Dr Ernest Ng Wee Oon

Consultant Cardiologist & Electrophysiologist

Pantai Hospital Kuala Lumpur

 

This is a sensation in which a patient is aware of his heartbeat which may be rapid, irregular or forceful. The heart may appear to skip beats, beat constantly or intermittently at a fast rate.
 

Although palpitations are common and usually benign or harmless, they can make the patient very symptomatic and can affect their quality of life. In a number of patients however, palpitations could be due to underlying disease that warrants further investigation.
 

Causes
 

• Stress and anxiety; increased tea or coffee consumption

• Ectopic beats – these are extra beats from the heart originating from the atrium or ventricle

• Atrial fibrillation (AF) – this is a condition where there is uncoordinated atrial activity leading to rapid and irregular heart beats. Some patients with AF may be at risk of having a stroke

• Supraventricular tachycardia (SVT) – this is a condition where the patient develops sudden onset rapid palpitation (over 160 beats a minute). This is due to an abnormal circuit in the heart usually due to an extra electrical pathway

• Ventricular tachycardia (VT) – patients with a previous history of a heart attack and a weak heart can sometimes develop this condition which can be life-threatening. In some patients however, VT is associated with a more benign prognosis. These patients usually have no underlying heart disease

• Anaemia – if the blood count is low, the heart may beat faster than normal in order to meet the extra body demand for oxygen

• Thyrotoxicosis – this is due to an overactive thyroid gland

 Investigations
 

• 12 lead Electrocardiogram (ECG)
• Full blood count, renal profile and thyroid function tests
• Holter monitor or event recorder
• Exercise stress test – especially is the palpitation is related to exercise or ischaemic heart disease is suspected
• Echocardiogram – this is used to exclude underlying heart function weakness or valve disease
• Electrophysiology study – this is useful especially to diagnose the mechanism of SVT. Radiofrequency ablation at the same time offers a treatment option

Management

The management will depend on the cause of palpitation. Reassurance is given if the condition is not life-threatening and there is no underlying heart disease. Specialist referral is indicated especially if there is a suspicion of heart disease or failure. In addition, many patients with SVT can now be cured at the time of electrophysiology study using radiofrequency ablation.