Heart Palpitation

Normally people are not much aware of their “heartbeats”. A heart palpitation is recognized when an individual has an extreme knowledge/recognition about the beats of their heart when it is not beating in a correct way.

This happens when their heart either beats too rapid, slow, heavy or not regular/abnormal.

Heart Palpitations also differ in terms of the perception of an individual. They include:
  • Fluttering i.e. unsteady
  • Heart either beats extra or skips i.e. ectopic beats
  • Sensations of just completed with the exercise
  • Hard beats
  • Fast beats

Palpitations could also be sensed in the neck, throat or chest and also in the ear if an individual is sleeping.

Time for palpitations varies i.e. from few seconds to even a few minutes.

A few times, heart palpitations would not be a common event/phenomenon. Many of the cases are not harmful and do not indicate any dangerous issues.

While some sense various palpitations through-out the day, due to which sometimes they sense as they might suffer from a heart attack.

There are various factors causing heart palpitations such as emotional, some medicines, and some underlying medical conditions, changes in the hormones, heart ailments/heart diseases, life-style causes/conditions and more.

Some of the key contents about pregnancy and heart palpitations

  • The most common thing in pregnancy is palpitations. They are completely harmless or hurtles, few of them do show a prominent/notable arrhythmia.
  • If palpitations occur in pregnant women, they need assistance which is more careful, to decide whether the symptoms they are facing could be allotted to “normal physiology” or needs any more examinations/inquiry for pathology.
  • It is important to manage the earlier arrhythmias in pregnant women, which needs a “multi-disciplinary team approach.”
  • Major of the treatments that are against arrhythmias is of utmost safety during pregnancy. Important to avoid any further slowing down of the treatment which is quick and successful for “pathological arrhythmias.”

Objectives that require learning:

  • To understand out of all the women showing palpitations, which ones require in-depth examination/study.
  • To be able to know the changes which are normal in the electrocardiogram in pregnant women, and able to recognize the “common arrhythmias.”
  • To know the ways to manage the common cardiac arrhythmias at the time of pregnancy.
  • To understand the functioning of anti-arrhythmic medicines (risks and benefits) during pregnancy and breast-feeding.

Pregnancy and Heart Palpitations

Arrhythmias are very common and may be a cause of concern for the good health of mother and fetus/ baby. Major of the situations, cardiac conditions/issues could result in anxiety and eagerness. As mentioned maximum of the arrhythmias or palpitations that occur are not harmful but could cause trouble, so important to make them understand proper actions at the time of “symptomatic episodes” along with providing some comfort and satisfaction to pregnant women. In very few cases, the use of sensible drugs would result in a safe and favorable outcome. If a woman is already suffering from heart conditions that have a structural issue but arrhythmias are considered to be “one of the five independent predictors of having a cardiac event” that happens at the time of pregnancy and therefore treatment needs to be done properly.

There are a lot of changes that occur during pregnancy. Apart from the increase in the belly, there are other changes that are not visible. For example, the quantity of blood is increased. The entire Heart and its functioning undergoes a lot of changes during pregnancy to get used to it, such as an increase in the rate of heart, cardiac output, increase in the concentrations of plasma catecholamine, adrenergic receptor sensitivity, stretch in the atria, increase in the volumes of the diastole due to intravascular expansion of the volume, changes in emotions and hormones.

With an increase in the quantity of blood, the heart rate also increases rapidly by 25 percent. An increase in the rate of heart results in intermittent heart palpitations.

One of the common symptoms is considered to be heart palpitations during pregnancy. Heart Rate increases during pregnancy by 25%, therefore sinus tachycardia in the third trimester is very common.

During pregnancy, heart palpitations could be normal and not harmful. But this could also depict that you are suffering from a health issue which is serious.

The impact of pregnancy on heart palpitations

While the baby is growing, the heart has loads of work to do. The supply of blood needs to be increased for providing the baby/fetus with blood for their growth and development.

Approximately 20 percent of the body’s blood will move in the direction of the uterus during the third trimester. Since there is extra blood in the body, the pumping of the heart occurs fast for the blood to pass through. The rate of heart increases by 10 to 20 beats per minute.

During the second trimester, there could be a slight decrease in the blood pressure as the blood vessels in the body get dilated or “bigger.”

There could be some issues that may happen when the workload of the heart. This consists of the abnormal rhythm of the heart such as heart palpitations.

Symptoms and Causes of Heart Palpitations

The palpitations of the heart for women varies. Few of them have a feeling of uneasiness or light-headedness like, the heart is beating too hard. Few of them have a sensation in the chest of the heart flip-flopping.

There are various causes of palpitations of the heart when a woman is pregnant:

  • Stress or anxiety
  • The effect of an increase in the volume of the blood
  • Consumption of caffeine-rich foods
  • Allergic and cold medications that contain pseudoephedrine
  • Medical conditions such as pulmonary hypertension and coronary artery disease
  • Initial pregnancy causing damage to the heart
  • Medical condition such as Thyroid

A few of the times it is also difficult to identify the “underlying heart disorder” when pregnant. This happens because the symptoms for heart condition and pregnancy are very same like fatigue, breathless, swelling.

What is the ideal time to call a doctor?

There would be frequent visits to the doctor during pregnancy. As the due date nears by, the appointment will occur on a weekly basis. You need to call a doctor if the palpitations of the heart are experienced regularly, the palpitations are lasting for a longer time or are more severe.

It is important to go for emergency medical treatment if some severe symptoms do occur. These consists of palpitations of the heart along with:

  • Problems in breathing
  • Pain in the chest
  • Blood comes in the cough
  • Pulse is very irregular
  • Heart Rate is very fast
  • Breathlessness with or without any strain

Diagnosis of heart palpitations

There would be three ways to diagnose arrhythmias:

First: To get a specific diagnosis for arrhythmias to get an accurate/dependable thought about the prediction and treatment which is appropriate for the condition. Second: To find out if along with arrhythmias there is a heart disease/condition associated with it. Final: Important to avoid/remove disorders that are systemic and show along with arrhythmias. This includes: Problems in the Thyroid functions, hemorrhage, pulmonary embolism, any sort of infections of inflammations could be taken into consideration if “unexplained sinus tachycardia or atrial fibrillation.”

It is very important to take the patient’s history and examine them. Need to remember that in the third trimester, patients may become” symptomatic”, so even a small arrhythmia may show symptoms such as shortness of breath or pain in the chest. One of the common symptoms is palpitations. Important to also take a proper history of the family, to identify if the condition of arrhythmias is caused due to genetic predisposition.

Initially, a medical history would be taken and then the diagnosis of heart palpitations would occur. It is important to inform the physician if any sort of palpitations has occurred before, any other known heart disease/condition, family history of heart disease/ailments.

The physician would ask to conduct some tests such as:

An EKG: It estimates the “electrical activity” of the heart.

Holter monitor is to be worn i.e. keeps a check on the rhythm of the heart for a duration of around 24-48 hours.

Testing of the blood for issues like electrolyte imbalances or not proper thyroid function.

Depending on the condition, more particular tests will be asked to be done such as Echocardiography, Exercise ECG, Tilt-Table Testing (can be done before 24 weeks of pregnancy or after pregnancy), Pharmacological testing, Electrophysiological Studies (this is very rarely done because majorly arrhythmias are managed pharmacologically at-least till the time of delivery).

Treatment for heart palpitations

If there are no severe symptoms caused by the palpitations, do not result in any serious issues, the physician would not suggest any treatment? The palpitations would disappear, once the baby is delivered and the body returns back to its original state.

There are a number of medicines that help maintain the rhythm of the heart. The physician will take into consideration the harm to the mother and baby by taking the medications. Baby’s organs are developing in the first trimester and so any medications are to be avoided during this trimester.

Some medications include:

Adenosine: This could be used safely, with no harm or effect on the heart rhythm of the baby. Atropine (Safety profile is unknown, but it has been taken into consideration for “reviving”, Amiodarone: Used only if any kind of emergency; Complications include Excess use would result in fetal hypo and hyperthyroidism, goiter, Intra-Uterine Growth Restriction (IUGR), Prematurity.

Beta-blockers: Avoid using it during the 1st trimester as chances of IUGR (Intra-Uterine Growth Restrictions); Complications: Intra Uterine Growth Restriction (IUGR), Problems in breathing or temporary cessation of breathing, heart rate decreases, decrease in the blood sugar levels, increased amounts of bilirubin levels.

Digoxin has a profile which is safe to be used. Complications: Miscarriages, death of fetus due to toxicity.

Diltiazem, Disopyramide, and Flecainide all have limited data for safety profile and other details. All the medications have their own complications, so important to consider that before using the drugs.

There would be a treatment recommended by the physician if the palpitations occur as a result of arrhythmias or “out-of-rhythm heartbeat.” To return back the heart to the same rhythm, important to provide the heart a timely electric current. This procedure or treatment is considered to be safe during pregnancy.

Pregnant Women with a heart condition

Assessment of heart disease for women needs to be done at the time of puberty (approximately 12 to 15 years) by a doctor who is an expert in pregnancy management along with heart disease. They should be informed about the risks which need to be as appropriate as possible and reassessment needs to be done for the risk of heart diseases after every 5 years. Those women who confirm their pregnancy would be referred to a high-risk pregnancy and heart condition team.

Conclusion

There could be a number of arrhythmias that are linked with pregnancy such as ventricular and supraventricular arrhythmias. Important to consider management prior to conception (conceiving a child), throughout pregnancy the treatment should be done only if the symptoms are very severe.

Overall, the arrhythmias in pregnancy could be managed easily and safely under medical supervision, with very less amounts of risk to the fetus and pregnant mother. Important to avoid usage of any medications/drugs during the first trimester as organ development occurs at that time. The drugs that are chosen for pregnant women, later on, need to consist of its safety records. Also important to see whether there is any link with the structure of the heart condition/issues. Important to give the least effective dose also need to monitor the fetus and mother carefully.

In an emergency situation, where there was no treatment for medical purposes, DC Cardioversion could be administered safely during pregnancy. One of the rarest conditions is Cardiac Arrest, The doctor needs to be knowing about the important situations to be considered.

References

  1. https://pmj.bmj.com/content/84/988/66
  2. https://journals.sagepub.com/doi/10.1258/om.2009.090021
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