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Ordinarily, people are unaware of their heartbeat, and for good reason: The heart of an average person beats about 500,000 times per week. Palpitation is the awareness of oneís heartbeat and is often quite disturbing when it occurs. Physicians say it is one of the symptoms most likely to bring a patient to the office for an evaluation of heart disease.

Palpitations are different from the expected pounding one feels after exercise or heavy exertion. People who experience palpitations often describe the sensation as a fluttering-like a bird beating its wings in the chestóor a thumping, flip-flopping, skipped heartbeat, or a pounding in the chest or neck region.

The most common form of palpitation is not due to heart disease, but may simply be a heightened awareness of the heartbeat because of anxiety or tension. Palpitation is often experienced during a panic attack along with symptoms of tingling and shortness of breath caused by hyperventilation.

Palpitations also may be sensed in the presence of premature ventricular or atrial beats. The heart normally beats in a steady rhythm, like a drummer in a marching band. On occasion, an extra beat will occur prematurely and the regularity of the heart rhythm will be disturbed. This premature beat, as it is called, will be followed by a heavy beat, as if the heart were trying to catch up. This will be felt as an extra beat. Even though palpitations are most often not due to heart disease, they should always be brought to the attention of a physician if they happen repeatedly.

Palpitations not related to heart disease may be brought on by exercise, eating, emotions, smoking, drinking alcohol or caffeine-containing beverages, or taking certain prescription drugs.
Irregular or very rapid heartbeats, known as arrhythmias, may occur in people without heart disease but may also be indicative of cardiac problems. Extremely rapid heartbeats that occur without exertion are often due to conditions called supraventricular tachycardia or paroxysmal atrial tachycardia, indicating that the rapid heartbeat is originating in the upper, or atrial, chambers of the heart.

Usually the individual feels well except for the palpitations, which are generally short-lived. Nevertheless, anyone who experiences a series of rapid heartbeats without exertion, especially when the condition persists more than a few minutes, should have a medical evaluation. Most serious is a condition called ventricular tachycardia, which generally occurs in people with wellestablished heart disease. Here the arrhythmias originate in the ventricular, or lower, pumping chambers of the heart during ventricular tachycardia, the individual will often feel quite weak and short of breath because the amount of blood the heart is able to pump out is greatly reduced. Frustrating to both patients and doctors is that palpitations often subside before they can be evaluated by examination. It is important for individuals to remember when they occur and how they feel.

A Helter monitor examination or transtelephonic monitoring can often help diagnose otherwise elusive symptoms.

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