About Palpitations

Palpitations are a sense of a change in the heart rhythm, usually with it being faster and/or more irregular. In young people with structurally and functionally normal hearts, early beats, extra beats, pauses, etc. are common and normal, and also in unborn and newborn babies. These are usually intermittent and brief. Long "runs" of a rhythm change lasting more than a few beats are more unusual.

People often underestimate how fast a child's heart can normally go- a rate of 120 in a 10 year old is not that uncommon, and esp. not if there is any anxiety or symptom at the time!

Things that make palpitations more worrisome include:
1) Any such episodes associated with syncope (faitning), or near syncope.
2) Episodes that seem to be provoked by exertion, excitement, sudden fright, sudden pain, etc.-- anything that raises adrenaline levels in the body.
3) Any family history of heart rhythm issues in people LESS than 50 years old, or any history of things like Dilated or Hypertrophic Cardiomyopathy, Long QT Syndrome, Brugada Syndrome, etc. If there is such a history known or suspected, it is useful for the family to get specific records.
4) If the person involved has any known cardiac history- palpitations are still usually benign but a possible connection needs to be considered and reviewed.
5) Runs of uncountably fast, regular heart rate, especially with sudden onset and termination, are suspicious for "SVT." In a normal heart and in the absence of syncope or other significant symptoms, this is still NOT life-threatening unless it goes on uninterrupted for hours to days. It does need to be documented and in some cases treated (though not all will need treatment, in fact.)

Palpitations that last long enough should be counted by someone able to do it-- the person or an adult, and a journal of these is always useful. Long runs can be caught on paper at a clinic, ER, or on an event monitor, and this is very helpful.

Long runs that can often be terminated by "vagal maneuvers" like bearing down, face into ice water, carotid massage (ONE side only!), or gagging are suggestive of SVT. If we have never caught an episode on paper, I'd usually rather have the family do that one way or another first. Once we have a firm diagnosis and have made a plan, any method to stop subsequent episodes is fine.

As with syncope and chest pain, the great majority of cases are benign. Primary care providers can and should evaluate these sorts of symptoms first UNLESS one of the listed warning signs is present-- then I at least need to speak with the family/patient to establish some guidelines.