Palpitations and heart failure

Two topics, one worry

A patient with palpitations usually asks, “Is something wrong with my heart?” A patient with shortness of breath and swollen legs asks the same thing. The two share a page because sometimes they have a common root, but most of the time they are separate. We describe each on its own.

Palpitations

The UK’s National Health Service (NHS) describes palpitations as being more aware of your heartbeat: in the chest, neck or throat. It may feel fast, pounding, fluttering or irregular, with a skipped or extra beat. It lasts from a few seconds to a few minutes and sometimes longer.

Common causes according to the NHS: hard exercise, lack of sleep, stress and anxiety, some medicines (see the leaflet that comes with the medicine), alcohol, caffeine, nicotine and drugs, the menopause and pregnancy. And conditions such as iron-deficiency anaemia, an overactive thyroid, an abnormal heart rhythm and valve disease.

Atrial fibrillation

This is one kind of rhythm problem. The NHS lists its symptoms as an irregular pulse, palpitations, tiredness, less ability to exercise, chest pain or pressure, shortness of breath and dizziness. Some people have no symptoms and it is found at a routine check. The NHS says it can lead to clots, stroke and heart failure, and treatment is aimed at reducing those risks. Treatments include medicines to control the heart rate and rhythm, a blood-thinning medicine and, for some patients, procedures such as ablation or an electric shock. The type of treatment is decided by a heart specialist.

Assessment

The NHS names an ECG as the first test and says that if the cause is not clear, a heart specialist may ask for more tests. In atrial fibrillation an ECG, an echocardiogram, a chest X-ray and blood tests to rule out other causes are used. Note when the palpitations began, how long they lasted, what brought them on and how they ended; the doctor will use these notes.

Heart failure

The NHS describes heart failure as a condition in which the heart cannot pump blood properly. It has no cure, but treatment and lifestyle changes can reduce the symptoms and slow its progress.

Symptoms

• Breathlessness during ordinary activity or when lying flat
• Weakness, dizziness, great tiredness, especially after activity
• Swollen legs, ankles or abdomen and a bloated feeling
• Sudden weight gain
• A night-time cough, or a cough with pink, frothy phlegm

Causes

The NHS says it sometimes comes on suddenly after a heart attack or an infection, and sometimes over time because of high blood pressure or coronary artery disease. Valves, heart rhythm, anaemia, kidney disease and thyroid problems can also play a part. Age 65 or over, obesity, smoking and heavy drinking raise the risk.

Assessment

For diagnosis the NHS names blood and urine tests, an ECG, a chest X-ray, an echocardiogram and an MRI. The doctor works out the type of heart failure (why the heart is not pumping well) and its stage (how severe the symptoms are). Which tests are needed depends on each patient’s examination.

Treatment

The NHS groups treatment as follows: medicines that remove extra fluid, medicines that widen the blood vessels, medicines that slow the heart rate and, for some patients, treatment of the arteries or valves, a pacemaker or other devices. The NHS says cardiac rehabilitation should be offered to all these patients; ask your doctor about it. Only the doctor decides the medicine and the amount.

Daily care according to the NHS: take medicines as prescribed, weigh yourself regularly to catch fluid build-up early, have recommended vaccines such as the flu vaccine, stay active within your ability, eat a balanced diet, stop smoking and cut down on alcohol.

How it differs from vein-related leg swelling

In varicose veins and venous insufficiency, leg swelling usually gets better when the leg is raised and is often worse at the end of the day. In heart failure the swelling comes with shortness of breath, especially when lying down, weight gain and tiredness. This difference needs an examination; it cannot be diagnosed from a description.

Urgent signs

In these situations call 115 (the emergency number in Iran). If you are outside Iran, call your local emergency number.

• Palpitations do not stop, or come with chest pain, shortness of breath or fainting
• A fast or irregular heartbeat comes with sweating, nausea, a severe headache, weakness or numbness on one side of the face or body, blurred vision, confusion or difficulty speaking (the NHS, for atrial fibrillation)
• Severe shortness of breath: gasping, choking or being unable to speak, or pale or blue lips and skin
• You are coughing up pink, frothy phlegm
• Someone has collapsed and is not responding normally

The NHS says not to drive yourself in these situations.

If you have heart failure and develop shortness of breath when lying down or doing everyday tasks, or your weight has suddenly gone up, let a doctor know the same day.