Palpitations - How To Diagnose It?

What is Palpitation?
Palpitation is a feeling of awareness of your own heart beat. 
It is usually described as heart rate being either too fast (racing), too slow or a sensation of missing a beat.

Types of palpitations?

Normal (Benign) - 
These palpitations occur as a response to physical or mental stress like exercise, fever, pain, fear, anxiety etc. 
They are harmless and settle on their own once the precipitating factors disappear. They do not require any medical treatment.

Abnormal - 
These palpitations occur due to some underlying abnormality in either the structure of heart or the beating of heart. 
These can be dangerous and at times life threatening. They may or may not settle on their own and require some medical treatment.

Warning signs that suggest palpitations are abnormal?
Palpitations are abnormal if they are associated with chest heaviness, chest pain, uneasiness, sweating, weakness, giddiness, feeling of black out, fainting, nausea, vomiting, seizures.
Palpitations are more likely to be abnormal In people who have some existing heart disease and these patients should report to their doctor at the earliest.

What to do during palpitations?
Stay calm. 

Call for help. (If u are alone avoid driving, use a taxi or auto) Go to your nearest hospital/doctor and try to get an ECG during the palpitations. If you are helping someone having palpitations, if they faint, call for help, start CPR if they remain unresponsive and take them to the nearest hospita

Which doctor can treat palpitations?
Doctors who specialise in the treatment of palpitations are called Electrophysiologists. 
They specialise in heart rhythm and are capable of performing a variety of complex tests to identify and treat different types of palpitations.

Which investigations are used to diagnose palpitations?
ECG - Taken during palpitations and when the patient is normal is a very helpful tool. 
Holter - Externally applied recorder which continuously records heart rhythm for 24 hrs. 
ELR - Extended looper recorder, is like holter, but it records rhythm for longer durations. 
ILR - Internal loop recorde is attached within the body for recording rhythm for long duration. 
EPS - Electrophysiology study, is the most sure shot test to diagnose, identify and treat 
palpitations.

What is EPS?
EPS stands for Electrophysiology study. By this test a trained electro-physiologist studies the conduction and formation system of heart beat, to understand the source, cause and type of palpitation. 
It is a simple and safe procedure of 2-3 hours and can be done as a day care procedure (by admitting the patient for a few hours in hospital, with discharge on same day).
It requires fasting for 4 hrs, some standard blood investigations and is done with local anaesthesia and if required it can be combined with treatment like ablation in the same sitting.

In the procedure electro-physiologist take catheters into your heart to study and stimulate the palpitations and understand them. Once found they can use various techniques to stop the palpitations, the techniques are called Ablation.

What are the treatment options available for palpitations?
There are many options depending upon the nature of palpitations and condition of the patient - 
Drug therapy 
Cardioversion - where either a drug or electric shock is given to stop palpitations immediately. 

Ablations using many sophisticated computer softwares 

Device Therapy like ICD (Internal cardiac defibrillator) 

Combination of all the above therapies.

Your Electrophysiologist and you as a team can make a choice about the options that will be best for you.