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Dr. Marine researches, diagnoses, and treats different types of cardiac arrhythmias, among other cardiovascular conditions. Learn more about Dr. Marine.
Palpitations are characterized as a general or heightened awareness of your own heartbeat – whether it’s too fast, too slow, or otherwise irregular. You might feel like your heart is thumping, racing, or fluttering. And you could feel this sensation in your chest or your neck.
Palpitations are symptoms of everything from short or long-term stress to a variety of arrhythmias (irregular heartbeats). They may feel alarming, but do not always reflect a serious heart condition. Dr. Joseph E. Marine, Associate Professor of Cardiology at Johns Hopkins Bayview Medical Center, starts his evaluation by asking his patients what they hear.
“I ask them to tap out what their heartbeat feels like. Then I get a sense of whether we’re dealing with isolated skipped beats or a more sustained arrhythmia,” says Dr. Marine. “Patients frequently will feel their skipped beats more at night, when they’re lying in bed and nothing is distracting them from it.”
Palpitations can occur for a variety of reasons unrelated to heart disease. These include:
Palpitations can also result from a range of heart arrhythmias. These are classified by location, and type of heartbeat. A few common types:
It’s important to differentiate palpitations caused by stress or minor arrhythmias from those that may point to an underlying heart disease. Inconveniently, palpitations don’t always occur during the time you’re with your doctor.
Dr. Marine recommends coordinating an electrocardiogram (ECG) with the irregular heart beat symptoms the patient is having by using a Holter or event monitor.
A Holter monitor is a portable machine you would carry in your pocket or small pouch around your neck or waist for 24 to 48 hours. Electrodes connect your chest to the monitor wires to record your heart rhythms.
An event monitor records heart rhythms for a longer span of time (about a month). The patient activates the monitor whenever he or she experiences an irregular heartbeat.
Depending on the severity of the symptoms and underlying cause of the palpitation, your doctor will typically recommend one of three treatment options:
Other outpatient procedures include cardioversion (electric shock sent to the chest wall to synchronize the heartbeat to a normal rhythm), and an implantable defibrillator (a special type of pacemaker that automatically detects and terminates ventricular arrhythmias associated with heart disease).
“While palpitations can sometimes signal a more serious condition, they’re often just a sensation of a normal heartbeat,” says Dr. Marine. “Confirming that nothing is seriously wrong is sometimes all a person needs. Relaxation techniques and reassurance from a physician – I find that both are very helpful when the cause of palpitations is benign.”