Should I worry about my pounding heart?

I have lately experienced sensational palpitation through my body which I cannot explain. I visited a government health centre near my estate and a nurse told me it was nothing to worry about. Should I believe her?

You tell us that you “experienced sensational palpitation though my body which I cannot explain”. Let us first of all tell you that palpitation simply means that you are aware of the beating of your heart. This has been actively beating from long before you are born and only stops to tell you that you are dead. For most of your life, you are not aware that the pump in your body is busy keeping you alive by making sure there is good blood supply to all organs of the body.

When you become aware that the heart is indeed beating, there might be something the matter with you and it makes sense for you to go to a medical person (as you did) to explain to you why you are aware of the beating of the heart. Sometimes the cause is minor but at other times the situation might be more serious. Only an expert will know for sure.

In the hope that the nurse took a proper history and properly examined you, she could be right. If on the other hand she did not and more importantly you remain aware of the beating of your heart, then it might be worth your while to seek a second opinion on the basis that normal people are not aware of the beating of their hearts.

A story might help you understand this point.

A 17-year- old girl was brought to us by a set of very anxious parents because she had told them that she had recently begun to experience palpitations. In this day and age of Google, Mom had checked and “discovered” that her daughter might have a heart disease. A young doctor convinced them that it was more likely that she had anxiety due to the forthcoming exams and through friends of friends she had found her way to our attention.

The history of her palpitations told it all. She first became aware of her beating heart when “a very handsome boy sat next to her. It became worse when he kissed her!” In her rush to find the solutions for the problem, the mother had lost the opportunity to hear her daughter out. All the girl wanted was to let her mother into the secretes of her new life.

It later transpired that the parents had their own problems and hence the difficulties “hearing” the cries of their daughter. The place and duration of the palpitations was the key to the answer.

The mechanism of causing palpitations in this type of setting is worth describing briefly. The human being is made is such a way that he is able to respond to any threat placed before him. This is the so called fight or flight mechanism in which, under threat the person either fights back or takes off. Either can save the life of the person.

This reaction is brought about by the body releasing adrenaline which in turn helps to prepare all the organs of the body to either fight or flee. The sensation that the heart is beating in these circumstances is the evidence of increased rate of its beating. When the danger is over, then heart goes back to its resting rate and one is no longer aware of its beating.

So, whether it is the girl with a new potential boyfriend or the hunter confronted by a lion, the body response is very similar and could lead to palpitations.

This whole mechanism is the norm and for most people the sensation of the beating heart is transient and situational. There are however a number of conditions in which one is kept aware of the beating heart because of some underlying condition. The commonest are the anxiety disorders. These are a group of disorders of the mind that have, as the defining symptom. One of the key features of this condition is the feeling of being tense and inability to relax.

In a sense, one has the sense that they are in the fight or flight mode without the ability to switch off. A common example of such a state of being is the so called PTSD (Post Traumatic Stress Disorder). Classically, this is a condition that come after a life threatening event in which the person experiences a real danger to the self. After the event, and for months or years, the person is unable to relax, feels tense all the time and is in all respects ready for the fight or flight mode.

Is this perhaps something you can relate to?