Palpitations: No Cause for Concern, but ask advice

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Heart palpitations are common in athletes and are usually felt as a regular pounding or racing of the heart in the chest, throat, and/or neck. Some athletes describe it as the heart stopping and then restarting, or a rapid fluttering. Many of the causes are innocent but some require further specialist investigations.

The heart normally beats in a regular (sinus) rhythm with the upper chambers (atrium) contracting first followed by the lower chambers (ventricles). The contraction of the heart is facilitated by an intricate ‘wiring’ system in the heart (diagram 1), that can be examined using an electrocardiogram (figure 2a). Palpitations usually result from a premature contraction of the heart muscle (figure 2b) causing the symptoms mentioned above. These premature contractions are normally short lived and the heart quickly returns to its normal rhythm.

The low resting heart rate, known as bradycardia, observed in athletes may be one of the causes of palpitations. Other causes include stress, caffeine, alcohol and certain drugs (including some cold cures). Be aware that if you are very fit, your resting electrocardiogram may look different to the normal and you should be sure to inform your Doctor that you are a fit athlete.

Palpitations usually only last a couple of seconds. However, if palpitations occur very frequently or the rapid heart beat continues for many minutes, and/or there are other associated symptoms such as unusual shortness of breath and sweating, dizziness or fainting you should consult your doctor. If this happens you may require an echocardiogram (an ultrasound of your heart to assess the structure) and you may be investigated by wearing a heart rate monitor which can record the abnormal electrical activity during a bout of palpitations.

Many athletes will experiences palpitations during their athletic career, indeed everyone will experience palpitations at some time in their lives. Palpitations brought on by strenuous exercise or emotions are, however, rarely associated with underlying cardiovascular disease.

Remember that the key issues which make further investigation of palpitations important are:

  1. Were there other symptoms with the palpitations (see above) ?
  2. Did they go on for more than a few seconds?
  3. Is there a history of heart disease in your family?

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