The human heart starts beating from 4 weeks gestation (sometimes even before the woman realizes she is pregnant) and doesn’t stop till death. The average heart beats 90,000-130,000 times a day and we don’t even notice it! However in some instances, we become aware of our heartbeat; we either hear it as a “thumping sound” or we feel it thumping in our chest. It can be fast, or may feel like the heart “skipped a beat” This phenomenon is what we call “PALPITATIONS”. Palpitations are not the same as not being able to breathe, although one may cause the other.

Palpitations may be also occur with chest pain, light headedness, difficulty in breathing, the urge to empty the bowels or bladder.

Awareness of the heart beat is one of the most common reasons people seek cardiology care, as it causes a lot of concern.

What exactly causes palpitations?

Sometimes palpitations may be due to a natural reaction to:

• Fear: When we are scared, our bodies release adrenaline, which causes our heart to beat faster (The fear response). Awareness of this fast heart beat is what results in palpitations.
• Anxiety: Anxiety also provokes the fear response and causes us to be aware of our heart beat.
• Physical activity: It is natural for the heart rate to increase while you are doing exercise, so you may hear your heart beat while working out, but this should return to normal once you rest
• Pregnancy: many pregnant women experience palpitations. This may be due to the increase heart rate and blood volume in pregnancy.

Palpitations may also be due to what we ingest: Most of these chemicals cause palpitations by increasing the adrenaline levels in the body

• Caffeine is a potent stimulant. It is present in coffee, tea, some cocoa drinks, kolanut, cola based drinks (coke/pepsi).
• Nicotine: present in cigarettes and tobacco products.
• Alcohol in any form.
• Drugs such as cocaine, amphetamines, marijuana
• Energy drinks: these contain a potent mix of several stimulants including caffeine
• Slimming/”fat burning “tablets
• Asthma medication: Salbutamol, theophylline aminophylline
• Herbal remedies either in liquid or tablet preparations.

Medical conditions can also cause palpitations

• Thyroid disease
• Low blood sugar level
• Anemia (low blood levels)
• Low blood pressure, fever, dehydration, electrolyte imbalance
• Hormonal changes during menstruation, pregnancy, or just before menopause.

Abnormalities of the heart and heart rhythm may also cause palpitations;

• Hypertension
• Problems with the electrical system of the heart (yes your heart is powered by a battery and has electrical “wires” running through it!!) Also called arrhythmias
• Heart failure: when the heart is unable to supply blood to meet the needs of the body.
• Ischemic heart disease: Problems with the blood supply to your heart

Because there are so many causes of palpitations, it is important to be evaluated by a doctor who will take a history to ask if any of the above listed conditions are present. They will also examine you to look for any abnormalities. An ECG (electrocardiogram), and other blood work will be ordered. Depending on what is found, you may be counselled to avoid the substances or circumstances triggering the palpitations or you may be referred to a Cardiologist if the cause is heart related. It is important to note that not all cases of palpitations are treated with medication. Sometimes, just identifying the source of anxiety or fear can eliminate the problem. In addition, just avoiding the medication or drinks you are ingesting may get rid of palpitations for good.