PALPITATIONS

A palpitation is the sensation that the heart is beating faster or stronger, or an increased awareness of your heartbeat, or that the heart is “skipping a beat”. Under normal circumstances, the heart beats in the background and we are not usually aware that it is there.

It is “normal” to feel the heart beat stronger during or after physical exertion, as it is working harder to pump blood around the body to meet the increased demands that exercise places for oxygen and other nutrients.

If you notice palpitations as described, while you are sitting or lying down, or if you get these symptoms long after exercise has stopped, or you feel dizzy or light-headed during this time, it may indicate a heart problem.

Palpitations may be an indication that your heart rhythm may not be normal – what we call an arrhythmia, which is abnormal or irregular beating of the heart. Occasional skipping of the heartbeat at rest, without the accompanying symptoms of chest pain or light-headedness, may be an indication of an extra heartbeat. Usually, after this extra heartbeat the timer in the heart “resets” itself, so you may feel a little pause right after, like there is no heartbeat, and then a strong beat. This can be “normal” for up to 30 per cent of normal people. It is important though to have it checked out with your physician.

Otherwise from heart disease, palpitations may be an indicator of another general medical problem, such as anaemia (low blood count) or an overactive thyroid gland.

There are also some foods, drinks and over-the-counter medication that have stimulants and may trigger palpitations. It is recommended that you cut these from your diet or treatment plan if palpitations are bothersome to you.

1. Caffeine: Tea (not herbal), for example green or black tea, Pepsi, Coca-Cola, chocolate, energy drinks (example Red Bull).

2. Pseudo-ephedrine: This is a common component of over-the-counter (OTC) cough and cold and sinus medications such as Tylenol Cold and Sinus and Allegra-D. This is the active ingredient that helps to dry up secretions and make you feel less congested. It is also a potent stimulant for the heart and can make the heart beat faster or stronger.

3. Side effect of prescribed medication such as high blood pressure medication.

SEE YOUR DOCTOR FOR PALPITATIONS IF:

* You have palpitations while sitting or lying down

* Not taking any caffeine or over-the-counter medication for cold or sinus

* Palpitations last for more than a few seconds

* You feel light-headed, faint or have chest pain during or after the palpitations.

Your doctor will take a detailed history and examination, and an (ECG) should be done with expert interpretation. Depending on these findings, the doctor may refer you to a cardiologist for further testing which may include additional tests, such as an (ECG) (Ultrasound of the heart) or 24 Hour Holter ( 24 hour ECG recording).

FAINTING (SYNCOPE) OR NEAR-FAINTING (PRE-SYNCOPE) AND DIZZINESS

Fainting is a sudden, brief loss of consciousness, usually lasting a few seconds. It usually results with the person falling to the floor, with prompt recovery of consciousness when the person is lying or sitting down. Loss of consciousness that is longer than a few seconds is not truly a fainting spell, and could be seizure or other indication of a brain problem. Some people may not experience loss of consciousness, but may feel light-headed, like they are going to black out, but do not actually black out. This is referred to as near-fainting.

This is to be distinguished from dizziness, which in medical language we call vertigo, and is classically described as a feeling of being unsteady, or that the person is spinning relative to the room, or the room is spinning. Dizziness is more an indication that the balance mechanism is out of whack, and could indicate an inner/middle ear problem or brain problem affecting the balance mechanism.

Fainting or near fainting may be what is referred to as a simple faint (vaso-vagal syncope), which has no underlying heart problem, can be due to dehydration or other easily remediable fixes. A simple faint does not usually indicate a heart problem, but if the person who has fainted has never had a medical examination, it should be done and then the person can be reassured if normal. When not due to vaso-vagal syncope, fainting may indicate the following potentially serious underlying heart conditions:

* Arrhythmias – abnormal fast or irregular heart beat

* Severe heart valve problems

* Other severe problems of heart structure.

Any episode of fainting should be reviewed by a physician.

COUGH

A cough that is lasting more than a few days and is not in association with flu-like symptoms may be an indication of heart disease, particularly heart failure.

A cough occurs in heart failure when the heart is not pumping strong enough and it leads to a build-up of fluid in the lungs. The cough associated with heart failure has the following features:

*Usually at night or while lying down

*Usually wet sounding

*May be dry, or wet sounding

*The mucus that comes up tends to be frothy or even pinkish.

Be reminded, if you experience any of these symptoms and are concerned, see your family physician right away. For chest pain lasting more than 10 minutes and for people over 40 years old, especially with any underlying medical problems such as high cholesterol, diabetes or hypertension, an emergency room visit is a must.

Do not wait to see your physician during regular hours, or “watch it”.

Dr Claudine Lewis is an adult cardiologist and medical director at Heart Smart Centre in Montego Bay. She is also a cardiologist at the Cornwall Regional Hospital and an associate lecturer with the University of the West Indies. Questions may be sent to questions@heartsmartcentre.com and for additional information call 684-9989 or visit the website www.heartsmartcentre.com