Q: There are times during the day when I can feel my heart beating irregularly, but everything else seems normal. Should I be worried?
Palpitations are an extremely common concern among women, particularly those under the age of 40 and those in perimenopause and menopause. They are a symptom, not a diagnosis: an awareness of your heartbeat, or a perception that your heart is beating in a way that feels unusual. There are serious problems that can cause palpitations, but other explanations are totally benign. In most cases, we never find a cause (and nearly all such cases are not dangerous).
The bigger things we worry about with palpitations are structural problems or electrical problems of the heart, called arrhythmias. Serious arrhythmias will usually cause not just the sensation of irregular heartbeats but other symptoms too — particularly dizziness or fainting. Some palpitations are caused by other, more systemic issues such as thyroid problems or anemia, both of which are common in women. Some people who experience palpitations may be diagnosed with anxiety or panic disorder.
Benign palpitations can often be attributed to risk factors you can do something about. Caffeine and alcohol can be triggers, as can fatigue. Palpitations can also be worse at different times in the menstrual cycle, and they are a side effect of some common medications, including asthma puffers, as well as certain cold and flu medication.
To sort out what’s what, a health care provider will start by taking a thorough history and physical exam. A symptom diary can be a great help. Record details like when and where you get the palpitations; what you’re doing when they come on; what they feel like; whether you get dizzy; whether you have to stop what you’re doing; and how long they last. If you’re able to take your own pulse and count the number of beats per minute, that’s helpful too.
This information, combined with a physical exam, can be used to determine what investigations, if any, are needed. If you’re having other symptoms, like sweating and weight loss, then you probably should have your thyroid checked. If you’re fainting, you definitely need to undergo some tests, and your provider might suggest a cardiology referral.
When it comes to a common symptom like palpitations, we need to walk the line between not wanting to over-investigate with unnecessary tests and procedures, and not wanting to be dismissive. That’s a difficult thing to do, and something that a doctor and patient have to work through together.
Danielle Martin is a family physician and vice-president, medical affairs and health system solutions, at Women’s College Hospital in Toronto.
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