Many patients come to see me with worry, concern, and even distress over palpitations. When they roll on their left side in bed, or when they're sitting reading, or perhaps before a business presentation, they can feel their heart beat stronger, or faster, or with an irregularity or thud that alarms them.
As a cardiologist, I need a diagnosis to provide the insurance carrier, so we call these events "palpitations." The Latin root is palpare, which means "gentle tap," but in real life it may not be so gentle.
Because palpitations cause a considerable amount of concern and lead to many office visits, I thought it would be helpful to briefly explain heartbeats.
How the heartbeat works
In its optimal state, the top of the heart (atria) and the bottom of the heart (ventricles) beat in perfect synchrony about 50 to 90 times a minute at rest. This is called sinus rhythm and it's the most efficient way for the heart to pump blood.
This process starts at the top of the heart in the sinus node, travels to the middle of the heart (or the AV node), then the electrical wave-front moves on to cause the contraction that sends blood to the whole body.
There are many ways that this ballet can be altered. The top of the heart can fire early, causing a premature atrial contraction (PAC). Or the bottom of the heart can fire, early creating a premature ventricular contraction (PVC).
These can occur once and cause a thud in the chest, but they can also occur in multiples or runs, called atrial or ventricular tachycardia, which can indicate a serious underlying problem.
Another common problem I see is when the top of the heart loses all organization of rhythm and quivers, (some say it fibrillates like a bag of worms), creating atrial fibrillation or AFIB. This is so common that it dominates my hospital and office practice.
When you should be concerned?
All of us have some premature beats at times. In fact, the average person experiences a small number of skipped beats. Sometimes seemingly healthy people experience every other heartbeat as a skip, something called bigeminy, which can make the pulse hard to measure and cause worry that the heart rate is 30 beats per minutes when it's actually 60.
Although most people just need a little reassurance that everything's normal, it's often a good idea to search for root causes, particularly in people with medical issues, athletes, older adults, and those with additional symptoms like dizziness, near blackouts, and shortness of breath.
Some thing to consider: