Extrasystoles – common causes of palpitations

Cardiac stumbling is a symptom that is often perceived as very uncomfortable, mainly when it occurs at rest, for example, when lying down. But only rarely is the irregular heartbeat due to a disease. The most common cause is extra beats of the heart, the so-called extrasystoles. You can learn more about other reasons behind a stumbling heart, whether stumbling hearts can be dangerous and when you should seek medical advice.

What is palpitations?

When the heart stumbles, those affected feel palpitations or an irregular heartbeat – usually caused by extrasystoles. Sometimes, it feels as if the heart would stop for a moment. Stumbling can occur at rest and under load. Even in healthy, young people, the heart can stumble. There are many reasons for this – it does not necessarily have to be a disease.

 

Heart palpitations as a symptom of cardiac arrhythmia

Palpitation is the symptom of an abnormal heart rhythm. Such disorders can cause various symptoms. The nature of the symptoms depends on which cardiac arrhythmia is present:

• Bradycardia: The heart beats too slowly. Dizziness, weakness or fainting may occur.
• Tachycardia:  The heart beats too fast at rest. Complaints such as tachycardia, palpitations, dizzy spells or shortness of breath, restlessness and nervousness can result.
• Palpitations: The heart beats irregularly. Extra heartbeats or a delay in heartbeats (heart failures) are perceived as palpitations. However, it can also happen that those affected either do not notice the vibrations of their hearts or experience dizziness or shortness of breath.

Symptom palpitations – possible causes

If the heart stumbles, it can have various causes. Extra beats of the heart, so-called extrasystoles, are most often responsible for irregular heartbeat.

Usually, the rhythm of the heartbeat in the atrium is controlled by what is known as the sinus node. An electrical impulse causes the ventricles and atria to contract. With extrasystoles, there is an additional impulse in one of these two areas. Depending on the area of ​​the heart in which they arise, a distinction is made between:

• Extra beats from the heart atria (supraventricular extrasystoles)
• Extra beats from the heart chamber (ventricular extrasystoles)

The doctor can tell which form it is by measuring the heart currents in the electrocardiogram (ECG). Those affected cannot distinguish between supraventricular and ventricular extrasystoles.

Atrial fibrillation can also lead to an irregular heartbeat. In atrial fibrillation, the heart often beats irregularly and faster for minutes, hours or days. This can lead to reduced physical performance.

 

What causes extrasystoles?

The extra beats of the heart in the normal rhythm can occur as single beats, double beats, or bursts. Many extrasystoles in a row are called salvos. In healthy people, cardiac arrest due to extrasystoles is often harmless and not dangerous. Possible triggers of extrasystoles include:

• psychological stress and strong emotions such as stress, joy, fright, fear or excitement
• Stimulants such as caffeinated drinks, alcohol or nicotine can be to blame if the symptoms appear after eating
• Potassium deficiency (hypokalemia), for example, after exercise, caused by heavy sweating
• high fever
• side effects of medication
• Hormonal changes during menopause
• physical changes during pregnancy

In rare cases, certain diseases lead to extrasystoles and, as a result, cardiac stumbling:

• An overactive thyroid gland and an underactive thyroid gland affect the cardiovascular system and, thus, also the heart rhythm.
• Diseases of the coronary arteries ( coronary heart disease ) or the heart valves, as well as heart muscle inflammation (myocarditis), can cause extrasystoles, and the disorder can also become noticeable after a heart attack.
• In Roemheld syndrome, air builds up in the stomach and intestines after eating hasty and plentiful food intake. A nervous stomach, food intolerance or stress can also lead to air accumulation in the digestive tract. This air can press on the diaphragm, affecting the heart’s rhythm.
• In the case of a diaphragmatic hernia (hiatus or diaphragmatic hernia), the stomach can slide up into the chest cavity towards the heart and cause cardiac arrhythmias there. However, a rupture in the diaphragm is often harmless and does not cause any symptoms.

palpitations in pregnancy

A woman’s heart is particularly challenged during pregnancy: It has to pump more blood through the body to supply the unborn child with oxygen. The heart muscle has to beat more frequently, and the pulse increases. In addition, the blood pressure – due to the hormonal changes – is low. As a result, some pregnant women experience dizziness more often. The growing baby can also press against the heart from below. These factors contribute to the heart’s inability to beat relatively evenly and can sometimes lose its rhythm.

Towards the end of pregnancy or shortly after birth, a specific form of heart failure, peripartum or postpartum cardiomyopathy (PPCM), can develop in rare cases. This is noticeable, among other things, by heart palpitations and palpitations. Other signs include shortness of breath, leg swelling, tiredness and dizziness. In addition, affected women often cannot sleep while lying down.

The hormone prolactin is responsible for this, which is released in increased amounts shortly before and after childbirth to initiate the formation of breast milk. If PPCM is suspected, medical advice should be sought.

Palpitations: often at rest and when lying down

Heart palpitations are particularly noticeable when lying down or at rest. This is because the heart beats slower at rest, and extrasystoles occur more frequently than during exercise when the heartbeat is faster overall. In addition, one listens more to oneself when resting and notices the vibrations more easily than, for example, when exercising.

 

How many extrasystoles are normal?

How often cardiac stumbling is expected in a day cannot be said in general terms. In people with a healthy heart, up to 500 ventricular extrasystoles per day, which is an average of 21 extra beats per hour, are still considered normal by experts.

If there are more than 1,000 extrasystoles within a day, an average of more than 40 extra beats per hour, this is said to occur more frequently.

In individual cases, up to 20,000 extrasystoles can occur per day. In the long term, those affected can develop cardiac insufficiency due to the many additional beats.

Heart palpitations – when to see a doctor?

If heart palpitations are intermittent or go unnoticed, they are usually harmless and do not require treatment.

However, if heart palpitations, palpitations or tachycardia occur more frequently, it is advisable to visit the family doctor’s or a specialist cardiology practice. This is the case, for example, if the complaints occur with the following frequency:

• several times a week
• several times a day
• every day or
• for hours at a time

The diagnosis is usually made using an EKG. While in some cases, the extrasystoles can already be seen in the resting ECG or a stress ECG, in other cases, they only become noticeable in the context of a long-term ECG. An examination using heart ultrasound (echocardiography) can help detect heart changes.

If there are permanent symptoms accompanied by dizziness, shortness of breath, feelings of anxiety or impaired consciousness, heart palpitations can become dangerous. Now, it is an emergency, and emergency medical help should be requested immediately by dialling 112.

Even if cardiac stumbling caused by extrasystoles often turns out harmless, it can indicate an acute or permanent circulatory disorder of the heart muscle and heart muscle or heart valve diseases. The arrhythmia can also occur as a result of a heart attack. When in doubt, it always makes sense to seek medical advice.

Heart palpitations – what to do?

If heart palpitations occur without a cause of heart disease or another medical condition, you can try to do something about it yourself.

The following measures and exercises against palpitations can counteract the triggers of extrasystoles:

1. Avoid stress. If this is impossible, you can use exercises and techniques to reduce stress, such as yoga, walks, autogenic training or progressive muscle relaxation.
2. Eat a healthy diet and avoid caffeinated drinks, alcohol and nicotine.
3. Eat your meals calmly and chew thoroughly. This relieves the stomach and can avoid air in the digestive tract. Tea preparations from medicinal herbs such as anise, caraway or fennel also benefit the stomach and intestines.
4. If you are taking medication, check for possible side effects. Some medications can affect heart rhythm. These include heart medication, medication for nerve problems or depression. Please get in touch with the doctor treating you if you have any questions about the effects and side effects of medication.
5. Supply your body with magnesium and potassium, especially after sporting activities. The minerals are essential for the function of the muscles, including the heart muscle. They are found in numerous foods such as bananas, nuts, dried fruit and vegetables, and various types of mineral water, for example. However, you should seek medical advice before taking magnesium and potassium supplements.

 

treatment of cardiac arrest

Cardiac stumbling and extrasystoles can also be treated with medication. Low-dose beta-blockers are the most commonly used. These should normalize the heartbeat and bring the heart into the right rhythm.

If your measures and drug therapy cannot successfully contain the vibrations, an ablation (catheter ablation) can be performed. With the help of a catheter in some regions of the heart, the points of origin of the excitation and faulty lines are sclerosed. After the ablation, the heart’s activity is checked using an ECG, heart ultrasound and repeated blood pressure measurements.