22.DEC.2016 5 MIN READ | 5 MIN READ

A fast, irregular heart beat can be triggered by anxiety or emotional stress, but it may also be a symptom of a condition called atrial fibrillation.

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

What are palpitations?

Palpitation is a general description of an increased awareness of our own heart beat. We may feel that the heart is beating faster, beating harder, skipping beats or beating irregularly. Some patients even describe their heart beats as ‘fluttering’ or ‘popping out of the chest.’

Are palpitations always abnormal?

Palpitations are not always abnormal. Some patients may feel their heart beating fast or differently but upon monitoring the heart rhythm, no abnormalities are found. These palpitations may be psychological.

What are the causes of palpitations?

Palpitations can have triggers. They can be triggered by anxiety or emotional stress. Stimulants such as coffee or tea or exercise can also bring on palpitations. Traditional medicine products, eg. ginseng or mah huang, have stimulants which can also cause palpitations. Certain medical problems can also cause palpitations, the most famous of which are thyroid overactivity or thyrotoxicosis which is due to an excess of thyroid hormones.

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 to 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 heart beat. It can also lead to giddiness, shortness of breath, confusion, chest pain, and 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 that of old age where there is degeneration of the body’s pacemaker and the heart beat goes wonky. Abnormalities and damage to the heart can also cause atrial fibrillation and these would include heart attacks, high blood pressure, congenital heart problems, abnormal heart valve, post-heart surgery, lung diseases, infections, sleep apnea, over active thyroid and exposure to stimulants such as alcohol.

What problems can atrial fibrillation cause?

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.


Article contributed by Dr Kenneth Ng, cardiologist at Mount Elizabeth Hospital

Ng Kwan Chung Kenneth
Mount Elizabeth Hospital

Dr Kenneth Ng is a cardiologist with more than 10 years of experience, and currently practises out of his clinic at Mount Elizabeth Novena Hospital. He specialises in caring for patients through preventive cardiology. He also has an interest in advanced heart failure, which he manages through artificial heart pumps, heart failure surgery and heart transplantation.