Why people get Palpitations?

1. Palpitations can be caused by a variety of factors. In simple words, “During palpitations there is some problem with the Electrical system of the heart. The electricity in the heart might be generated too much OR may be generated in the parts of heart other than the usual areas where it is normally generated”.
2. In most cases it is harmless but creates a lot of stress and anxiety for the patients.
3. Some patient may struggle with the feeling of it.
1. Heart
2. Lungs
3. Abdomen (Tommy)
4. Muscular-Skeletal (Muscles and Bones)

Causes

The following are the commonest causes or triggering factors for palpitations:

1. Important heart cause includes:
1. Arrythmias
2. Heart Attack (prior or current if associated chest-pain)
3. Heart valve disease
4. Heart muscle problems (Cardiomyopathy)
5. Heart failure
2. Important other causes include:
1. Stress, anxiety or panic attacks
2. Various Stimulants, including caffeine (coffee/tea/energy drinks), nicotine, cocaine, amphetamines, and medications containing pseudoephedrine (cold & cough medications).
3. Alcohol Intake
4. Too much (Hyperthyroidism) or to little (Hypothyroidism) thyroid hormone.
5. General health conditions including: High Fever, during women periods (menstruation), pregnancy or menopause and anemia.

How to diagnosis Palpitations

1. Although there are several possible types of Palpitations, it is VERY important to rule out any serious life-threatening Arrythmias or other life-threatening emergencies.
2. If you have palpitations you should consult your local physician or nearby hospital. You need to immediately call, your local Emergency services (Emergency Contacts).
3. The doctor will check for your symptoms and advise appropriate tests.

The doctor may order the first few tests to find the possible diagnosis. This may include:

1. ECG or EKG: This records the electrical signals of your heart. It's a common test used to detect heart problems and monitor the electrical status of heart. This is a non-invasive, painless test with quick results.
2. Blood Tests: This is performed to check your blood count, Kidney functions, electrolytes levels and Thyroid functions tests.
3. Chest X-ray: An X-ray of your chest allows doctors to check the condition of your lungs. It helps to diagnose any lung infections, collapse of lung (leaking of air from lungs), heart failure and the size and shape of your heart and major blood vessels.
4. Echocardiogram: An echocardiogram uses ultrasound waves (signals) to take pictures of your heart. It is used to check your beating heart and its various parts including valves (doors), walls, pumping of blood in and outside heart, Pressures in various parts of heart.
5. Ambulatory Holter Monitoring: This is a portable device which you on your arm to record a continuous ECG, usually for 24 to 72 hours. You are advised to keep a diary of the timings when you feel palpitations.
6. Event Recording: This is used for prolonged monitoring. If you don’t catch anything on the ambulatory Holter monitor or if the events occur less than once weekly, your doctor might recommend an event recorder. You wear an event recorder as much as possible throughout the day and push a button on a recording device to indicate when you have symptoms. The device records your heartbeat so that your doctor can assess the heart rhythm when you have symptoms. You might wear an event recorder for several weeks.
7. Implantable Loop Recorder: If the above recording devices fails to find the event of palpitation and the associated ECG, then the doctor may advise for Implantable loop recorder. This device is about the size of Cigarette lighter and implanted under the skin in the upper part pf chest. This device can monitor your ECG for up to 3 years.

Treatment of Palpitations

This depends on the underlying diagnosis (Types of Arrhythmias) and the status of patient on admission to hospital.

1. If the patient is unwell with palpitations, please call the ambulance and report to the nearest hospital with emergency services. (treatment of acute arrythmias).
2. If the patient is stable with palpitations and occurs intermittently, please follow the following management plan:

Chest Pain related to Other Causes

1. Heartburn
1. There is usually a burning feeling behind your breastbone or lower part of ribs.
2. It may get worse before eating food and improves after food.
2. Swallowing disorders: Disorders of the esophagus can make swallowing difficult and even painful.
3. Panic attack
1. In some people, you may feel discomfort during a panic attack. You may feel rapid heartbeat, rapid breathing, profuse sweating, and shortness of breath, nausea, dizziness and a fear of dying.
2. Your doctor must check all other causes before label you as panic attack.
4. Shingles It is the viral infection of the nerves. It appears as a band of blisters from your back around to your chest wall. Usually very painful.

1. Although there are several possible causes of chest pain, it is VERY important to rule out any serious Life-Threatening Heart and Lung Emergencies.
2. If you have chest pain you should consult your local physician or nearby hospital. You need to immediately call, your local Emergency services (Emergency Contacts)
3. The doctor well check for :
1. Symptoms: as discussed before for each condition
2. Tests: These will be requested what the doctor is suspecting.

The doctor may order the first few tests to find the possible diagnosis. This may include:

1. ECG or EKG: This records the electrical signals of your heart. It's a common test used to detect heart problems and monitor the electrical status of heart. This is a non-invasive, painless test with quick results
2. Blood Tests: This is performed to check your blood count, Kidney functions, electrolytes levels and to check some proteins or enzymes, which may be elevated of there a heart muscle damage.
3. Chest X-ray: An X-ray of your chest allows doctors to check the condition of your lungs. It help to diagnose any lung infections, collapse of lung (leaking of air from lungs), heart failure and the size and shape of your heart and major blood vessels.
4. Computerized Tomography (CT Scan): In a computerized tomography (CT) scan, bloods clots can be checked in your lungs ((pulmonary embolism), any tears in the vessels (arteries) around heart (aorta) and any other lungs related problem.
5. Echocardiogram: An echocardiogram uses ultrasound waves (signals) to take pictures of your heart. It is used to check your beating heart and its various parts including valves (doors), walls, pumping of blood in and outside heart, Pressures in various parts of heart.

This depends on the underlying diagnosis and the status of patient on admission to hospital.
The treatment is divided into two steps:

1. Step 1: This is the generalized treatment usually received by most patients:
1. Will be attached heart monitor/ Blood pressure monitor and ECG/EKG.
2. You may be started on oxygen (Mask).
3. Pain relievers with morphine or other medications.
4. If patient deteriorates during this time, he may needed to be intubated ( breathing machine).
2. Step 2: As soon as the patient been given above treatment, the doctor continue with the specific treatment, which depends on the diagnosis of the conditions. The main conditions with chest pains and its emergency treatment includes:
1. Acute (sudden) Heart attack
2. Acute (sudden) Attack of Angina
3. Acute (Sudden) Heart Failure
4. Acute (Sudden) Arrhythmias (Heart rhythm issue)
5. Pulmonary embolism.
6. Aortic dissection You may need emergency operation to repair the Tear in aorta
7. Lung collapse (Pneumothorax): The doctor may have to insert a tube in your chest to reinflate your collapsed (air leak) lung.
3. Non-Heart conditions and Treatment: This includes
1. Blood thinners: If patient is diagnosed with Clots in the lungs or having heart attack.
2. Acid-suppressing medications: If chest pain is caused by excessive stomach acid or Stomach Ulcer disease.
3. Antidepressants: If you are having panic attacks.