Palpitations and a racing or skipping heartbeat

Understanding palpitations

A palpitation is an unusual awareness of your own heartbeat — a sudden fluttering, racing, pounding or skipping sensation in the chest, throat or neck. Your heart normally beats without you noticing it; a palpitation is what happens when you do notice it. It is one of the most common reasons people see a heart specialist, and in most cases it is not a sign of a dangerous problem. Even so, feeling your own heartbeat is unsettling, and a small number of causes do need prompt attention — which is why new or troubling palpitations are always worth having checked rather than guessed at.

It helps to understand how a normal heartbeat works. The heart has four chambers: two upper chambers (the atria) that receive blood, and two lower chambers (the ventricles) that pump it out to the lungs and body. Each beat starts as a tiny electrical signal from the heart's natural pacemaker (the sinus node), crosses the atria, then passes through a relay point (the AV node) into the ventricles — keeping the heartbeat regular, usually 60 to 100 beats a minute at rest, faster with exercise or emotion. A palpitation happens when this rhythm changes, beats more forcefully, or you simply become more aware of a heartbeat that was always there.

What palpitations feel like

Palpitations feel different from person to person. These are common descriptions patients use, offered to help you put your own experience into words for a clinician — not a checklist for diagnosing yourself.

• ●A fluttering or "butterfly" feeling in the chest
• ●Pounding or hammering, as though the heart is working hard
• ●Racing, where the heartbeat feels very fast
• ●A skipped beat — a pause, then a stronger thud as the heart catches up
• ●A "flip" or somersault sensation in the chest
• ●A pulsing or throbbing feeling in the neck

Episodes can last seconds, minutes or longer. Some people notice them mainly at rest — classically lying on the left side in bed, when the heart sits closer to the chest wall. Others notice them during exertion, with stress, or after caffeine or alcohol. Noting when an episode happens, what you were doing, how long it lasted and what else you felt is useful information for your appointment.

What causes palpitations

Palpitations have many possible causes, from entirely normal to occasionally serious. Grouping them this way can help you see where your own experience might fit.

Everyday and lifestyle triggers

Most common causes are not heart disease at all: exercise, strong emotion, caffeine, alcohol, nicotine, dehydration, poor sleep, fever and pregnancy can all make the heart beat faster or harder.

Extra heartbeats (ectopic beats)

Many "skipped beats" are ectopic beats — extra heartbeats that fire early, before the heart has finished filling. That early beat pumps out less blood and may go unnoticed; the pause that follows is felt as a gap, and the stronger beat after is felt as a thud. Ectopic beats are common and, alone, are usually harmless.

Rhythm problems (arrhythmias)

An arrhythmia is a genuine electrical problem, not a single extra beat:

• ●Atrial fibrillation (AF) — the upper chambers quiver rapidly and irregularly instead of contracting normally
• ●Supraventricular tachycardia (SVT) — a short-circuit in the upper electrical pathways causes sudden, fast, regular episodes
• ●Atrial flutter — a fast, organised electrical circuit in the upper chambers, related to atrial fibrillation
• ●Ventricular arrhythmias — an electrical problem starting in the lower chambers; less common, more likely to need urgent attention

Causes outside the heart

• ●Anaemia (a low blood count) — common in Nigeria, it forces the heart to pump faster to deliver enough oxygen
• ●An overactive thyroid gland speeds up the whole body, including the heart rate
• ●Low blood sugar triggers stress hormones that cause a racing, pounding heartbeat
• ●Anxiety and panic — a genuine physical response, not "just nerves"
• ●Low potassium or magnesium, minerals that help control the heart's electrical signals

Medicines and substances

Some medicines can cause or worsen palpitations, including salbutamol inhalers, decongestants, thyroid tablets, and some herbal, "energy," weight-loss and stimulant products. Tell your clinician about everything you take — herbal and over-the-counter products are not automatically safe.

Who is more likely to get palpitations

These factors make a rhythm-related cause more likely, and are worth mentioning at your appointment:

• ●High blood pressure — very common in Nigeria and often undiagnosed, it strains the heart over time
• ●Diabetes
• ●Thyroid disease
• ●Anaemia
• ●A family history of rhythm problems or sudden cardiac events
• ●Increasing age
• ●Existing structural heart disease, such as a prior heart attack or valve problem
• ●Heavy or binge alcohol use

What happens if a rhythm problem goes untreated

Most palpitations are harmless. The minority caused by a true arrhythmia matter, though serious complications remain uncommon.

Stroke. In atrial fibrillation the upper chambers quiver instead of contracting properly, so blood can pool and clot; a clot that breaks free can travel to the brain and block a vessel there — why blood thinners so often feature in atrial fibrillation care.

Heart failure. A rhythm that stays abnormally fast for weeks or months, if unrecognised, can gradually weaken the heart's pumping ability.

Fainting and injury. Some rhythm problems briefly reduce blood flow to the brain, risking falls, particularly while driving or working at height.

Cardiac arrest. Rarely, a dangerous ventricular arrhythmia can stop the heart pumping effectively — uncommon, and far more likely with significant underlying heart disease.

How Cardiocare finds the cause

The right pathway depends on your symptoms, examination and overall health. It typically draws on some or all of the following:

• 01
  History and examination. When episodes happen, how long they last, what brings them on, plus an examination of your heart, pulse and blood pressure.
• 02
  12-lead ECG (electrocardiogram). A painless recording of the heart's electrical activity from pads on the chest and limbs, taking minutes.
• 03
  Holter or event monitoring. A portable ECG recorder worn for a day or longer — the test must be worn when the symptom happens to catch it.
• 04
  Ambulatory blood pressure monitoring. Where relevant, a cuff records readings over 24 hours.
• 05
  Echocardiogram. A painless ultrasound scan showing the heart's structure and pumping.
• 06
  Blood tests. Full blood count for anaemia; thyroid function; electrolytes (potassium, magnesium); blood sugar.
• 07
  Exercise or stress testing. Monitors the heart's rhythm and response during exercise.
• 08
  Electrophysiology (EP) study. For selected complex cases, a catheter-based test maps the heart's electrical pathways to pinpoint an arrhythmia's source.

A normal ECG taken while you feel fine does not necessarily mean nothing is wrong — it means the rhythm was normal at that moment. This is why monitoring timed to catch your actual symptoms is often the most useful test of all.

How palpitations are treated

Treatment is matched to the cause — there is no single treatment for palpitations as such.

When the cause is benign

Treatment is often reassurance and reducing known triggers such as caffeine, alcohol, poor sleep or dehydration; occasional ectopic beats in an otherwise healthy heart usually need no medicine.

Treating the underlying cause

Where palpitations come from another condition, treating it often resolves them — correcting anaemia, an overactive thyroid, or blood pressure control.

Medicines, by class

Where medicine is needed, it is chosen by what it does, and your clinician will discuss the right option and dose for you:

• ●Beta blockers — slow and steady the heart rate
• ●Rhythm-control medicines — help keep the heart in, or restore it to, a normal rhythm
• ●Anticoagulants (blood thinners) — prevent the clots that can lead to stroke in atrial fibrillation

Procedures

Available through Cardiocare's on-site cardiac catheterisation ("cath") laboratory:

• ●Cardioversion — a controlled electrical shock, under sedation, that resets the heart to a normal rhythm
• ●Catheter ablation — while sedated, thin catheters are guided through a vein, usually from the groin, to treat the tissue causing the abnormal rhythm
• ●Pacemakers and other devices — for rhythms that are too slow, an implanted device can help keep the heartbeat regular

Living with palpitations: everyday self-care

Whatever the cause, small daily habits can reduce how often palpitations happen:

• ✓Cut back on caffeine and energy drinks, and notice whether symptoms improve
• ✓Limit alcohol, and avoid binge drinking
• ✓Protect your sleep — poor sleep is a common, under-recognised trigger
• ✓Stay well hydrated, especially in Abuja's heat
• ✓Manage stress in whatever genuinely works for you — exercise, prayer and family support, or counselling
• ✓Keep up regular activity as advised; most benign palpitations need no exercise restriction

During an episode

Sit or lie down safely, breathe slowly and stay calm. Note the time, duration and what you were doing — a simple symptom diary is useful evidence for your clinician. Stop and seek help if chest pain, severe breathlessness, fainting or near-fainting occur, or it does not settle.

Preparing for your appointment

What to bring

• ✓A list of all medicines you take, including herbal and over-the-counter preparations
• ✓Any previous ECGs, blood test results or hospital letters
• ✓Your HMO card or payment details
• ✓A valid means of identification

What we will ask

When your palpitations started, how long episodes last, how often, what triggers them, and what else you notice alongside them, such as dizziness or breathlessness.

Questions worth asking us

• ●What do you think is causing my palpitations?
• ●Do I need any tests, and what will each involve?
• ●Is this likely to be serious?
• ●What should I do if it happens again before my next visit?