of palpitations (before, during or after) are important clues for us.
5.) Do you have any previously diagnosed diseases and medications you use?
Some diseases, especially anemia, thyroid hormone disorders, lung diseases and psychiatric diseases, and sometimes the drugs used for these can be the cause, trigger or exacerbation of palpitations.
6.) Do you have any habits?
Tea, coffee, soft drinks, cigarettes, alcohol, substance use
7.) Were you able to count your heart rate during palpitations? Have you measured your blood pressure?
During full palpitation (which may be possible in palpitations exceeding 2-3 minutes), the person or his/her relative who feels the palpitation counts the pulse or measures the pulse with an electronic sphygmomanometer (or now with the existing applications of some smartphones), it will help us to make a diagnosis. It gives a serious hint. As you can see from the pictures, the pulse can be counted from the wrist, arm or through our jugular vein in the neck region. Counts made with a blood pressure monitor also allow us to know the current blood pressure value.
Yes, with the answers we receive to these and similar questions, we can sometimes strongly guess what the event is without the need for another examination. However, since we cannot act with predictions even if they are strong, we take the steps to confirm the diagnosis in order. Physical Examination, electrocardiography, echocardiography, rhythm holter, event recorders are the other steps we use in palpitation evaluation.
Of course, information such as “if you have answered the above questions in this way, the reason for your palpitation is this” is not the subject of this article. As always, the diagnosis process should start with the face-to-face communication of the patient and the physician.