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“My heart bumps, goes fast and sometimes seems to stop. Am I in trouble doctor?”
There are many causes of palpitation - extra beats , missed beats, fast heart rhythms and even slow rhythms at times.
They cause an uncomfortable feeling in the chest or neck, especially on going to bed, after a meal, after strong coffee or tea and very often in the setting of stress - waiting for a Court appearance, separation, divorce, bereavement, and winning the Lottery!
The headline fact about them is that they are only rarely serious. Very often they are due to extra beats (extrasystoles).
These are premature beats which may not be felt. They are followed by a pause, which is often ‘felt’ and a heavy beat which makes up for the small amount of blood pumped with the previous ‘extra’ beat.
Sometimes palpitation is caused by atrial fibrillation - an irregular, chaotic heart beat caused by the top part of the heart (normally controls the regular beating) going ‘out of sync’. This is a very important rhythm disturbance since it is often associated with heart pathology, albeit, not always serious pathology in itself.
The electrical system of the heart consists of very delicate tissues like a spiders web inside th heart. This becomes scarred with age - the commonest cause of the problem. This is not dangerous but the heart tends to form internal clots because it not longer beats regularly.
These may be shaken loose and can travel to the lungs (pulmonary embolism ) or brain to produce a stroke. We try to prevented these at all costs by using some form of anticoagulation.
Diagnosis requires an ECG, a 24h ECG, an exercise test and an echocardiogram to visualise the internal chambers and valve structures of the heart.