Anxiety in "young highly-strung personalities" may cause the heart to palpitate, resulting in potentially life-threatening problems, a leading cardiologist has cautioned.

"Anxiety is one of the important causes in young highly-strung personalities and is affected by the state of mind. Psychological problems can thus induce one to palpitate. It is therefore important to consider the psycho-social aspect before coming to a conclusion," said Dr Upendra Kaul, Executive Director and Dean Cardiology, Escorts Heart Institute and Fortis Vasant Kunj.
Dr Kaul, a Padma Shri awardee, explained palpitation as "an abnormality of heartbeat that ranges from often unnoticed skipped beats or accelerated heart rate to very noticeable changes accompanied by dizziness or difficulty breathing."



"It (heart palpitation) is a common cause of seeking medical attention and can range in terms of seriousness from absolutely benign to potentially a life threatening problem," said Dr Kaul.

Heart palpitations are reported by many persons at all ages and both sexes, he wrote in an article `Palpitations of Heart: What can we do about them?`
Palpitations can be attributed to three major causes, anxiety being one of them, Dr Kaul said.

The other is Hyperdynamic circulation caused by leaking heart valves, disorders of thyroid gland, fever, anaemia and pregnancy.

Disorders of the heart rhythm can also cause palpitations and some of these disorders like a ventricular tachycardia and ventricular fibrillation can be life threatening if not recognised in time, warned Dr Kaul.

Depending on the type of rhythm problem, these symptoms may be just momentary or more prolonged. Actual blackouts or near blackouts, associated with palpitations, should be taken seriously because they often indicate the presence of an underlying heart disease, he said.

The most important initial clue to the diagnosis is one`s description of the palpitations. The approximate age of the person when first noticed and the circumstances under which they occur are important, as is information about caffeine intake (tea or coffee drinking).

The diagnosis is usually not made by a routine medical examination and electrical tracing of the heart`s activity (ECG), because most people cannot arrange to have their symptoms to be present while visiting the doctor.

Nevertheless, findings such as a heart murmur or an abnormality of the ECG may be discovered, which could point to the probable diagnosis, he said.

Blood tests, particularly tests of thyroid gland function
are also important baseline investigations (an overactive thyroid gland is a potential cause for palpitations; the treatment in that case is to treat the thyroid gland over-activity).

The next level of diagnostic testing is usually 24 hour (or longer) ECG monitoring, using a form of tape recorder called a Holter monitor, which can record the ECG continuously during a 24-hour period.

For this type of monitoring to be helpful, the symptoms must be occurring at least once a day. If they are less frequent, the chances of detecting anything with continuous 24, or even 48-hour monitoring, are substantially lowered.

Other forms of monitoring are available, and these can be useful when symptoms are infrequent. A continuous-loop event recorder monitors the ECG continuously, but only saves the data when the wearer activates it, Dr Kaul said.

Once activated, it will save the ECG data for a period of time before the activation and for a period of time afterwards.
A new type of continuous-loop recorder has been developed recently that may be helpful in people with very infrequent, but disabling symptoms, he added.

This recorder is implanted under the skin on the front of the chest, like a pacemaker. It can be programmed and the data examined using an external device that communicates with it by means of a radio signal.

Investigation of heart structure can also be important in diagnosis of palpitations.

"There are many gratifying treatment modalities available these days to prevent serious events. These include pacemakers, implantable defibrillators which recognise serious arrhythmias and treat them before a nearly fatal event," Kaul said.

"Healthy lifestyle from a young age can go a long way to keep your heart healthy and prevent palpitations and many serious complications," he advised.

Regular exercising, eating a "heart healthy diet," keeping blood pressure, blood sugar and blood cholesterol levels under strict control would help, he said.