Everything you need to know about palpitations

You can feel your heart beating in your chest. It beats fast or irregularly and you even feel like it sometimes skips a beat. Recognizable? Then you're not the only one, because over 18.6 to 46.8 percent of women suffer from cardiac arrhythmia*. It is therefore a daily topic in the consulting room of Cycle expert and cardiologist and women's heart expert Janneke Wittekoek. She takes us step by step into the world of heart palpitations in women.

We are performing this interview with you, because a lot of our readers asked for it. We were a little shocked at how often women seem to suffer from it.

“Indeed, I encounter it very regularly in my practice and find that many people are frightened by it. And yes, the feeling of it is very unpleasant. I’m 52 now and sometimes have them myself. Fortunately, most of the time I can conclude that your heart is healthy. The palpitations are then the result of the lifestyle or of other things. There is a long list of things that can affect your heart rate.”

How do you diagnose correctly?

“If someone comes to me with heart arrhythmia symptoms, I start a full cardiac workup where I check everything. Is the heart muscle normal, do the heart valves function properly, are there no inflammations, is there any fluid around the heart? I also check if the blood flow of the heart muscle works properly and I look at any genetic factors. Is there a history of cardiovascular disease? Lastly, I check the risk factors, such as high blood pressure, cholesterol, diabetes and being overweight. On the basis of that workup, I can estimate how big the chance is that heart arrhythmia arises from a diseased heart.”

What do you do if the heart is healthy?

“Then blood work is the next step. For example, we know that if your thyroid gland works too hard it can affect your heart rate as well. We also check your iron levels. If your Hb-levels are low, your heart will compensate for that by beating faster. For people with heavy menstrual bleeding, you frequently see that anemia is the reason for palpitations. Furthermore, I look in the blood for certain inflammatory substances.”

An important cause for palpitations

“An important cause for palpitations is hormones. Especially for people in the perimenopause palpitations are a known problem. But also young people who are not in the perimenopause yet of pregnant people can suffer from this. They suffer from cycle related arrhythmias. Research shows that the feminine hormone estrogen plays an important role in this. We know that this hormone has a protective effect against heart skips and that it also protects the vessel wall. For people in the perimenopause, the estrogen levels decrease. In people with a menstrual cycle, you see that they suffer the least from palpitations just before ovulation: that is, precisely during the estrogen peak. This explains why women are more susceptible to heart rhythm disorders than men. Why do some suffer more than others? Some people produce more estrogen than others. Hereditary factors also play a role.”

Sleep also plays an important role

“An important factor is sleep. Especially for people in the perimenopause, but also during pregnancy for example. These are very heavy periods, you need an almost comatose-like sleep to recover well. And if you don’t have that every night, your resilience breaks down. Your entire nervous system is on edge and the more tired they are, the quicker your heart rate can get. For people in the perimenopause, sleep is an issue and this results in more palpitations during the perimenopause. 

If your nervous system becomes too wound up because your body doesn’t recover right, you can get in a negative spiral. You can see the spiral come into existence for these people: they don’t sleep well, as a result they are on edge and they drink an extra cup of coffee during the day to stay awake. The effect of the caffeine comes on top of it. In the evening they drink a glass of wine to relax and voila, the effect of alcohol also comes into play. It’s one thing on top of another and the palpitations only get worse.”

What are the consequences of that?

“The heart rhythm is regulated by a cardiac conduction system. This is a network of special cells in the heart muscle. When your heart skips a beat, there is actually a too-early heartbeat. You don't feel that early heartbeat, but the beat that comes after compensates for the too-early beat, and you feel your heart pounding. If a heart does not get enough rest, it becomes easier and easier to generate such an extra beat. At some point, an area in the heart, which causes the skips to happen, can literally compete with your normal heart rhythm. For example, your normal rhythm is 70 beats per minute, and if the area in the atrium that causes a skip is sufficiently fed, the heart simply fires 5 times in a row. That gives a very restless, unpleasant feeling.”

Why do most people get palpitations in bed or when resting?

“That’s actually quite a logical moment. During the day your heart rate is higher due to the activities you do. The chance that you notice the palpitations is much lower and the difference in heart rhythm is also much smaller. When you get home in the evening and you sit on the couch or lie in bed, your heart gets to rest and your heart rate slows down. You are more aware of your heart rate and so you notice the difference in rhythm much faster.”

Are palpitations dangerous?

“Most arrhythmias are not immediately life-threatening, but I also notice myself that it can cause anxiety, so I understand these people well. They are often told, ‘Oh gosh your heart is totally fine, no need to worry about that.’ But that isn’t very helpful to those who suffer from these palpitations. Moreover, we can support the heart very well, which improves your quality of life and you can break a pattern and still work a little more on, for example, sleeping patterns and lifestyle. With the people in my consultation room I therefore look very carefully at which knobs we can turn. Hormone supplementation for more balance can work well. But also a very low dose of beta-blockers to chemically protect the heart against stimuli. That gives rest, then the heart can also recover a bit and when things are going a bit better and the lifestyle pattern has been broken you can slowly start to see how it feels without medication.” But it is important to look at this with a holistic view, lifestyle really plays a role and customization is needed.

When should you go see your GP?

“First, you should learn how to check your own pulse by feeling at the wrist. You can learn how to do so on the website of the NHS. You can also buy a tracker which signals when your heart rate is irregular. If you appear to have a very irregular pulse you should see your GP. You should also go and see your GP if you have other symptoms such as tiredness, chest pain, dizziness, or feeling like you might faint. The GP can do a number of things such as taking an ECG of your heart and measuring certain blood levels (such as hb level, thyroid function, calcium/potassium concentration or whether there is inflammation). That way a number of things can already be ruled out.'

*Sources:

• Everyday Health