Alternate Names: Irregular heartbeat; Palpitations; Heart pounding

Considerations: Normally the heart beats between 60 and 100 times per minute. In people who are physically fit (those who exercise routinely) and in people who take medications that slow the heart, the rate may drop below 55 beats per minute.

When a person gets excited or frightened, has a fever, an overactive thyroid gland, anemia, or other illnesses, the heart may beat faster than 100 times per minute.

Everyone experiences palpitations at some time in life. Pounding of the heart, brought on by strenuous exercise or strong emotions, is rarely associated with serious disease.

Often, people who complain about palpitations do not have heart disease, but are overly concerned about the possibility of heart disease, and become sensitive to normal heart actions. Extra heart beats are commonly noticed just before going to sleep or when resting quietly.

The significance of an abnormal heart rhythm usually depends on the presence of other symptoms of heart disease that accompany it.

Common Causes:

• anxiety and fever are the most frequent causes of a rapid heartbeat (other than exercise)
• medication can cause a surge in the heart rate
  • This frequently happens with thyroid pills, caffeine, and appetite suppressants.
  • Antiasthmatics (such as Theo-Dur) and the nicotine in tobacco can also raise the heart rate.
• acidemia (respiratory acidosis or metabolic acidosis)
• being frightened
• congenital heart disease
• overactive thyroid
• hyperventilation
• hypoxemia
• drugs such as antiarrhythmics, beta blockers, caffeine, cocaine, psychotropics, or sympathomimetics
• diagnostic procedures on the heart

Home Care: If a person seems stressed or anxious, focus on dealing with the stress and anxiety.

Not all cardiac rhythm disorders are treated with medications. Every anti-arrhythmic medication currently available can produce side effects, some of which are potentially more dangerous and troublesome than the arrhythmia itself.

Except for those who need to monitor their heart rate for specific reasons (such as taking digitalis or a beta blocker, or to monitor for aerobic exercise), monitoring the pulse on a regular basis is not necessary.

Call If:

• a rapid heartbeat continues for more than an hour, or if there is shortness of breath, chest pain, unusual sweating, dizziness, or fainting.
• there are very frequent extra beats (more than 6 per minute or coming in runs of 3 or more).
• the pulse is more than 100 beats per minute (without exercise, anxiety, or fever).

What To Expect: If the patient is in distress, cardiac rhythm will be monitored and emergency intervention will be performed as necessary to restore normal cardiac rhythm. Otherwise, the doctor will want to know the exact pulse rate and whether or not the rhythm was regular at the time the problem occurred. Often the symptoms will disappear by the time the doctor sees the patient.

Medical history questions documenting palpitations in detail may include:

• type
  • Do you feel skipped or stopped beats?
  • Is there a slow heart rate?
  • Is the heartbeat rapid, racing, pounding, or fluttering?
  • Is there a regular pattern to the unusual heartbeat sensation?
  • Is there an irregular pattern?
  • Is the heartbeat sensation induced by a change in body position?
• time pattern
  • Did the palpitations begin or end suddenly?
  • Did they occur in response to reminders of a traumatic event?
• associated complaints
  • Was the pulse (heart rate) fast?
  • What was the heart rate (how many beats per minute)?
    • Normal is less than 100 for adults, slightly faster for children and infants.
• other
  • What other symptoms are present?

• ECG
• chest X-ray (seldom needed)
• holter monitor (for 24 hours)