Does smoking too many cigarettes cause?
In recent times, many men and women are coming to the clinic with a complaint of “Gabhara”, an increased heartbeat. A normal adult heartbeat at rest is 60 to 100 beats per minute (bpm), though this can vary with age, fitness, and health conditions. Athletes may have resting heart rates below 60 bpm, and a rate of over 100 bpm can be a sign of tachycardia. Heart rate changes during sleep or exercise. In medical terms, palpitations are due to consciousness or perception of heart action. As a general rule, whatever causes a higher heart rate, tachycardia, or arrhythmia (irregular rhythm) of the heart can cause palpitations.
Since when the patient has been experiencing palpitations, their frequency, duration of each episode have to be clinically evaluated.
What is the daily consumption of tea, coffee, alcohol, cigarettes and does the symptom occur when the patient is nervous or any history of cardiac death or serious heart disease in the family or any history of drugs like ephedrine, adrenalin, aminophylline, atropine, thyroid extract are being used, is the patient a diabetic or on hypoglycaemic drugs and their doses etc., have to be kept in mind before coming to any conclusion on the palpitations.
The doctor has to make a complete physical examination, laying stress on the cardiovascular system while looking for signs of thyroid toxicity, loss of weight, diarrhoea, insomnia, any history of rheumatic fever, or pain in the precordium suggestive of IHD (Ischemic Heart Disease), and an ECG is also to be obtained for accurate diagnosis.
The palpitation has significance in rheumatic fever, which is an inflammatory disease triggered by an untreated strep throat infection that can affect the heart, joints, skin, and brain, leading to symptoms like joint pain, fever, heart issues, and uncontrolled movements. It’s crucial to treat strep throat to prevent this serious complication, which can cause permanent heart damage. Treatment involves eradicating the strep bacteria with antibiotics and managing symptoms to prevent recurrence.
Further in ischemic heart disease, also known as coronary disease (CAD) or coronary heart disease (CHD), is a condition where the heart muscle receives insufficient blood flow and oxygen, usually due to plaque build-up in the arteries that supply the heart, palpitations have an importance this reduced blood flow, or Ischemia, can cause chest pain(angina), a heart attack, or even sudden death. Risk factors include high cholesterol, high blood pressure, diabetes, smoking, obesity, and lack of exercise.
When a patient is complaining of palpitations, the conditions such as the physiological causes, fever, exercise, the pharmacological causes: beverages and drugs, anxiety neurosis, anaemia, extrasystoles, atrial fibrillation, paroxysmal atrial tachycardia, paroxysmal ventricular tachycardia, thyrotoxicosis, hypoglycaemia, phaeochromocytoma have to be thoroughly examined.
Excessive drinking of tea, coffee, or alcohol commonly causes palpitations. Administration of drugs like ephedrine, adrenaline, aminophylline, atropine, and thyroid extract can likewise be the cause. Most of the causes of palpitations fall in this group and, therefore, are of no consequence. Strange surroundings, examination hall, interviews, etc., may cause palpitations in most people, but more so in neurotics. A cardiac neurosis may be based on the fear of heart disease, especially ischaemic.
A recent death in the family due to myocardial infarction is particularly liable to generate consciousness of heart action, tachycardia, palpitations, and left-sided chest pain. Physical examination reveals no abnormality, and the ECG is within normal limits. Causes tachycardia and high output of the heart in an effort to compensate for the low oxygen-carrying capacity of the blood. Palpitations may thus result in anaemic patients. In some other patients, extrasystoles are symptomless, while in others they produce a fluttering sensation in the heart region and palpitations. The pulse shows a missed beat. After every extra beat, there is a compensatory pause.
The extra beat is not felt at the wrist, but the compensatory pause after the extra beat shows up at the wrist as a missed beat. If the extrasystoles are multiple, the pulse may be completely irregular, making it difficult to differentiate it from atrial fibrillation. However, examination of the heart, especially after exercise, provides the clue. After exercise, AF refers to Atrial Fibrillation, a heart condition, which usually becomes worse, while extrasystoles usually become less frequent, and then it may be possible to clearly detect the extra beat and the compensatory pause. The extra systoles may arise without any underlying heart disease or may be symptomatic of such diseases as rheumatic carditis, ischaemic heart disease,e or thyrotoxicosis.
The extrasystoles may arise from a focus in the atria or the ventricles. The differentiation between supraventricular ad ventricular extra systoles is only possible by ECG, which in any case is essential to rule out any underlying heart disease.
Atrial fibrillation (AF)
This may or may not cause palpitations. AF almost always supervenes on a pre-existing heart disease (rheumatic or ischaemic) and thyrotoxicosis. Lone AF is rare. The pulse is irregularly irregular. And exercise makes the irregularity worse. Distinction from extra systoles has been described above. ECG is essential since it clearly diagnoses the abnormal rhythm as well as underlying ischemia, if any.
Paroxysmal atrial tachycardia
In certain individuals, for no apparent reason, the heart beat suddenly becomes very fast, 140-220/minute, and causes severe palpitations lasting from a few minutes of a few hours. Pressure on the eyes or pressure on the carotid sinus may terminate the attack immediately. The carotid sinus is a specialized area in the neck where the common carotid artery branches into the internal and external carotid arteries. It acts as a baroreceptor, meaning it senses changes in blood pressure and helps regulate heart rate and blood pressure. It’s located near the angle of the jaw, at the level of the thyroid cartilage. Sometimes an atrio-ventricular block may develop, i.e. some of the impulses from the atria are blocked from reaching the ventricles. The atrial rate remains fast, while the ventricular rate falls. An AV block signifies that some underlying disease is present, diagnosed by ECG.
Paroxysmal ventricular tachycardia
This is of serious import. Usually, it is preceded by ventricular extrasystoles. The underlying cause is not uncommonly myocardial infarction. The cardiac rate is 140-220/minute. Carotid pressure is ineffective. ECG is essential to differentiate between atrial and ventricular tachycardia. It is a cardiac emergency as it may progress to ventricular fibrillation and death.
Thyrotoxicosis
Is a fairly common cause of palpitations as it can cause tachycardia, extrasystoles, and AF. A physician has to look for other signs, loss of weight, exophthalmos, visible sclera above the cornea, lid la,g and fine tremors in the fingers of outstretched hands.
Hypoglycaemia
In diabetic patients, an overdose of insulin, and less commonly of oral hypoglycaemic drugs, is a frequent cause of palpitations along with sweating, headache, and weakness before the patient goes into coma.
Phaeochromocytoma
An uncommon cause of episodic hypertension and palpitations is a rare, usually benign tumor of the adrenal medulla that secretes excessive amounts of catecholamines, like epinephrine and norepinephrine, leading to serious health problems such as high blood pressure, heart issues, and other symptoms of the “fight-or-flight” response. Treatment typically involves surgery to remove the tumor, often after preoperative management to control hormone levels.
Like this, there are several medical, psychological, and general conditions that can cause palpitations. Therefore, a person with palpitations without being worried should consult a qualified physician. Modern research has proved that meditation, Yoga, Dhyana, and Pranayam, when properly practiced general palpitations without underlying illness can be controlled completely.
