What is a Palpitation?
A palpitation is an awareness of the heartbeat which may be the feeling of the heart beating too fast (tachycardia) or the heart beating irregularly or skipping a beat. Palpitations may be due to feeling a normal fast heart rate eg. when anxious, exercising or with fever. They may also occur with dehydration, excessive ingestion of caffeine or with an overactive thyroid gland. Palpitations can be due to a problem with the heart and for this reason assessment by a doctor is advisable.
Cardiac reasons for palpitations include problems with the heart rhythm, known as arrhythmia. The commonest cardiac cause for palpitations in babies, children and teenagers is SVT (supraventricular tachycardia). Ectopic beats arise abnormally, not from the normal pacemaker of the heart.
Symptoms
children may complain of feeling their fast heart rate or an irregular heartbeat. Some complain of feeling “hard or “banging” ,“thumping” or “throbbing” heart beats. Younger children may complain non-specifically of their chest hurting. Parents may notice that they can see their child’s heart pulsation in the chest or the neck. If they place their hand on their child’s chest they may be able o feel it beating quickly or irregularly.
Diagnosis
A detailed clinical history consisting of detailed questions about the palpitations and family history will be taken by Dr Naqvi. Then a clinical examination will be performed which may reveal a heart murmur if there is an associated problem with the heart structure. In most cases the clinical examination will be normal.
An ECG will also be performed which may show abnormalities suggesting a predisposition to palpitations. eg. a WPW pattern. An echocardiogram (ultrasound assessment of the heart) will be performed to examine the function and structure of the heart. The heart rhythm over a longer period can be assessed with a 24 hour ECG, Alivecor and/or another type of event monitor. An exercise test may also be recommended. It may take a period of time to actually document the palpitations as they can be infrequent.
Treatment
If your child is having a palpitation which is associated with feeling faint or dizzy urgently take your child to hospital. If palpitations last more than about 10 minutes start planning to go to hospital.
There are various manoeuvres you can try which may slow the heart rate including:
- 1. Putting something cold on your child’s back down the back of their shirt eg. a packet of frozen peas from the freezer so that your child gets a sudden shock – this will send nerve impulses to their heart to slow down.
- 2. Helping your child to do a handstand.
- 3. Ask your child to puff out their cheeks and hold their breath whilst pinching their nose for as long as they can. At the same time, they need to strain.
- 4. Encouraging young children to blow as hard as they can into a straw, blow bubbles, a balloon or a windmill.
Palpitations which are an awareness of a normal heart rate do not require treatment.
An acute attack of SVT palpitations which persists requires treatment in hospital urgently with an injected intravenous medication. Less commonly DC cardioversion is needed.
Prevention Of Palpitations
SVT attacks are prevented with oral medication, often with a beta blocker which can be given in a liquid or a tablet form.
Older children with proven recurrent SVT can be treated with a curative cardiac procedure via a keyhole procedure – a radiofrequency ablation under general anaesthetic. Dr Naqvi works with a superb team of world leading electrophysiologists who perform keyhole heart treatments (radiofrequency ablations) and if needed will refer your child to the one who is best for your child’s heart.
Prognosis
The outlook for children with palpitations is usually very good. Dr Naqvi has cared for many babies and children with palpitations and has followed them up until adulthood. Some children with SVT outgrow it particularly those affected in the first year of life. Others are well controlled for years on medication.
She says “Having palpitations early in life does not stop children doing well in sports or from having a happy full life. I know some who are successful athletes and others who are academic high achievers.” There are a number of well-known people who have suffered with palpitations including Tony Blair and Jesse J.
For more information about SVT please see the following links:
