Palpitations

Palpitations are by definition an unpleasant feeling of one's own heartbeat.

Patients report irregular heartbeat (arrhythmia), rapid heartbeat (tachycardia) or parents bring a child and say that their "chest rises as hard as the heart".

Cardiac arrhythmia in children is usually a harmless occurance (when they inhale, the heart speeds up, and when they exhale, it slows down), but in some cases it can be the first manifestation of a serious illness.

Rapid heartbeat normally occurs during physical activity, fever, excitement or fear, in which cases it is not a problem.

Since young children have a thin wall of the rib cage, it rises easily during normal heartbeat, which is usually faster in children than in adults.

Accelerated heartbeat can be a manifestation of some systemic diseases or the use of medications.

Palpitations that require treatment are those that most often begin/stop abruptly, disrupt daily routine activities, or last for hours or days. Anamnestic data on the existing heart disease in the patient or in the family suggest heart disease.

For quick orientation, it is necessary to feel the pulse on the arm and determine whether it is incorrect and whether it corresponds to what the patient feels. If the patient or parent can count the heart beats, then the tachycardia is most likely not dangerous.

Patients often report non-existent palpitations.

In order to determine the cause of palpitations, in addition to anamnestic data, it is necessary to perform a complete cardiovascular examination and look for signs of non-cardiac diseases.

In case of very fast heart beat, as well as in case of frequent and long-lasting palpitations, one should urgently visit the nearest health institution, where a 12-channel ECG will be performed, or conduct a variant of ECG monitoring such as continuous telemetry or holter ECG.

When palpitations are infrequent, well tolerated, and short-lasting, increased monitoring is advised, avoiding stimuli and with increased fluid intake.

Palpitations that occur during physical exercise require a stress test, and potentially lethal palpitations require an electrophysiological study (EPS).

MD Drasko Nikcevic

The author of this text is a specialist in pediatrics and a subspecialist in cardiology. Education acquired in established institutions of the region was the foundation for a successful career of one of the key experts in the treatment of cardiac diseases in children in Montenegro.