by Dr Helen Wall
It’s all very acceptable having your heart skip a beat when you’re in a rom com movie, but in real life the sensation of your heart beating hard and fast or dipping in and out of beats can be truly frightening. In medical terms the sensation of a noticeable heartbeat doing any of the above is referred to as palpitations. Some of you may be reading this having had palpitations and wondering should you be worried. What if anything will your GP likely do?
Palpitations come up commonly in my GP consultations and mostly in women. The majority of women with palpitations are not found to have any underlying illness but there are key steps that we need to take to determine this. Firstly, there are many lifestyle factors that can trigger runs of palpitations and we should always start by asking about these. Stress, anxiety, lack of sleep, dehydration, caffeine, alcohol and some medications can all be common triggers. Palpitations should not be brought on suddenly by exercise, painful or prolonged and should not cause you to faint, be short of breath, go dizzy or collapse. These are ‘alarm symptoms’ that would make me more worried as your GP. If you are experiencing palpitations with any of these features please seek more urgent medical attention.
Most of the time no cause is found but there are some heart related (e.g. atrial fibrillation, a heart murmur) and non-heart related (e.g. overactive thyroid, salt imbalance) conditions that can present with palpitations. Expect the GP to examine you and request some blood tests and an ECG (recording of the heart’s rhythm) to rule these conditions out or to find them and manage them accordingly. If your symptoms are persistent or particularly bothersome we might refer you to a heart specialist (cardiologist) for further tests. Of course you can have palpitations all month except the very day you go to see your GP or specialist. Don’t worry, the specialist will likely arrange for you to go home with a device on to try and capture what your heart is doing during your palpitations. In most cases there will be nothing to worry about.
For those of you who’ve had palpitations, even if there’s ‘nothing to worry about’ they can remain terrifically bothersome and I’ve seen women driven to distraction by recurring palpitations in their perimenopause stage of life due to changing hormone levels. Some resources suggest up to half of menopausal women will experience palpitations at some point and HRT may or may not help with these. We seem to be chalking a lot up to the menopause these days and whilst I’m all for outing the plethora of symptoms that occur in menopause it’s also important to not rely on this as the cause unless other causes have been firmly ruled out. Once you have the all clear, look to reduce the frequency and severity of your palpitations by looking at the known triggers mentioned above. Sometimes I do wonder if life would be easier in the movies!
Top Tip: try splashing cold water on your face or hold your nose and breathe out against it to stimulate the vagus nerve that manages your heart rate and may calm palpitations then breathe deeply to relax.
This article was written by Dr Helen Wall an accomplished medical professional with a rich background in healthcare and public health. As well as being a senior GP partner she has had many varied roles across the health system over the years as well as training medical students and GPs. She has additional qualifications In women’s health and an honorary doctorate in public health. Her passion for advocating for patients and utilising effective communication skills is evident not only in her medical practice but also as a freelance Media GP, where she serves as the resident GP for BBC Breakfast and contributes a weekly GP column to Woman magazine. Her multifaceted career and commitment to both her profession and the well-being of her patients exemplify Dr. Helen Wall as a compassionate and influential figure in the field of medicine and public health.
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