Palpitations explained: Expert insight from a leading specialist

Written by: Professor Mark Gallagher
Published: | Updated: 14/08/2023
Edited by: Sophie Kennedy

Many people experience palpitations from time to time and may feel concerned about their heart health as a result. However, as highly respected consultant cardiologist Dr Mark Gallagher explains in this expert guide, palpitations can be connected to a number of factors and are not necessarily related to the heart’s ability to function. In this informative article on palpitations, the leading specialist also explains how and why our body perceives the heart rate as being overly slow, fast or forceful.

What are palpitations?

Palpitations is a very general term which simply refers to any perception of an abnormality of the heart rhythm. Palpitations are something one perceives within oneself and can be linked to any of a large number of related factors.

Palpitations can be an abnormal perception of a perfectly normal heart rhythm. For instance, a person may feel their heart thumping at seventy beats per minute and have the sensation that it’s beating too powerfully, too slowly or too quickly, even though the heart rate is exactly as it should be (between sixty and eighty beats per minute).

Alternatively, palpitations may relate to a perception of an abnormality that truly exists, such as a perception of the heart beating at thirty or two hundred beats a minute, which would, of course, be abnormal. Therefore, although the term palpitation can be useful to describe your symptoms, it covers such a broad range of different areas that it can be misleading. Naturally, people all have different expectations and understandings of the meaning of palpitations within this enormously broad definition.

What is the difference between palpitations and a fast heart rate?

Tachycardia is a condition where the heart rate exceeds one hundred beats per minute. A perception of tachycardia is part of palpitations but many people who have tachycardia actually don’t experience the feeling of palpitations at all.

It’s important to remember that palpitations are just what is perceived by the person experiencing them and what is actually occurring within the heart may not correlate well with that. Our neurological system is very well designed to tell the body what is going on outside of it and our organs of perception for the outside world far exceed our means of perceiving what is going on within our body. In fact, this can be far more hit and miss, such as our localisation of pain in the body to its source. The accuracy of this perception is generally quite poor and we will often feel pain to be coming from the knee when, in fact, the problem is in the hip, for example.

In the deep organs of the body, this localisation is even worse. There is no particular evolutionary pressure which has made us accurate in perceiving what our heart is doing in terms of its regularity and its rate. There is no reason we should have a good sense of the regularity of its heart rate. This is unlike the great mechanisms we have for sensing which position our joints are in, for example, if they are at the right angle or if they are straight. There are sensory organs within the joints to tell us these things but in the heart, we have absolutely minimal sensory information going out.

However, what we do have, of course, is sensory organs in the ribs, the skin over the chest and the muscles between the ribs and this accounts for much of what we perceive about what the heart is doing. Rather than the heart’s activity itself, however, this simply relates to the movement of the heart and its force against the chest wall and therefore, a lot of what we perceive is just related to the position we’re in at the time.

For example, I often hear patients say that they get they experience palpitations when they lie on their left side. That is just a perception because when you lie on your left side, the heart lies up against the chest wall more than it ordinarily would and you feel that movement. If you lie on your right side or stand up, you feel it much less. Naturally, when you’re up and around with the distractions of daily life, you don’t focus your attention on your heart to the same extent as when you are lying in bed so a lot of these things are potentially misleading.

If you are concerned about your heart health or palpitations and wish to schedule a consultation with Dr Gallagher, you can do so by visiting his Top Doctors profile.

By Professor Mark Gallagher

Professor Mark Gallagher is a leading London cardiologist who sees patients at Spire St Anthony's Hospital, BMI The Runnymede Hospital and St George's Hospital NHS Trust, London. He has been the Clinical Lead in electrophysiology at St George's for over ten years and is consistently the busiest electrophysiologist in the region, performing 450-500 procedures yearly. Dr Gallagher's field of particular interest is ablation for atrial fibrillation and other complex atrial arrhythmias.

Professor Gallagher attended medical school and completed basic medical training and initial training in cardiology in Ireland. He later moved to St George's Hospital, London in 1996 to pursue subspecialist training in cardiac electrophysiology and pacing.

Professor Gallagher was a research fellow and later became a registrar and senior registrar at St George's between 1996 and 2002. At the beginning of 2003, Professor Gallagher moved to Rome, Italy where he started an interventional EP unit in the new university hospital "Policlinico Tor Vergata".

Professor Gallagher transferred from Rome to Cardiff in 2007 before returning the following year to St George's Hospital. 

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