What is it?
Palpitations are an uncomfortable awareness of the heart beat.
Sometimes they feel like a missed beat or a thump that can be
widely felt in the chest, throat or ears.

What Causes it?
For the heart to work as an efficient Pump it must beat in an orderly
sequence with the collecting chamber (atrium) contracting before
the pumping chamber (ventricle). To achieve this the heart normally
follows a rhythm or beat which begins in the atrium Even
though palpitations often produce a feeling that the heart has
missed a beat, they are usually caused by extra beats produced
when the heart is overactive. The extra beat occurs earlier dm the
expected normal beat. This is too early for the heart to have filled
fully and may be felt as a weak beat. It does however suppress the
next expected normal beat leading to a pause before the next beat
is felt. During this longer than expected delay the heart fills up
more than usual producing a very strong beat which is felt as a
thump.

What are the risks?
Palpitations, in the absence of underlying heart disease are usually
quite safe. Even though the heart feels like it missed a beat it has
not. The feeling can be quite uncomfortable but is unlikely to
cause any major problem. It is rare for palpitations to cause dizziness
or collapse.

How do you treat it?
The main treatment is avoidance of factors, which trigger overactivity
of the heart rhythm. The commonest of these is caffeine in
strong coffee, or when lots of cups of coffee or tea are drunk. Caffeine
is also present in cola drinks and chocolate. Other causes include
smoking, tiredness, periods of stress and other illnesses
such as fevers. Occasionally tablets are required. These are usually
low dose beta blockers (Betaloc, Tenomiin, Noten) that are
used for a short period of time until the precipitant has been removed.
Ectopics are common and generally quite safe requiring no
treatment.