My Pounding Heart: Is it Anxiety or Atrial Fibrillation?

Dr Kenneth Ng, cardiologist at Mount Elizabeth Hospital, explains the possible causes of heart palpitations and what atrial fibrillation is.

What are heart palpitations?

Palpitation is a general description of an increased awareness of our own heartbeat. We may feel that the heart is beating faster, beating harder, skipping beats or beating irregularly. There might even be extra heartbeats that occur just before a regular beat, called ectopic beats. Some patients even describe their heartbeats as 'fluttering' or 'popping out of the chest'.

What are the symptoms of heart palpitations?

When you are experiencing heart palpitations, it can feel like your heart is:

• Skipping beats
• Fluttering rapidly
• Beating too fast
• Pounding
• Flip-flopping

What are the causes of palpitations?

Palpitations can have triggers. They can be triggered by:

• Anxiety or emotional stress
• Stimulants such as coffee, tea or exercise
• Traditional medicine products, which may have stimulants
• Certain medical problems such as thyroid overactivity or thyrotoxicosis
• Depression
• Strenuous exercise
• Fever
• Hormone changes associated with menstruation, pregnancy or menopause

Sometimes heart palpitations can indicate a serious problem, such as an overactive thyroid gland (hyperthyroidism) or an abnormal heart rhythm (arrhythmia).

Arrhythmias may manifest in several different ways. You may experience a very fast heart rate (tachycardia), an unusually slow heart rate (bradycardia), a normal heart rate that varies from the usual heart rhythm of a combination of the three.

Atrial fibrillation is a condition that can cause palpitations as it can cause the heart to beat very fast and irregularly. The major clue is that the patient will complain of an irregular heart beat.

What is atrial fibrillation?

Atrial fibrillation is an irregular and often rapid heart beat. It is due to the chaotic and irregular beating of the 2 upper chambers of the heart. The irregular beating can come and go and the duration of the abnormal heart beat can be from seconds to hours to days. The heart rate can vary between 100 – 200 beats per minute.

What are the symptoms of atrial fibrillation?

The most common symptom of atrial fibrillation is that of a fast and irregular heartbeat. It can also lead to:

• Giddiness
• Shortness of breath
• Confusion
• Chest pain
• Fatigue

However, in many cases, it does not cause any symptoms and is only picked up during a routine examination of the pulse or the electrocardiogram.

What are the causes of atrial fibrillation?

The most common cause is old age where there is degeneration of the body's pacemaker and the heartbeat becomes abnormal.

Abnormalities and damage to the heart can also cause atrial fibrillation. These include:

• Heart attacks
• High blood pressure
• Congenital heart problems
• Abnormal heart valve
• Post-heart surgery
• Lung diseases
• Infections
• Sleep apnoea
• Overactive thyroid and exposure to stimulants such as alcohol

What are the complications of atrial fibrillation?

Atrial fibrillation results from the chaotic electrical beating of the upper chambers of the heart. As such, the chambers are not really contracting but merely quivering. This cause the blood in the upper chamber of the heart to stagnate and form tiny clots. These clots can then migrate up to the brain and cause strokes.

Atrial fibrillation also causes the heart to beat very fast. If the heart continues to beat very fast for a long period of time, the heart function can weaken and it will then lead to the development of heart failure.