Palpitations can be described as skipping beats, a pounding heart or a fluttering sensation in your chest. People are more aware of their heartbeats, especially while exercising or shortly thereafter. In addition, palpitations may be associated with caffeine intake, stress, anxiety or fever. The heart may speed up to 160-200 beats per minute during intense exercise. Going up a flight of stairs or being startled by noise can account for normal increases in heart rates. Young patients who are experiencing anxiety, stress and difficulty breathing may complain of a pounding heart. However, as soon as they relax and calm down the pounding sensation will disappear.
Further evaluation may be necessary if the heart begins to race for a long time or for no apparent reason, or if it is going so fast that counting the heartbeats becomes impossible. Other patients may complain of “skipping a beat” or “flip-flop” sensation for a very short time. This symptom could be due to extra heartbeats. If the extra heartbeats originate from the upper heart chambers they are called premature atrial contractions (PACs), which are usually benign (“no big deal”). If they originate from the lower heart chambers then they are called premature ventricular contractions (PVCs) and may need additional testing. About one-fourth of healthy children and adolescents may experience premature or extra heartbeats. A few heart conditions, such as mitral valve prolapse, may be associated with palpitations.
Palpitations of long duration or those associated with dizziness, paleness, fatigue, sweating, chest pain, fainting, or a chaotic, quivering irregular rhythm deserve further investigation.
Dr. Villafañe did a research study on over 60 pediatric patients with palpitations who underwent a cardiovascular evaluation. Most of the patients were found to have benign palpitations (“no big deal”) and did not require further follow-up by us. Most of them just needed reassurance that they would be fine and to practice some relaxation techniques. We usually recommend avoiding caffeine or stressful situations.