Stellenbosch University
Welcome to Stellenbosch University
Get into the rhythm, your heart rhythm!
Author: Dr. Jo-Anne Kirby and Sr. Erika Botha
Published: 04/06/2019

South Africa is celebrating World Heart Rhythm week from 4-10 June 2019. A heart rhythm problem often presents with palpitations.

So, what exactly are palpitations? Heart palpitations are the feelings of having a fast beating, fluttering or pounding heart. Stress, exercise, medication or, rarely, a medical condition can trigger them. Although heart palpitations can be worrisome, they're usually harmless. During exercise it's normal for your heart to beat harder and faster, but is it out of control fast or unusually quick?


What causes heart palpitations?

Most palpitations are not dangerous and often can be explained by external factors. These external factors can include exercise, emotions like stress or anxiety, or increased amounts of nicotine or caffeine. Certain medications can also trigger heart palpitations, including inhalers for asthma and over the counter cold treatments, so talk to your doctor about the potential side effects of your medications if you're concerned.

Typically, when heart palpitations are caused by factors like these, it will feel as though your heart is pumping faster or harder than usual or you will notice skipped or fluttering heartbeats. These symptoms are usually felt in your chest but can also be felt in the throat or neck, so don't be alarmed if you notice symptoms in these places, as well.

As well these external factors, palpitations can be caused by a wide range of abnormal heart rhythms. Some of these are actually relatively common and not dangerous at all. These palpitations will be very short, no more than a couple of seconds, and not accompanied by any other symptoms. However, when palpitations last a few minutes or more, or are combined with other symptoms, that's when it has the potential to be a bigger issue. It could mean that you are at risk for complications like heart failure or cardiac arrest.

Although results like these are rare, it's important to understand the warning signs for serious cardiac issues like these. Reduce your risk for any heart problems by leading a healthy lifestyle. Quit smoking, eat a balanced diet and aim to exercise for 30 to 60 minutes five days per week.


So when should I see a doctor about the palpitations?

If palpitations last longer than a few seconds, or are associated with other symptoms, there may be some underlying medical concerns. If your palpitations are accompanied by dizziness, fainting, shortness of breath, or chest pain, you should seek medical attention.

Have a listen to your heart and go see a doctor when you have any of the following:

  • More than 3 odd beats in 10 seconds or 12 odd beats in a minute
  • You have recently started or changed a medication
  • Together with the palpitations:
    • You feel dizzy like you want to faint or have fainted
    • You have chest pain or pressure on your chest
    • You feel unusually short of breath


What can I do to help my doctor get to the right diagnosis?

Find out from your family if there are any known heart problems and what the diagnosis is.

Bring a list of any medication and their dosage, as well as any supplements you take.

Try and count how fast your heart is beating when it feels too fast to you. You can feel at your wrist or next to your Adams' apple and count how many beats you feel in 10 seconds and multiply by 6 to get how many beats in 1 minute.

If possible, try to see the doctor or at least a nurse while it feels like you are having the palpitations, an electrocardiogram (ECG) taken while its present is very useful, but don't stay away just because it has resolved - a resting ECG without the palpitations can give your doctor a lot of information, even when there are no symptoms!

Do not consult Dr Google, it will just make you scared!


What is the doctor likely to do?

The doctor will take a history of your problem, ask about your current medical conditions and check what medications and supplements you are taking (bring a list with you to your appointment).

A physical examination of your heart and a blood pressure measurement will be done.

A resting ECG (and in some cases an exercise stress ECG – where you exercise and increase your heart rate while connected to an ECG).

Possibly some other tests may be done, such as a sugar and haemoglobin (for anemia) test, or take blood for a thyroid test.


How fast can my heart rate go while I am exercising?

Subtract your age in years from 230 and you will get your maximum heart rate. For example, if you're 50, your maximum heart rate is 230-50 = 180, whereas if you are 20 years of age, your heart rate maximum is 210 beats per minute. If your heart rate is faster than this during exercise, consult with your doctor.


What about slow heart rates?

Normal average heart rate is 60-80 beats per minute but in very fit individuals, it can go as slow as 40 beats per minute when resting. If your heart rate is very slow and you don't feel well, that also indicates that you should consult your doctor.


If you are concerned about the rhythm of your heart, or experience palpitations and would like to consult a doctor, please contact Campus Health Service here and make a booking. Campus Health Service has the equipment to do an ECG and perform a stress exercise ECG (on an exercise bike).